BACKGROUND Surgical site infections are a leading cause of morbidity and mortality after caesarean section, especially in Low and Middle Income Countries. We hypothesized that a combined infection prevention and control with antimicrobial stewardship joint program would decrease the rate of post- caesarean section surgical site infections at the Obstetrics & Gynaecology Department of a Tanzanian tertiary hospital. METHODS The intervention included: 1. formal and on-job trainings on infection prevention and control; 2. evidence-based education on antimicrobial resistance and good antimicrobial prescribing practice. A second survey was performed to determine the impact of the intervention. The primary outcome of the study was post-caesarean section surgical site infections prevalence and secondary outcome the determinant factors of surgical site infections before/after the intervention and overall. The microbiological characteristics and patterns of antimicrobial resistance were ascertained. RESULTS Total 464 and 573 women were surveyed before and after the intervention, respectively. After the intervention, the antibiotic prophylaxis was administered to a significantly higher number of patients (98% vs 2%, p < 0.001), caesarean sections were performed by more qualified operators (40% vs 28%, p = 0.001), with higher rates of Pfannenstiel skin incisions (29% vs 18%, p < 0.001) and of absorbable continuous intradermic sutures (30% vs 19%, p < 0.001). The total number of post-caesarean section surgical site infections was 225 (48%) in the pre-intervention and 95 (17%) in the post intervention group (p < 0.001). A low prevalence of gram-positive isolates and of methicillin-resistant Staphylococus aureus was detected in the post-intervention survey. CONCLUSIONS Further researches are needed to better understand the potential of a hospital-based multidisciplinary approach to surgical site infections and antimicrobial resistance prevention in resource-constrained settings.

中文翻译：

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实施感染预防和控制与抗菌药物管理联合计划，以预防剖腹产手术部位感染和抗菌药物耐药性：坦桑尼亚三级医院的经验。


背景技术手术部位感染是剖腹产术后发病和死亡的主要原因，特别是在低收入和中等收入国家。我们假设，感染预防和控制与抗菌药物管理联合计划将降低坦桑尼亚三级医院妇产科的剖腹产术后手术部位感染率。方法干预措施包括： 1. 感染预防和控制的正式和在职培训； 2. 关于抗菌药物耐药性和良好抗菌药物处方实践的循证教育。进行了第二次调查以确定干预措施的影响。该研究的主要结果是剖腹产后手术部位感染的患病率，次要结果是干预前后手术部位感染的决定因素和总体情况。确定了微生物学特征和抗菌素耐药性模式。结果 干预前和干预后分别对 464 名和 573 名女性进行了调查。干预后，接受抗生素预防的患者数量显着增加（98% vs 2%，p < 0.001），剖腹产手术由更合格的操作员进行（40% vs 28%，p = 0.001）， Pfannenstiel 皮肤切口率（29% vs 18%，p < 0.001）和可吸收连续皮内缝合率（30% vs 19%，p < 0.001）较高。干预前组剖腹产后手术部位感染总数为 225 例 (48%)，干预后组为 95 例 (17%) (p < 0.001)。干预后调查发现革兰氏阳性菌株和耐甲氧西林金黄色葡萄球菌的患病率较低。 结论 需要进一步研究，以更好地了解以医院为基础的多学科方法在资源有限的环境中预防手术部位感染和抗菌素耐药性预防的潜力。