Prevalence of Methicillin-resistant Staphylococcus aureus in the Surgical Wards of the Port-of-Spain General Hospital, Trinidad and Tobago / Prevalencia del estafilococo dorado resistente a la meticilina en las salas quirúrgicas del Hospital General de Puerto España, Trinidad y Tobago

ABSTRACT Objective: Methicillin-resistant Staphylococcus aureus (MRSA) is associated with soft tissue infections in surgical patients. In severe cases, it may result in pneumonia, septicaemia and osteomyelitis. Limited data are available with regard to its prevalence and associations in the Caribbean. This study aimed to assess the prevalence of MRSA in patients hospitalized in the surgical wards of the Port-of-Spain General Hospital (POSGH), Trinidad and Tobago, and determine associated risk factors. Methods: Over the period of April 1 to August 1, 2013, all patients from the surgical wards of the POSGH who had had wound swabs taken were identified. Demographic data included duration of hospital stay, surgical and medical history, antibiotic use and type of wound swab. Microbiological reports were then retrieved and analyses done. Results: A total of 153 patients had wound swabs taken. There were 38 patients (24%) infected with Staphylococcus aureus, with 15 (39.5%) growing MRSA. Increased susceptibility to MRSA was associated with age, gender, ethnicity, duration of hospital stay, co-morbidities, previous antibiotic use, previous surgery and the type of wound (p < 0.05). Conclusion: The prevalence of MRSA in the surgical wards of the POSGH was 39.5% of Staphylococcus aureus isolates. Risk factors included the age range of 60-69 years, patients with co-morbidities, hospital stays of longer than one week, previous surgery and prior use of antibiotics. We recommend more awareness of this problem in the practice of Caribbean medicine to improve infection rates.

RESUMEN Objetivo: El estafilococo dorado resistente a la meticilina (EDRM) se asocia con infecciones de tejidos blandos en pacientes quirúrgicos. En casos severos, puede dar lugar a pulmonía, septicemia y osteomielitis. Los datos disponibles con respecto a su prevalencia y asociaciones en el Caribe son limitados. Este estudio persigue evaluar la prevalencia de EDRM en pacientes hospitalizados en las salas quirúrgicas del Hospital General de Puerto de España (POSGH, siglas en inglés) en Trinidad y Tobago, y determinar los factores de riesgo asociados. Métodos: Durante el período del 1 de abril al 1 de agosto de 2013, fueron identificados todos los pacientes de las salas quirúrgicas del Hospital POSGH a quienes se les había practicado frotis de las heridas. Los datos demográficos incluyeron la duración de la estadía hospitalaria, las historias clínicas y quirúrgicas, el uso de antibióticos, y el tipo de frotis de la herida. Luego se obtuvieron los informes microbiológicos y se realizaron los análisis. Resultados: A un total de 153 pacientes se le tomaron frotis de heridas. Hubo 38 pacientes (24%) infectados con estafilococos dorados, de los cuales 15 (3.5%) presentaban EDRM creciente. El aumento de la susceptibilidad a EDRM se asoció con la edad, el género, la etnicidad, la duración de la estadía hospitalaria, las co-morbilidades, el uso previo de antibióticos, las cirugías previas, y el tipo de herida (p < 0.05). Conclusión: La prevalencia de EDRM en las salas quirúrgicas del Hospital POSGH fue 39.5% de aislados de estafilococos dorados. Los factores de riesgo incluyeron un rango de edad de 60-69 años, pacientes con co-morbilidades, estancia hospitalaria de más de una semana, cirugía previa, y uso previo de antibióticos. Recomendamos tomar más conciencia de este problema en la práctica médica en el Caribe a fin de mejorar las tasas de infección.

Rates and Risk Factors Associated with Surgical Site Infections in a Tertiary Care Center in South-Western Nigeria.

Background: Surgical site infections [SSI] are one of the most common nosocomial infections. This study was therefore carried out to determine the incidence and risk factors associated with surgical site infection among patients in a tertiary care center in Western Nigeria. Methods: The study was a 6 months Retrospective cohort study which reviewed case files obtained from the surgical departments. The study was carried out between 23rd January 2012 and 3rd february 2012 at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Result: A total of 386 surgical patients were recruited into the study. The overall incidence rate of SSI was 13.0%. The children had the highest infection rate of 22.9%. Factors associated with SSI were Pre-existing Medical Condition [X2=70.76, p=0.00001] Department of Care [X2=11.68, p=0.039] and age[X2=9.50, p=0.05]. There was no statistically significant difference in the SSI rate among the respondents due to Sex [X2=1.74, p=0.187], Operation site [X2=9.01, p=0.109] and Occupation [X2=5.84, p=0.12]. Forty-nine (98.0%) out of the 50 clinical surgical site infections were culture-positive and 20 (40.0%) of them had polymicrobial infection. The most frequently isolated bacteria were Staphyloccocus aureus, 16 [32.7%] and E. Coli 17 [34.7]. Pre-existing medical condition [OR=0.46, C.I=0.36-0.59] and length of post operative stay in the hospital [OR=0.33, C.I=0.21-0.50] were predictors of risk of surgical site infection. Conclusion: The study suggests that pre-existing medical condition and length of post operative stay in the hospital were predictors of risk of surgical site infection. This suggest that home based care of surgical wounds in patients that are ambulatory should be encouraged.