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Surgical site infection and pathogens in Ethiopia: a systematic review and meta-analysis.

ABSTRACT: Background:Surgical site infection is a common complication in patients who underwent surgery. The prevalence is higher in low-income countries. In Ethiopia, prevalence and pathogens of surgical site infection (SSI) reported are variable. This systematic review and meta-analysis aimed to find the pooled prevalence of SSI. Besides, it aimed to find pathogens of surgical site infection in Ethiopia. Methods:The databases for the search were PubMed, Web of Science, and Google Scholar by the date 21/08/2018. To assess publication bias Egger's test regression analysis was applied. Subgroup analysis was conducted based on the study population and region. Results:This meta-analysis included a total of 15 studies with 8418 study subjects. The pooled prevalence of surgical site infection was 25.22% (95% CI: 17.30 to 33.14%). Staphylococcus aureus (30.06%) was the most common pathogen identified. Followed by Escherichia coli (19.73%), Klebsiella species (17.27%), and Coagulase-Negative staphylococci (12.43%) were the commonly isolated pathogens. Conclusions:The national prevalence of surgical site infection was high. The most common identified pathogen was Staphylococcus aureus. Followed by Escherichia coli, Klebsiella species, and Coagulase-Negative staphylococci. Strict adherence to surgical site infection prevention techniques needs to get more attention.

SUBMITTER: Birhanu Y

PROVIDER: S-EPMC7035652 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Surgical site infection and pathogens in Ethiopia: a systematic review and meta-analysis.

Birhanu Yeneabat Y Endalamaw Aklilu A

Patient safety in surgery 20200221

<h4>Background</h4>Surgical site infection is a common complication in patients who underwent surgery. The prevalence is higher in low-income countries. In Ethiopia, prevalence and pathogens of surgical site infection (SSI) reported are variable. This systematic review and meta-analysis aimed to find the pooled prevalence of SSI. Besides, it aimed to find pathogens of surgical site infection in Ethiopia.<h4>Methods</h4>The databases for the search were PubMed, Web of Science, and Google Scholar ...[more]

PMID: 32110246

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Project description:IntroductionWorldwide, surgery related deaths within 30 days of the procedure accounts the third contributor among all causes of deaths, with an estimated 4.2 million people annually and half of these deaths occur in low and middle income countries.ObjectiveTo determine the pooled prevalence of surgical site infection following cesarean section and its predictors in Ethiopia.MethodsA systematic review and meta-analysis were conducted by using PRISMA guideline. An appropriate and comprehensive search of PubMed, MEDLINE, EMBASE, CINAHL, Google Scholar, HINARI and Scopus was done. This SRMA included all articles conducted in all regional state of Ethiopia reporting the prevalence/proportion/incidence of SSI after cesarean section and/or associated factors. All observational study designs were included in this SRMA. Articles which lack our outcome of interest: SSI following cesarean section and its predictors were excluded from this SRMA. The I2 statistic was used to quantify heterogeneity across studies. Funnel plot asymmetry and Egger's tests were used to check for publication bias. A random effect model was used to estimate the pooled prevalence of SSI. Adjusted Odds Ratio (OR) with 95% Confidence Interval (CI) was also considered to determine the association of identified variables with SSI. Statistical analysis was conducted using STATA version 17 software.ResultInitially 6334 studies were identified and finally 19 studies were found eligible for the analysis. Studies with a score of 7 and above were included for the final systematic review and meta-analysis. The review was comprised of 14 cross sectional studies, 4 cohort and one case control studies. The pooled estimate of SSI in Ethiopia was 11.13% (95%CI, 9.29-12.97%). Prolonged labor (AOR = 3.16, 95% CI; (2.14-4.68)), chorioamnionitis (AOR = 4.26, 95% CI; (1.99-8.91)), prolonged PROM (AOR = 3.80, 95% CI; (2.51-5.62)), repeated vaginal examination (AOR = 3.80, 95% CI; (2.45-5.88)), decreased hemoglobin level (AOR = 4.57, 95%CI; (3.16-6.60)), vertical skin incision (AOR = 3.09, 95% CI; (2.04-4.67)) and general anesthesia (AOR = 1.82, 95% CI (1.21-2.75)) are significantly associated with SSI after cesarean section in Ethiopia.ConclusionSSI after cesarean section in Ethiopia is high. Prolonged labor, chorioamnionits, prolonged PROM, repeated vaginal examination, decreased Hgb level, vertical skin incision and general anesthesia were positively associated. Thus, evidence based intra-partum care should be practiced.

Project description:BackgroundSurgical site infection (SSI) affects nearly one third of patients who have undergone a surgical procedure. It is a significant and substantial cause of surgical patient morbidity and mortality later with human and financial costs threat. There are fragmented and pocket studies which reported the prevalence of SSI among mothers who experienced for cesarean section and its risk factors. However, there is no any solid evidence established at the national level; which was also the interest of the authors to fill this gap. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of SSI after cesarean section and its associated factors at national level.MethodsOriginal articles were searched in PubMed, MEDLINE, EMBASE, CINAHL, Google Scholar, HINARI portal, and Cochrane Library. All observational studies defined outcome of variable "SSI as infection related to an operation procedure that occur at or near surgical incision within 30 days of operation or after one year if an implant is placed" were considered. Data were extracted using standard data extraction excel spread sheet checklists developed according to 2014 Joanna Briggs Institute Reviewers' Manual after the quality was assessed through Newcastle-Ottawa quality assessment scale. The I2 statistic was used to quantify heterogeneity across studies. Funnel plot asymmetry and Egger's tests were used to check for publication bias. A fixed effect model was used to estimate the pooled prevalence of SSI. Odds Ratio (OR) with 95% Confidence Interval (CI) was also considered to determine the association of identified variables with SSI. Statistical analysis was conducted using STATA version 14 software.ResultFrom initial 179 identified articles, 11 were eligible for inclusion in the final systematic review and meta-analysis. Studies with a score of 6 and above were included for final analysis. All included studies were institutional based cross sectional. The pooled estimate of SSI after cesarean section in Ethiopia was 9.72% (95%CI: 8.38, 11.05). Premature rapture of membrane (PROM) >?12?h (OR?=?5.32, 95%CI: 3.61, 7.83), duration of labor>?24?h (OR?=?3.67, 95%CI: 2.45, 5.48), chorioamnionitis (OR?=?9.11, 95%CI: 5.21, 15.93), anemia (OR?=?4.56, 95%CI: 2.88, 7.22) and having vertical skin incision (OR?=?4.17, 95%CI: 2.90, 6.02) had increased odds of developing SSI after cesarean section.ConclusionThe prevalence of SSI after cesarean section in Ethiopia was high compared with the sphere standards of communicable disease control (CDC) guidelines for SSI after cesarean section. Therefore, Ministry of Health with its stake holders should give special emphasis on community and institution based programs in manner to prevent prolonged labor, PROM, chorioamnionitis and anemia which will also have synergistic impact on SSI after cesarean section. Moreover, there is also a call to health professionals not to use vertical incision as primary option of cesarean section to reduce the risk of developing surgical site infection among mothers.

Project description:IntroductionSurgical site infections (SSIs) are one of the most common postoperative complications after appendectomy leading to recurrent surgery, prolonged hospital stay, and the use of antibiotics. Numerous studies and meta-analyses have been published on the effect of open versus conventional laparoscopic appendectomy (CLA) reporting faster postoperative recovery and less postoperative pain for CLA. A development from CLA has been the single-port appendectomy (SPA), associated with a better cosmesis but seemingly having a higher risk of wound infections. The aim of this systematic literature review and meta-analysis is to investigate whether reduced port or SPA alters the ratio of SSIs.MethodsPubmed, Embase, and Cochrane databases were screened for suitable articles. All articles published between January 1, 2002, and March 23, 2022, were included. Articles regarding children below the age of 18 were excluded as well as manuscripts that investigated solemnly open appendectomies. Articles were screened for inclusion criteria by two independent authors. Incidence of SSI was the primary outcome. Duration of operation and length of hospital stay were defined as secondary outcomes.ResultsA total of 25 studies were found through a database search describing 5484 patients. A total of 2749 patients received SPA and 2735 received CLA. There was no statistical difference in the rate of SSI (P = 0.98). A total of 22 studies including 4699 patients reported the duration of operation (2223 SPA and 2476 CLA). There was a significantly shorter operation time seen in CLA. The length of hospital stay was reported in 23 studies (4735 patients: 2235 SPA and 2500 CLA). A shorter hospital stay was seen in the SPA group (P < 0.00001). Separately performed analysis of randomized controlled trials could not confirm this effect (P = 0.29).DiscussionSPA is an equally safe procedure considering SSI compared to CLA and does not lead to an increased risk of SSI. A longer operation time for SPA and a minor difference in the length of stay does lead to the use of SPA in selected patients only.

Project description:ImportanceSurgical management of periarticular knee fractures can be challenging, and adverse outcomes may be severe. Recent literature indicates that the rate of periarticular knee surgical site infection (SSI) may range from 2% to 88% depending on the fracture site.ObjectiveTo examine the prevalence of deep SSI and the rate of septic arthritis after surgical repair of fractures around the knee.Data sourcesThe electronic databases MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from their inception to July 1, 2018.Study selectionEligible studies had to specifically report deep SSI rates and include fractures in the distal femur, patella, tibial plateau, or proximal tibia. Risk factors that were associated with increased the risk of deep SSI were also examined.Data extraction and synthesisThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data were extracted by multiple investigators. Comprehensive Meta-Analysis software was used for the pooling of data, using either random-effects or fixed-effects models, with respect to the degree of statistical heterogeneity present. Data analyses were conducted in October 2019.Main outcomes and measuresThe primary outcome was overall prevalence of deep SSI after periarticular knee fracture repair. The secondary outcomes were the overall prevalence of septic arthritis, risk factors associated with deep SSI, and the most commonly cultured bacteria specimens found periarticular knee infections.ResultsOf 6928 articles screened, 117 articles met inclusion criteria and were included in analysis. Among 11?432 patients included in analysis, 653 patients (5.7%) experienced deep SSIs, most commonly among patients with proximal tibia fractures (56 of 872 patients [6.4%]). Among studies that included information on septic arthritis, 38 of 1567 patients (2.4%) experienced septic arthritis. The 2 most commonly reported bacteria were methicillin-resistant Staphylococcus aureus, found in 67 SSIs, and methicillin-susceptible S aureus, found in 53 SSIs. Sixty-two studies (53.0%) in the sample received a Coleman Methodological Score of poor (<50 points).Conclusions and relevanceDeep SSIs occurred in nearly 6% of periarticular knee fracture repairs, and 2.4% of SSIs were associated with septic arthritis. Surgeons managing these injuries should be vigilant when wounds are not pristine. Efforts should be made to elevate the quality of research conducted not only in this subject but also in orthopedic surgery as a whole.

Dataset Information

Surgical site infection and pathogens in Ethiopia: a systematic review and meta-analysis.

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Surgical site infection and pathogens in Ethiopia: a systematic review and meta-analysis.

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