Efforts in surgical site infection surveillance at the Mbouo Protestant Hospital in Cameroon

Surgical site infections (SSIs) are a significant health concern in low- and middle-income countries. In Africa, up to one-third of patients undergoing surgery may be affected by an SSI, and high rates of antimicrobial resistance (AMR) pose an additional threat. Data on the epidemiology and microbiology of these infections are needed but scarce.

This prospective, observational, pilot study investigated the incidence, risk factors, and microbial spectrum of SSI. All consenting patients undergoing surgery at Mbouo Protestant Hospital in Cameroon were included. An active SSI surveillance system was established and continued after discharge. Data collection took place from April 2021 to February 2022. Risk factors for SSI and for mortality were recorded as well as microbial data. The SSI incidence and the Odd's ratios were calculated.

One hundred forty-eight patients were included. The total SSI incidence was 7% (11/148) with 3% (2/67) for Obstetrics/Gynaecology, 3% (1/30) for General Surgery and 16% (8/51) for Orthopaedics/Trauma. About 55% (6/11) of SSI appeared after discharge from hospital. Risk factors for SSI were Orthopaedic/trauma procedure, dirty/infected wounds, high intraoperative blood loss and long duration of the operation. The total postoperative mortality was 3% (4/148) with 0% (0/67) for Obstetrics/Gynaecology, 10% (3/30) for General Surgery and 2% (1/51) for Orthopaedics/Trauma. Mortality risk factors were laparotomy, high ASA class and high age. Multi-resistant Staphylococcus aureus and gram-negative bacteria were the main SSI germs. All (2/2) of the non-AMR SSI wounds healed until the end of the study in contrast to only 25% (1/4) of the AMR SSI, all of the non-healed being orthopaedic AMR SSI.

This pilot study reveals a significant burden of SSIs, AMR and perioperative mortality at a district hospital in Cameroon. Despite its limitations, the study identified critical areas for improvement, including developing adapted guidelines for orthopaedic SSIs, improving the implementation of SSI prevention guidelines, and enhancing perioperative antimicrobial stewardship. These findings emphasise the necessity of further research and targeted interventions in this underrepresented, low-resource setting.

Clinicaltrials.gov NCT05018884, date of registration 17/08/2021, retrospectively registered.