According to recent research, hospitals in the Global South must use more targeted antibiotics and conduct appropriate testing for surgical site infections (SSI) in order to help stop the development of antimicrobial resistance (AMR).

Researchers examined procedures at fifty-four hospitals in Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa. They found that inadequate testing and the use of the wrong antibiotics were the main causes of SSIs and MDRs.

Experts from the University of Birmingham led an international study team that examined 5,788 individuals having abdominal surgery, with funding provided by the National Institute for Health and Care study (NIHR) in the United Kingdom.

The researchers from the NIHR Global Health Research Unit on Global Surgery found that 1,163 people (or 22%) had SSIs; however, 80.4% of these patients did not have a wound swab obtained, which would have allowed for more focused antibiotic therapy.

The most frequently detected bacteria in the swabs obtained was E. Coli, and a large number of these microbes were resistant to the medicines prescribed prior to surgery. When data were available, multidrug resistance was discovered in 69.4% of instances.

The paper lays forth a number of crucial actions required to address the issue, such as:

• Lowering the total amount of antibiotics used by using antibiotics wisely and effectively;
• Mapping the patterns of local microorganisms using an adaptive monitoring network;
• Putting into practice evidence-based best practices on the front lines in conjunction with departmental communication, staff education, and behavioral modification;
• Investigating the efficacy of a specialized infection control group;
• Establishing the ability to screen microorganisms using quick, efficient, and affordable diagnostic methods; and
• Depending on local microbiological and resistance tendencies and evidence-based prescription.

Multidrug resistance in SSI, despite limited microbial capacity, is a substantial problem in Global South countries – an issue likely to affect most hospitals where surgery is performed, said co-author Dr. Elizabeth Li of the University of Birmingham.

Targeted antibiotic usage and appropriate diagnostics for surgical site infections are lacking. To avoid SSIs and lower MDR, local standards should be established, testing capacity should be increased, and infection control teams should be established.

Systemic flaws

Professor Shereen Varghese, a co-author from Christian Medical College & Hospital in Ludhiana, India, said: They found systemic inadequacies in MDR prevention and testing capabilities. This is linked to high levels of AMR and non-targeted antibiotic usage.

Testing capacity is inadequate, turnaround time is considerable, and treatment resistance is prevalent when infections do develop. Thus, the indiscriminate and inefficient administration of antibiotics prior to surgery is widespread. Improving patient care by targeted antibiotic prevention of SSIs will benefit patients in ways that go beyond surgery.

SSSI affects 15–25% of individuals following abdominal surgery and is the most common postoperative complication. It is also one of the most prevalent infections linked to healthcare in the world. Compared to patients from middle-income (14.0%) and high-income nations (9.4%), patients from low-income countries are disproportionately impacted (23.2%).

The emergence of SSIs raises the requirement for more antibiotic usage since they usually need treatment with antibiotics. Although the World Health Organization’s guidelines strongly advise against using prophylactic antibiotics to prevent SSI, it is routine practice to use undirected broad spectrum antibiotics inappropriately.

The formation and spread of antimicrobial resistance (AMR) is a natural process; nevertheless, improper use of antimicrobial drugs and inadequate infection prevention and control methods accelerate the development of MDR.