Hospital-acquired infections in patients with surgical infections at a tertiary hospital in Kigali, Rwanda: A prospective observational study

Introduction: Hospital-acquired infections (HAIs) account for a substantial burden on healthcare systems, with surgical site infections being the most common. Limited data exist on HAIs in low-resource settings, particularly device-associated HAIs. This study aimed to characterize the incidence and different types of HAIs among patients with surgical infections in Kigali, Rwanda. Methods: We conducted a prospective, observational study on all patients with surgical infections admitted to a tertiary referral hospital in Kigali. Patient demographics, clinical features, and outcomes, including HAIs, were analysed. Data on devices associated with HAIs, such as the use of Foley catheters, intubation outside of the operating theatre, and central lines, were also gathered. The incidence and types of HAIs were determined. Results: Over 14 months, 124 patients were admitted and underwent surgery for surgical infections. Appendicitis (n=24, 19%), soft tissue infection (n=27, 22%), and abscesses (n=26, 21%) were the most common diagnoses. Seventy-three patients (59%) had comorbidities. Sixteen (13%) required postoperative admission to the intensive care unit. The perioperative mortality rate was 10% (n=13). Thirty-two patients (25%) developed HAIs. Urinary tract infections were seen in 2 patients (2%), and 1 patient developed pneumonia. In total, 30 patients (24%) had SSIs, with 15 (12%) experiencing superficial SSIs, 18 (15%) with deep SSIs, and 16 (13%) with organ-space SSIs. There were no instances of catheter-associated urinary tract infections, ventilator-associated pneumonia, or central line–associated bloodstream infections. Conclusions: The incidence of HAIs among patients with surgical infections was high, with surgical site infections being the most prevalent. Minimizing device exposure is crucial for reducing the risk of other device-related HAIs.