Genetic relationship between bacteria isolated from intraoperative air samples and surgical site infections at a major teaching hospital in Ghana

Summary Background In low- and middle-income countries (LMIC) the rate of surgical site infections (SSI) is high, leading to negative patient outcomes and excess health care 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 a 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 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 were found by MALDI-TOF in 8 cases. Matching ribotypes were found in 6 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 SSI. This indicates the need for awareness of intraoperative air quality in LMIC.