Surgical Site Infection after Abdominal Surgery in 3 Rural Hospitals: Etiologic, Clinical, Bacteriologic and Therapeutic Profile in a Rural Setting

Abstract

Background: The Centers for Disease Control and Prevention (CDC) defines a Surgical Site Infection (SSI) as the occurrence of an infection within 30 days following a surgical procedure or within 90 days in the presence of a prosthetic device. Although surgical site infection remains a significant problem for patients, their families, healthcare staff, and the healthcare system, especially in developing countries, local data are scarce. Materials and Methods: A prospective cohort study incorporating a nested matched case–control analysis was conducted in three hospitals in Dschang between 1 October 2023 and 31 January 2024 among all patients who underwent abdominal surgery and met the inclusion criteria. Sampling was consecutive and exhaustive. After obtaining informed consent, patients were followed up to 30 days after surgery, assessing risk factors, bacteriological profile, clinical presentation, and therapeutic aspects of surgical site infection in three rural hospitals in the city of Dschang. ethical clearance and consent were obtained prior to data collection. Results: Out of a total of 153 abdominal surgeries, 15 surgical site infections were identified (SSI). The incidence of SSI was 9.8%. There were 129 female patients among 153 participants with a sex-ratio W/M of 5,37. The mean age was 28+12 [1-86] years. The mean postoperative stay was 5,5±2 [2- 35] days. The main clinical manifestations were fever, pain, swelling, suppuration, and dehiscence. Of the 15 surgical site infections, there were 7 superficial infections, 4 deep infections, and 4 organ infections. The main pathogens identified were Staphylococcus aureus, coagulase-negative staphylococci, and Citrobacter. In multivariate analysis, we found that a hospital stay lasting more than 10 days, Altermeier classes III (contaminated surgery) and IV (dirty surgery), anaemia, and HIV were statistically associated with the occurrence of surgical site infection, with p-values of 0.000, 0.025, 0.03, and 0.034, respectively. However, the prolonged hospital stay may be a consequence and only the Altermeier classes III and IV had considerable relative risk (27.08), the risk associated with anaemia and HIV being just 0.104 and 0.079. Conclusion: Surgical site infections are a significant concern in our setting, and their prevention requires better control of the identified risk factors.