Community- and Hospital-Acquired Infections in Surgical patients at a Tertiary Referral Hospital in Rwanda.

Abstract

BACKGROUND:

Extended-spectrum β-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 third-generation 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.

• Authors: Vital Muvunyi, Christophe Mpirimbanyi, Jean Bosco Katabogama, Thierry Cyuzuzo, Theoneste Nkubana, Jean Baptiste Mugema, Emile Musoni, Christian Urimubabo, Jennifer Rickard
• Journal: World journal of surgery (World J Surg) Vol. 44 Issue 10 Pg. 3290-3298 (10 2020) ISSN: 1432-2323 [Electronic] United States
• PMID: 32535645 (Publication Type: Journal Article, Observational Study, Research Support, N.I.H., Extramural)

Topics

• Adult
• Community-Acquired Infections (drug therapy, prevention & control)
• Cross Infection (drug therapy, prevention & control)
• Cross-Sectional Studies
• Drug Resistance, Bacterial
• Enterobacteriaceae Infections (drug therapy, prevention & control)
• Escherichia coli (isolation & purification)
• Female
• Humans
• Male
• Middle Aged
• Staphylococcus aureus (isolation & purification)
• Tertiary Care Centers