Multidrug-Resistant Bacteria Causing Post-Caesarian Section Surgical Site Infection at Regional Referral Hospitals in Dar es Salaam, Tanzania
Abstract
Background
Surgical site infections (SSI) are the most common nosocomial infection among surgical patients. When infection is associated with multidrug-resistant bacteria, it leads to poor prognosis and increased morbidity, mortality, hospital stay, and cost of treatment. This study determined the etiological agents of SSI and their antimicrobial susceptibility pattern in post-caesarian section women at Regional Referral Hospitals in Dar es Salaam, Tanzania.
Methods
We conducted a cross-sectional study between June 2022 and January 2023 by enrolling 175 patients with signs and symptoms of SSI who provided informed consent. A structured questionnaire was used to collect demographic and clinical information. Under aseptic techniques, pus swabs were collected for aerobic bacterial culture. Isolates were identified using Analytical Profile Index-20E. Antimicrobial susceptibility tests were performed using Kirby-Bauer disc diffusion and interpreted per clinical laboratory standard institutes 2022 guidelines. We performed descriptive statistics using STARTA version 15 and summarized continuous variables as mean and standard deviation and categorical variables as proportions.
Results
Multiple 185 pathogens were isolated, the majority, 129(69.7%) being gram-negative. The predominant bacteria was Klebsiella pneumoniae, 58(29.9%), followed by Staphylococcus aureus, 55(28.3%). The extended-spectrum beta-lactamase production was observed in 35(38.5%) Enterobacterales. Of 55 Staphylococcus aureus, 29(52.7%) were methicillin-resistant and 19(34.5%) inducible clindamycin resistant. The overall proportion of multidrug-resistant bacteria was 145(78.8%), observed more in Klebsiella spp (91.7%), Staphylococcus aureus (85.5%) and Pseudomonas aeruginosa (46.7%). Most gram-negative bacteria, 72(55.8%), were resistant to more than four antibiotic classes.
Conclusion
Various pathogens, predominantly Gram-negative bacteria, caused prost-caesarian section SSI. More than three-quarters of the pathogens were multidrug-resistant, including commonly prescribed antibiotics. The findings call for strengthening infection prevention and antimicrobial stewardship interventions.
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