Etiology and Antimicrobial Susceptibility of Surgical Site Infections at Moi Teaching and Referral Hospital, Eldoret-Kenya

Background:  Surgical Site Infection (SSI) poses a burden to patients and the healthcare system by increasing cost and hospital stay as well as causing significant morbidity and mortality. The incidence of SSI in sub-Sahara Africa is approximately 10% and 60% for clean wounds and dirty wounds respectively. We determined bacterial etiology and antimicrobial susceptibility of surgical site infections at Moi Teaching and Referral Hospital, Eldoret-Kenya. Methods: We conducted a cross sectional study among 57 cases of SSI. Data was collected on sociodemographic and clinical characteristics using a structured questionnaire. Pus swab was collected from the cases for culture and antimicrobial sensitivity. Blood culture was done for participants who presented with systemic features of infection including fever of 37.50C and above. Frequencies and proportions were determined for bacterial etiology and antimicrobial susceptibility. Results:  A total of 55 bacterial organisms were isolated from 46 patients. The most common isolate was Staphylococcus aureus - 22 (40.0%) followed by Escherichia coli- 11 (20.0%), Acinetobacter baumannii- 6 (10.9%), Klebsiella pneumoniae -5 (9.1%), Pseudomonas aeruginosa-4(7.3%), Proteus mirabilis 2(3.6%) and Streptococcus pyogenes 1 (1.8%). Methicillin Resistant Staphylococcus Aureus (MRSA) comprised 59% (13) of all Staphylococcus aureus. Gram positive bacteria had over 50% resistance to Ceftriaxone, Cotrimoxazole, Ciprofloxacin, Azithromycin, Erythromycin, Cefuroxime and Levofloxacin. Gram negatives had more than 50% resistance to Ceftriaxone, Cefotaxime, Ceftazidime, Cefepime and Levofloxacin. MRSA and Acinetobacter baumannii showed multidrug resistance. Conclusion: Staphylococcus aureus was the commonest causative agent for SSI with MRSA constituting 59% of Staph aureus infection. Organisms causing SSI were resistant to most commonly used antimicrobial agents at MTRH.  Recommendations: Active surveillance for SSI causing organisms and their susceptibility patterns should be instituted at MTRH. Antimicrobial use should be rationalized according to local susceptibility patterns.