Surgical infections present a significant burden of disease globally. Management focuses on source control and appropriate antibiotic therapy. This remains a challenge in low- and middle-income settings, where access to surgical care and antibiotics is limited. This paper discusses the complex challenges facing the management of surgical infections in low- and middle-income countries.
Get full access to this article
View all access options for this article.
References
1.
RickardJL, NtakiyirutaG, ChuKM. Identifying gaps in the surgical training curriculum in Rwanda through evaluation of operative activity at a teaching hospital. J Surg Educ, 2015; 72:e73-81.
2.
AmehEA, AbantangaFA, Birabwa-MaleD. Surgical aspects of bacterial infection in African children. Semin Pediatr Surg, 2012; 21:116–124.
3.
GlobalSurg Collaborative. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: A prospective, international, multicentre cohort study. Lancet Infect Dis, 2018; 18:516–525.
4.
BiccardBM, MadibaTE, KluytsHL, et al.Perioperative patient outcomes in the African Surgical Outcomes Study: A 7-day prospective observational cohort study. Lancet, 2018; 391:1589–1598.
5.
SartelliM, CatenaF, AnsaloniL, et al.Complicated intra-abdominal infections worldwide: The definitive data of the CIAOW Study. World J Emerg Surg, 2014; 9:37.
6.
NdayizeyeL, NgarambeC, SmartB, et al.Peritonitis in Rwanda: Epidemiology and risk factors for morbidity and mortality. Surgery, 2016; 160:1645–1656.
7.
SamuelJC, QureshiJS, MulimaG, et al.An observational study of the etiology, clinical presentation and outcomes associated with peritonitis in Lilongwe, Malawi. World J Emerg Surg, 2011; 6:37.
8.
AdesunkanmiAR, OseniSA, AdejuyigbeO, AgbakwuruEA. Acute generalized peritonitis in African children: Assessment of severity of illness using modified APACHE II score. ANZ J Sur, 2003; 73:275–279.
9.
MabewaA, SeniJ, ChalyaPL, et al.Etiology, treatment outcome and prognostic factors among patients with secondary peritonitis at Bugando Medical Centre, Mwanza, Tanzania. World J Emerg Surg, 2015; 10:47.
10.
BaliRS, VermaS, AgarwalPN, et al.Perforation peritonitis and the developing world. ISRN Surg, 2014; 2014:105492.
11.
YadavD, GargPK. Spectrum of perforation peritonitis in Delhi: 77 cases experience. Indian J Surg, 2013; 75:133–137.
12.
MazuskiJE, TessierJM, MayAK, et al.The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection. Surg Infect, 2017; 18:1–76.
13.
SolomkinJS, MazuskiJE, BradleyJS, et al.Diagnosis and management of complicated intra-abdominal infection in adults and children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect, 2010; 11:79–109.
14.
KhamnuanP, ChongruksutW, JearwattanakanokK, et al.Necrotizing fasciitis: Epidemiology and clinical predictors for amputation. Int J Gen Med, 2015; 8:195–202.
15.
MearaJG, LeatherAJ, HaganderL, et al.Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet, 2015; 386:569–624.
16.
MockCN, DonkorP, GawandeA, et al.Essential Surgery: Key Messages from Disease Control Priorities, 3rd edition. Lancet, 2015; 385:2209–2219.
17.
SawyerRG, ClaridgeJA, NathensAB, et al.Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med, 2015; 372:1996–2005.
18.
Membrilla-FernandezE, Sancho-InsenserJJ, Girvent-MontllorM, et al; Secondary Peritonitis Spanish Study G.. Effect of initial empiric antibiotic therapy combined with control of the infection focus on the prognosis of patients with secondary peritonitis. Surg Infect, 2014; 15:806–814.
19.
DessieW, MulugetaG, FentawS, et al.Pattern of bacterial pathogens and their susceptibility isolated from surgical site infections at selected referral hospitals, Addis Ababa, Ethiopia. Int J Microbiol, 2016; 2016:2418902.
20.
SeniJ, NajjukaCF, KateeteDP, et al.Antimicrobial resistance in hospitalized surgical patients: A silently emerging public health concern in Uganda. BMC Res Notes, 2013; 6:298.
21.
MagalaJ, MakoboreP, MakumbiT, et al.The clinical presentation and early outcomes of necrotizing fasciitis in a Ugandan tertiary hospital: A prospective study. BMC Res Notes, 2014; 7:476.
22.
HawserSP, BouchillonSK, HobanDJ, BadalRE. Epidemiologic trends, occurrence of extended-spectrum beta-lactamase production, and performance of ertapenem and comparators in patients with intra-abdominal infections: Analysis of global trend data from 2002–2007 from the SMART study. Surg Infect, 2010; 11:371–378.
23.
ChangYT, CoombsG, LingT, et al.Epidemiology and trends in the antibiotic susceptibilities of gram-negative bacilli isolated from patients with intra-abdominal infections in the Asia–Pacific region, 2010–2013. Int J Antimicrob Agents, 2017; 49:734–739.
24.
AkujobiCN, NwaigweCG, EgwuatuTO, OgunsolaFT. Bacterial pathogens associated with secondary peritonitis in Lagos University Teaching Hospital (LUTH). Niger J Clin Pract, 2006; 9:169–173.
25.
ShreeN, AroraBS, MohilRS, et al.Bacterial profile and patterns of antimicrobial drug resistance in intra-abdominal infections: Current experience in a teaching hospital. Indian J Pathol Microbiol, 2013; 56:388–392.
26.
LeeAC, ChandranA, HerbertHK, et al.Treatment of infections in young infants in low- and middle-income countries: A systematic review and meta-analysis of frontline health worker diagnosis and antibiotic access. PLoS Med, 2014; 11:e1001741.
27.
AlsanM, SchoemakerL, EgglestonK, et al.Out-of-pocket health expenditures and antimicrobial resistance in low-income and middle-income countries: An economic analysis. Lancet Infect Dis, 2015; 15:1203–1210.
28.
SartelliM, WeberDG, RuppeE, et al.Antimicrobials: A Global Alliance for Optimizing their Rational use in intra-Abdominal infections (AGORA). World J Emerg Surg, 2016; 11:33.
29.
ChaisathapholT, ChayakulkeereeM. Epidemiology of infections caused by multidrug-resistant gram-negative bacteria in adult hospitalized patients at Siriraj Hospital. J Med Assoc Thai, 2014; 97(Suppl 3):S35–S45.
30.
NeidellMJ, CohenB, FuruyaY, et al.Costs of healthcare- and community-associated infections with antimicrobial-resistant versus antimicrobial-susceptible organisms. Clin Infect Dis, 2012; 55:807–815.
31.
Antimicrobial Resistance: Global Report on Surveillance. World Health Organization; Geneva. 2017.
32.
Prioritization of Pathogens to Guide Discovery, Research, and Devleopment of New Antibiotics for Drug-Resistant Bacterial Infections, including Tuberculosis. World Health Organization; Geneva. 2017.
33.
Antibacterial Agents in Clinical Development. World Health Organization; Geneva. 2017.
34.
Le DoareK, BielickiJ, HeathPT, SharlandM. Systematic review of antibiotic resistance rates among gram-negative bacteria in children with sepsis in resource-limited countries. J Pediatric Infect Dis Soc, 2015; 4:11–20.
35.
TurnerP, PolS, SoengS, et al.High prevalence of antimicrobial-resistant gram-negative colonization in hospitalized Cambodian infants. Pediatr Infect Dis J, 2016; 35:856–861.
36.
FerjaniS, SaidaniM, AmineFS, Boutiba Ben BoubakerI. A comparative study of antimicrobial resistance rates and phylogenetic groups of community-acquired versus hospital-acquired invasive Escherichia coli. Med Mal Infect, 2015; 45:133–138.
37.
NtirenganyaC, ManziO, MuvunyiCM, OgbuaguO. High prevalence of antimicrobial resistance among common bacterial isolates in a tertiary healthcare facility in Rwanda. Am J Trop Med Hyg, 2015; 92:865–870.
38.
KajumbulaH, FujitaAW, MbabaziO, et al.Antimicrobial drug resistance in blood culture isolates at a tertiary hospital, Uganda. Emerg Infect Dis, 2018; 24:174–175.
39.
ChaudhuriBN, RodriguesC, BalajiV, et al.Incidence of ESBL producers amongst gram-negative bacilli isolated from intra-abdominal infections across India (based on SMART study, 2007 data). J Assoc Physicians India, 2011; 59:287–292.
40.
YangQ, XuYC, KiratisinP, DowzickyMJ. Antimicrobial activity among gram-positive and gram-negative organisms collected from the Asia–Pacific region as part of the Tigecycline Evaluation and Surveillance Trial: Comparison of 2015 results with previous years. Diagn Microbiol Infect Dis, 2017; 89:314–323.
41.
VegaS, DowzickyMJ. Antimicrobial susceptibility among gram-positive and gram-negative organisms collected from the Latin American region between 2004 and 2015 as part of the Tigecycline Evaluation and Surveillance Trial. Ann Clin Microbiol Antimicrob, 2017; 16:50.
42.
ScherbaumM, KostersK, MurbethRE, et al.Incidence, pathogens and resistance patterns of nosocomial infections at a rural hospital in Gabon. BMC Infect Dis, 2014; 14:124.
43.
BiedenbachDJ, BouchillonSK, HobanDJ, et al.Antimicrobial susceptibility and extended-spectrum beta-lactamase rates in aerobic gram-negative bacteria causing intra-abdominal infections in Vietnam: Report from the Study for Monitoring Antimicrobial Resistance Trends (SMART 2009–2011). Diagn Microbiol Infect Dis, 2014; 79:463–467.
44.
Ponce-de-LeonA, Rodriguez-NoriegaE, Morfin-OteroR, et al.Antimicrobial susceptibility of gram-negative bacilli isolated from intra-abdominal and urinary-tract infections in Mexico from 2009 to 2015: Results from the Study for Monitoring Antimicrobial Resistance Trends (SMART). PLoS One, 2018; 13:e0198621.
45.
SuwantaratN, CarrollKC. Epidemiology and molecular characterization of multidrug-resistant gram-negative bacteria in Southeast Asia. Antimicrob Resist Infect Control, 2016; 5:15.
46.
LobSH, HackelMA, HobanDJ, et al.Activity of ertapenem against Enterobacteriaceae in seven global regions: SMART 2012–2016. Eur J Clin Microbiol Infect Dis, 2018; 37:1481–1489.
47.
PfallerMA, ShortridgeD, SaderHS, et al.Ceftolozane–tazobactam activity against drug-resistant Enterobacteriaceae and Pseudomonas aeruginosa causing healthcare-associated infections in Latin America: Report from an antimicrobial surveillance program (2013–2015). Braz J Infect Dis, 2017; 21:627–637.
48.
LegeseMH, WeldearegayGM, AsratD. Extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae among Ethiopian children. Infect Drug Resist, 2017; 10:27–34.
49.
MushiMF, MshanaSE, ImirzaliogluC, BwangaF. Carbapenemase genes among multidrug resistant gram negative clinical isolates from a tertiary hospital in Mwanza, Tanzania. Biomed Res Int, 2014; 2014:303104.
50.
JonesRN, Guzman-BlancoM, GalesAC, et al.Susceptibility rates in Latin American nations: Report from a regional resistance surveillance program (2011). Braz J Infect Dis, 2013; 17:672–681.
51.
SartelliM, CatenaF, di SaverioS, et al.The challenge of antimicrobial resistance in managing intra-abdominal infections. Surg Infect, 2015; 16:213–220.
52.
SartelliM, DuaneTM, CatenaF, et al.Antimicrobial stewardship: A call to action for surgeons. Surg Infect, 2016; 17:625–631.
53.
OkekeIN, LaxminarayanR, BhuttaZA, et al.Antimicrobial resistance in developing countries I: Recent trends and current status. Lancet Infect Dis, 2005; 5:481–493.
54.
OkekeIN, KlugmanKP, BhuttaZA, et al.Antimicrobial resistance in developing countries II: Strategies for containment. Lancet Infect Dis, 2005; 5:568–580.
55.
ChandySJ, ThomasK, MathaiE, et al.Patterns of antibiotic use in the community and challenges of antibiotic surveillance in a lower-middle-income country setting: A repeated cross-sectional study in Vellore, South India. J Antimicrob Chemother, 2013; 68:229–236.
56.
NguyenKV, Thi DoNT, ChandnaA, et al.Antibiotic use and resistance in emerging economies: A situation analysis for Viet Nam. BMC Public Health, 2013; 13:1158.
