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

Vital Muvunyi, Christophe Mpirimbanyi, Jean Bosco Katabogama, Thierry Cyuzuzo, Theoneste Nkubana, Jean Baptiste Mugema, Emile Musoni, Christian Urimubabo, Jennifer Rickard

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)3290-3298
Number of pages9
JournalWorld Journal of Surgery
Volume44
Issue number10
DOIs
StatePublished - Oct 1 2020

Bibliographical note

Funding Information:
This research was supported by the National Institutes of Health’s National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences. Acknowledgements

Publisher Copyright:
© 2020, Société Internationale de Chirurgie.

PubMed: MeSH publication types

  • Journal Article
  • Observational Study
  • Research Support, N.I.H., Extramural

Fingerprint

Dive into the research topics of 'Community- and Hospital-Acquired Infections in Surgical patients at a Tertiary Referral Hospital in Rwanda'. Together they form a unique fingerprint.

Cite this