Infection with high proportion of multidrug-resistant bacteria in conflict-related injuries is associated with poor outcomes and excess resource consumption: a cohort study of Syrian patients treated in Jordan

Andreas Älgå, Sidney Wong, Muhammad Shoaib, Kalle Lundgren, Christian G Giske, Johan von Schreeb, Jonas Malmstedt, Andreas Älgå, Sidney Wong, Muhammad Shoaib, Kalle Lundgren, Christian G Giske, Johan von Schreeb, Jonas Malmstedt

Abstract

Background: Armed conflicts are a major contributor to injury and death globally. Conflict-related injuries are associated with a high risk of wound infection, but it is unknown to what extent infection directly relates to sustainment of life and restoration of function. The aim of this study was to investigate the outcome and resource consumption among civilians receiving acute surgical treatment due to conflict-related injuries. Patients with and without wound infections were compared.

Methods: We performed a cohort study using routinely collected data from 457 consecutive Syrian civilians that received surgical treatment for acute conflict-related injuries during 2014-2016 at a Jordanian hospital supported by Médecins Sans Frontières. We defined wound infection as clinical signs of infection verified by a positive culture. We used logistic regression models to evaluate infection-related differences in outcome and resource consumption.

Results: Wound infection was verified in 49/457 (11%) patients. Multidrug-resistance (MDR) was detected in 36/49 (73%) of patients with infection. Among patients with infection, 11/49 (22%) were amputated, compared to 37/408 (9%) without infection, crude relative risk = 2.62 (95% confidence interval 1.42-4.81). Infected patients needed 12 surgeries on average, compared to five in non-infected patients (p < .00001). Mean length of stay was 77 days for patients with infection, and 35 days for patients without infection (p = .000001).

Conclusions: Among Syrian civilians, infected conflict-related wounds had a high prevalence of MDR bacteria. Wound infection was associated with poor outcomes and high resource consumption. These results could guide the development of antibiotic protocols and adaptations of surgical management to improve care for wound infections in conflict-related injuries.

Trial registration: ClinicalTrials.gov ( NCT02744144 ). Registered April 13, 2016. Retrospectively registered.

Keywords: Multidrug-resistance; Refugee; Resource limited setting; War wounds; Wound infection.

Conflict of interest statement

Ethics approval and consent to participate

This study was performed in accordance with the Declaration of Helsinki and approved by the Ethics Review Committee of Jordan Ministry of Health (MOH REC 150037) and the Ethics Review Board of MSF International (www.msf.org/en/msf-ethics-review-board) (ID 1520). The need for written consent to participate in this study was formally waived by the ethics committees.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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