[Surgical site infection survey in the orthopaedic surgery department of the "Hôpital communautaire de Bangui," Central African Republic].

As we have been confronted to frequent surgical site infections (SSI) in our practice in Bangui, CAR and because of the scarcity of studies about this subject in Central Africa area, we conducted a prospective survey in order to determine the frequency the causative bacteria and the main risk factors of SSI in Bangui. All patients who underwent surgery in the orthopaedics surgery department of the "Hôpital Communautaire de Bangui", CAR, between May 2003 to April 2004 were enrolled. We included all consenting patients responding to the following criteria: Altemeir class 1 to 3 and operated for the first time. The following risk factors have been studied: ASA score, time length of the procedure, pre operative stay in the ward, type of procedure, and use of antibioprophylaxy. Bacteriological study was performed at the Institut Pasteur in Bangui. During the study period, 278 cases were included (207 were male and 71 were female) and 51 SSI (18%) were diagnosed among which 48 cases during hospitalization and only 3 cases after discharge. The infections were superficial in 31 cases (61%) and deep in 20 cases (39%) and often requiring new surgery procedure. The following factors were found to be predictive for a SSI: Altemeier class and a long time of surgery procedure. No difference in the frequency of SSI was noted in patients who received antibioprophylaxy or not. Methicillin-susceptible S. aureus was the most frequent species isolated in SSI, followed by Enterobacteriaceae and P. aeruginosa. A strain of E. cloacae harbouring an extended spectrum beta-Lactamase was also identified. SSI occurs at very high frequency in our practice in the "Hôpital Communautaire de Bangui", CAR. The antibioprophylaxy scheme used in our hospital (generally penicillin G), is not adapted to prevent SSI. It is of great importance to control and improve hygienic procedures in surgical practices in Bangui, to modify the antibioprophylaxy schemes and to implement SSI surveillance.