Surgical Infections in Low- And Middle-Income Countries: A Global Assessment of the Burden and Management Needs

Jennifer Rickard, Gregory Beilman, Joseph Forrester, Robert Sawyer, Andrew Stephen, Thomas G. Weiser, Julie Valenzuela

Research output: Contribution to journalReview articlepeer-review

38 Scopus citations


Background: The burden of surgical infections in low- and middle-income countries (LMICs) remains poorly defined compared with high-income countries. Although there are common infections necessitating surgery prevalent across the world, such as appendicitis and peptic ulcer disease, other conditions are more localized geographically. To date, comprehensive assessment of the burden of surgically treatable infections or sequelae of surgical infections in LMICs is lacking. Methods: We reviewed the literature to define the burden of surgical infections in LMICs and characterize the needs and challenges of addressing this issue. Results: Surgical infections comprise a broad range of diseases including intra-abdominal, skin and soft tissue, and healthcare-associated infections and other infectious processes. Treatment of surgical infections requires a functional surgical ecosystem, microbiology services, and appropriate and effective antimicrobial therapy. Systems must be developed and maintained to evaluate screening, prevention, and treatment strategies. Solutions and interventions are proposed focusing on reducing the burden of disease, improving surveillance, strengthening antibiotic stewardship, and enhancing the management of surgical infections. Conclusions: Surgical infections constitute a large burden of disease globally. Challenges to management in LMICs include a shortage of trained personnel and material resources. The increasing rate of antimicrobial drug resistance, likely related to antibiotic misuse, adds to the challenges. Development of surveillance, infection prevention, and antimicrobial stewardship programs are initial steps forward. Education is critical and should begin early in training, be an active process, and be sustained through regular programs.

Original languageEnglish (US)
Pages (from-to)478-494
Number of pages17
JournalSurgical infections
Issue number6
StatePublished - Aug 2020

Bibliographical note

Publisher Copyright:
© Copyright 2020, Mary Ann Liebert, Inc., publishers 2020.


  • antimicrobial resistance
  • antimicrobial stewardship
  • infection control
  • infections
  • surgery


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