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. 2020 May 19;9(1):69.
doi: 10.1186/s13756-020-00740-7.

Implementing a combined infection prevention and control with antimicrobial stewardship joint program to prevent caesarean section surgical site infections and antimicrobial resistance: a Tanzanian tertiary hospital experience

Elisa Gentilotti  1   2 , Pasquale De Nardo  3   4 , Boniface Nguhuni  3   4 , Alessandro Piscini  3   4 , Caroline Damian  5 , Francesco Vairo  3 , Zainab Chaula  4 , Paola Mencarini  3 , Peter Torokaa  4 , Alimuddin Zumla  6   7 , Emanuele Nicastri  3 , Giuseppe Ippolito  3
Affiliations

Implementing a combined infection prevention and control with antimicrobial stewardship joint program to prevent caesarean section surgical site infections and antimicrobial resistance: a Tanzanian tertiary hospital experience

Elisa Gentilotti et al. Antimicrob Resist Infect Control. .

Abstract

Background: Surgical site infections are a leading cause of morbidity and mortality after caesarean section, especially in Low and Middle Income Countries. We hypothesized that a combined infection prevention and control with antimicrobial stewardship joint program would decrease the rate of post- caesarean section surgical site infections at the Obstetrics & Gynaecology Department of a Tanzanian tertiary hospital.

Methods: The intervention included: 1. formal and on-job trainings on infection prevention and control; 2. evidence-based education on antimicrobial resistance and good antimicrobial prescribing practice. A second survey was performed to determine the impact of the intervention. The primary outcome of the study was post-caesarean section surgical site infections prevalence and secondary outcome the determinant factors of surgical site infections before/after the intervention and overall. The microbiological characteristics and patterns of antimicrobial resistance were ascertained.

Results: Total 464 and 573 women were surveyed before and after the intervention, respectively. After the intervention, the antibiotic prophylaxis was administered to a significantly higher number of patients (98% vs 2%, p < 0.001), caesarean sections were performed by more qualified operators (40% vs 28%, p = 0.001), with higher rates of Pfannenstiel skin incisions (29% vs 18%, p < 0.001) and of absorbable continuous intradermic sutures (30% vs 19%, p < 0.001). The total number of post-caesarean section surgical site infections was 225 (48%) in the pre-intervention and 95 (17%) in the post intervention group (p < 0.001). A low prevalence of gram-positive isolates and of methicillin-resistant Staphylococus aureus was detected in the post-intervention survey.

Conclusions: Further researches are needed to better understand the potential of a hospital-based multidisciplinary approach to surgical site infections and antimicrobial resistance prevention in resource-constrained settings.

Keywords: Antimicrobial resistance; Antimicrobial stewardship; Caesarean section; Resource-limited settings; Surgical site infection.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Four-steps protocol of the study. PRE-Int = pre-intervention; CS = caesarean section; SSI=Surgical Site Infections; DRRH = Dodoma Regional Referral Hospital; AMS = Antimicrobial stewardship; SOPs = Standard Operating Procedures; IPC=Infection Prevention and Control; ID = Infectious Diseases; OGD = Obstetrics & Gynaecology Department; POST-Int = post-intervention
Fig. 2
Fig. 2
Number of patients surveyed for post-CS SSI in the Pre-Intervention and Post-Intervention groups
See this image and copyright information in PMC

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