Surgical patients in low-income countries more likely to acquire a drug-resistant infection following surgery

Low-income countries have a greater risk of surgical site infection (SSI) after gastrointestinal surgery, according to a study published in Lancet Infectious Diseases. The international, prospective, and multicenter cohort study also pointed out that people who had surgery in these countries have an increased chance of developing an infection linked to drug-resistant bacteria.

• The study involved 12,539 patients from low-, middle- and high-income countries, according to the U.N.’s Human Development Index (HDI). In total, researchers looked at data from 343 hospitals in 66 countries regarding patients who had undergone a gastrointestinal resection in a two-week timeframe.
• Aside from the clinical data, variables from the GlobalSurg1 study, as well as those from other studies, were included in the risk adjustment models. Outcomes were defined as by the 30-day SSI incidence, based on the criteria set forth by the U.S. Centers for Disease Control and Prevention, and relationships were evaluated using the Bayesian multilevel logistic regression models.
• Incidences of SSI varied depending on the HDI classification of the country: high-income countries had a 9.4 percent incidence rate, middle-income countries had 14 percent, and low-income countries had 23.2 percent. After risk factor adjustment, low-income countries were noted to be at most risk of an SSI at a 1.60 ratio. In comparison, middle-income countries only had a 1.12 ratio of getting an SSI.
• In addition, 21.6 percent of 610 patients with SSI had one that is resistant to prophylactic antibiotics. Those in low-income countries had the largest incidence at 35.9 percent, followed by middle-income countries at 19.8 percent and 16.6 percent of high-income countries.

The results scored the need for ” high-quality interventional research, urgent, pragmatic, randomized trials” in low-income countries to develop measures to reduce complications.

Journal reference:

GlobalSurg Collaborative. SURGICAL SITE INFECTION AFTER GASTROINTESTINAL SURGERY IN HIGH-INCOME, MIDDLE-INCOME, AND LOW-INCOME COUNTRIES: A PROSPECTIVE, INTERNATIONAL, MULTICENTRE COHORT STUDY. Lancet Infectious Diseases. 2018. DOI: 10.1016/S1473-3099(18)30101-4