Surgery 900
Patients having surgery in low income countries are more likely to develop an infection than those in wealthier nations.

Patients having surgery in low income countries are more likely to develop an infection than those in wealthier nations, which may be linked to drug-resistant bacteria, research led by the Universities of Birmingham, Edinburgh and Warwick suggests.   

Patients in low income nations also have higher antibiotic use and are more likely to be infected with bacteria that are resistant to medicines, the study found. 

The findings shed light on a link between antibiotic use and infection and highlight an urgent need to tackle surgical infection in low income nations, scientists say. 

Infection at the site of a surgical wound is a complication that prolongs recovery times for patients and can be fatal. Until now, the extent of the problem in low income countries was unknown. 

To address this, researchers looked at hospital records – from 66 low, middle and high income countries – for more than 12,000 patients undergoing surgery on the digestive system. 

  • Patients in low income countries were 60% more likely to have an infection in the weeks following an operation compared with high and middle income countries 
  • Those who developed a wound infection were more likely to die, although the infection was not necessarily the cause of death. Infected patients were also found to stay in hospital three times longer
  • Drug-resistant bacteria do not respond to antibiotics, making it hard to treat infection. Their spread has been linked to overuse of antibiotics and is an urgent global healthcare challenge

The research was led from the Universities of Edinburgh, Birmingham, and Warwick as part of the GlobalSurg Collaborative, an international network of doctors who gather healthcare data by recruiting healthcare centres through social media. It was published in Lancet Infectious Diseases and was funded by the National Institute of Health Research (NIHR). 

Professor Dion Morton, of the University of Birmingham's Institute of Cancer and Genomic Sciences, said: “Countries with a low Human Development Index carry a disproportionately greater burden of surgical infections than countries with a middle or high Human Development Index. 

“In view of World Health Organization (WHO) recommendations on measures for surgical site infection prevention that highlight the absence of high-quality evidence for interventional research, urgent, pragmatic, randomised trials are needed to assess measures aiming to reduce this preventable complication.” 

The National Institute for Health Research (NIHR) awarded £7 million to the Universities of Birmingham, Edinburgh and Warwick to establish a joint research unit focussed on developing global surgical research in July 2017.

Over a period of four years, until March 2021, the NIHR Global Health Research Unit will establish sustainable international research hubs across a range of low and middle income countries (LMICs). Initially, up to five international hubs will be set up across southern, central and western Africa, central and south America, and south Asia.