Compelling data from seven low- and middle-income countries (specifically, Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa) points to disturbing trends within the healthcare arena. These countries are showing increased levels of multidrug resistance (MDR) among surgical site infections (SSIs), a lack of sufficient microbiologic testing capabilities, and the widespread ineffectiveness of prophylactic (preventive) antibiotics.
This information was published in The Lancet Global Health and originates from secondary analysis of data from the FALCON trial, a study designed to evaluate two World Health Organization recommended interventions to minimize SSIs post-abdominal surgery. SSIs are common healthcare-linked infections worldwide. Patients in under-resourced countries are particularly susceptible, in stark contrast to those in wealthier nations.
The FALCON trial enlisted international team members, primarily from the University of Birmingham, to collect and analyze abdominal surgery patients’ wound swabs from these seven countries. Insights into the antimicrobial susceptibility of trial participant SSIs, microbiologic capabilities, and antimicrobial practices of facilities where surgery was performed were the primary focus.
It’s highlighted in the study that although antimicrobial resistance (AMR) naturally occurs, its growth and spread are greatly encouraged by the misuse of antimicrobial drugs and substandard infection prevention and control practices. This, in turn, accelerates progression into multidrug resistance.
A comprehensive analysis of the 5,788 patients in the trial noticed SSIs in 22% of participants across 50 hospitals. Simply 19.6% of these had a wound swab collected for microbiological analysis. 75% of these analyses took 48 hours or more to complete.
The most common bacterial species uncovered from analyzed wound swabs were Escherichia coli and Klebsiella pneumoniae. Crucially, a notable 69.4% of SSIs were due to MDR organisms. These results show that, despite prophylactic antibiotics use, consequent SSIs are generally ineffective, with increased occurrences of MDR organisms observed. Furthermore, regular reviews by infection control teams were only noted in half of the hospitals involved in the study.
According to an adjusted analysis, the appropriate prophylactic antibiotic coverage and the regular deployment of infection control teams corresponded with reduced MDR. But significant systemic inadequacies in testing capacity, prophylactic antibiotic use, and infection control skill are contributing to antibiotic treatment for SSIs, thereby escalating MDR infection prevalence.
Low-targeted antibiotic use and inadequate testing efforts against SSIs are significant issues. Improvements in these areas, guided by local-specific guidelines and empowered infection control teams, are key to curbing SSIs and MDR organisms’ rise.