BACKGROUND In low- and middle-income countries (LMICs) the rate of surgical site infections (SSI) is high, leading to negative patient outcomes and excess healthcare costs. A causal relationship between airborne bacteria in the operating room and SSI has not been established, at a molecular or genetic level. We studied the relationship between intraoperative airborne bacteria and bacteria causing SSI in an LMIC. METHODS Active air sampling using a portable impactor was performed during clean or clean-contaminated elective surgical procedures. Active patient follow-up consisting of phone calls and clinical examinations was performed 3, 14 and 30 days after surgery. Bacterial isolates recovered from SSI and air samples were compared by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) identification, ribotyping, whole genome sequencing (WGS), and metagenomic analysis. RESULTS Of 128 included patients, 116 (91%) completed follow-up and 11 (9%) developed SSI. Known pathogenic bacteria were isolated from intraoperative air samples in all cases with SSI. A match between air and SSI isolates was found by MALDI-TOF in eight cases. Matching ribotypes were found in six cases and in one case both WGS and metagenomic analysis showed identity between air- and SSI-isolates. CONCLUSION The study showed high levels of intraoperative airborne bacteria, an SSI-rate of 9% and a genetic link between intraoperative airborne bacteria and bacteria isolated from SSIs. This indicates the need for awareness of intraoperative air quality in LMICs.

中文翻译：

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在加纳一家主要的教学医院中，从术中空气样本中分离出的细菌与手术部位感染之间的遗传关系。

背景技术在低收入和中等收入国家（LMIC），手术部位感染（SSI）的发生率很高，导致患者预后不良和医疗费用过高。在分子或遗传水平上，尚未确定手术室中的空气传播细菌与SSI之间的因果关系。我们研究了术中空气传播细菌与引起LMIC的SSI细菌之间的关系。方法在清洁或清洁污染的选择性外科手术过程中，使用便携式撞击器进行主动空气采样。术后3、14和30天对患者进行积极的随访，包括电话通话和临床检查。通过基质辅助激光解吸/电离飞行时间质谱（MALDI-TOF）鉴定，比较了从SSI和空气样品中回收的细菌分离物，核糖分型，全基因组测序（WGS）和宏基因组分析。结果在128位患者中，有116位（91％）完成了随访，有11位（9％）发展为SSI。在所有SSI病例中，均从术中空气样本中分离出已知的病原细菌。MALDI-TOF在八例病例中发现了空气和SSI分离株之间的匹配。在6例病例中发现了匹配的核型，在1例病例中，WGS和宏基因组学分析均显示了空气和SSI分离株之间的同一性。结论该研究显示术中空气传播细菌水平高，SSI率为9％，并且术中空气传播细菌与从SSI分离出的细菌之间存在遗传联系。这表明需要了解中低收入国家的术中空气质量。116例（91％）已完成随访，11例（9％）已制定SSI。在所有SSI病例中，均从术中空气样本中分离出已知的病原细菌。MALDI-TOF在八例病例中发现了空气和SSI分离株之间的匹配。在6例病例中发现了匹配的核型，在1例病例中，WGS和宏基因组学分析均显示了空气和SSI分离株之间的同一性。结论该研究显示术中空气传播细菌水平高，SSI率为9％，并且术中空气传播细菌与从SSI中分离出的细菌之间存在遗传联系。这表明需要了解中低收入国家的术中空气质量。116例（91％）已完成随访，11例（9％）已制定SSI。在所有SSI病例中，均从术中空气样本中分离出已知的病原细菌。MALDI-TOF在八例病例中发现了空气和SSI分离株之间的匹配。在6例病例中发现了匹配的核型，在1例病例中，WGS和宏基因组学分析均显示了空气和SSI分离株之间的同一性。结论该研究显示术中空气传播细菌水平高，SSI率为9％，并且术中空气传播细菌与从SSI中分离出的细菌之间存在遗传联系。这表明需要了解中低收入国家的术中空气质量。在6例病例中发现了匹配的核型，在1例病例中，WGS和宏基因组学分析均显示了空气和SSI分离株之间的同一性。结论该研究显示术中空气传播细菌水平高，SSI率为9％，并且术中空气传播细菌与从SSI中分离出的细菌之间存在遗传联系。这表明需要了解中低收入国家的术中空气质量。在6例病例中发现了匹配的核型，在1例病例中，WGS和宏基因组学分析均显示了空气和SSI分离株之间的同一性。结论该研究显示术中空气传播细菌水平高，SSI率为9％，并且术中空气传播细菌与从SSI分离出的细菌之间存在遗传联系。这表明需要了解中低收入国家的术中空气质量。