Community- and Hospital-Acquired Infections in Surgical patients at a Tertiary Referral Hospital in Rwanda
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SURGERY IN LOW AND MIDDLE INCOME COUNTRIES
Community- and Hospital-Acquired Infections in Surgical patients at a Tertiary Referral Hospital in Rwanda Vital Muvunyi1 • Christophe Mpirimbanyi1,2 • Jean Bosco Katabogama1 • Thierry Cyuzuzo1 • Theoneste Nkubana4 • Jean Baptiste Mugema4 • Emile Musoni4 Christian Urimubabo3 • Jennifer Rickard1,3,5
•
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBL-PE) are increasing in globally. The aim of this study was to compare community-acquired infections (CAIs) and hospital-acquired infections (HAIs) and determine the rate of third-generation cephalosporin resistance and ESBL-PE at a tertiary referral hospital in Rwanda. Methods This was a cross-sectional study of Rwandan acute care surgery patients with infection. Samples were processed for culture and susceptibility patterns using Kirby-Bauer disk diffusion method. Third-generation cephalosporin resistance and ESBL-PE were compared in patients with CAI versus HAI. Results Over 14 months, 220 samples were collected from 191 patients: 116 (62%) patients had CAI, 59 (32%) had HAI, and 12 (6%) had both CAI and HAI. Most (n = 178, 94%) patients were started on antibiotics with thirdgeneration cephalosporins (ceftriaxone n = 109, 57%; cefotaxime n = 52, 27%) and metronidazole (n = 155, 81%) commonly given. Commonly isolated organisms included Escherichia coli (n = 62, 42%), Staphylococcus aureus (n = 27, 18%), and Klebsiella spp. (n = 22, 15%). Overall, 67 of 113 isolates tested had resistance to third-generation cephalosporins, with higher resistance seen in HAI compared with CAI (74% vs 46%, p value = 0.002). Overall, 47 of 89 (53%) isolates were ESBL-PE with higher rates in HAI compared with CAI (73% vs 38%, p value = 0.001). Conclusions There is broad and prolonged use of third-generation cephalosporins despite high resistance rates. ESBL-PE are high in Rwandan surgical patients with higher rates in HAI compared with CAIs. Infection prevention practices and antibiotic stewardship are critical to reduce infection rates with resistant organisms in a low-resource setting.
2
Department of Surgery, Kibungo Referral Hospital, Kibungo, Rwanda
3
Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
4
Clinical Laboratory, University Teaching Hospital of Kigali, Kigali, Rwanda
5
Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN 55455, USA
This manuscript was presented at the Academic Surgical Congress on February 6, 2020, in Orlando, Fl. Vital Muvunyi and Christophe Mpirimbanyi: Joint first author. & Jennifer Rickard [email protected] 1
Department of Surgery, University of Rwanda, Kigali, Rwanda
123
World J Surg
Introduction Surgical infections include both infectious conditions requiring surgery (e.g., appendicitis) and infectious complications of surgical procedures (e.g., surgical site infections) [1]. Surgical infections are managed by a combination of surgery and antibiotics
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