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recherche opérationnelle, LuxOR, MSF, antibio-résistance

LuxOR Operational Research Highlights 2019/2020


A patient with an external fixator at MSF's “L’Arche de Kigobe” trauma center in Bujumbura. © Evrard Ngendakumana/MSF



    Opened in 2015 as a response to politically fueled violence, L’Arche Kigobe is a MSF-supported Trauma Center in the center of Burundi’s capital Bujumbura. As in many low-resource settings, infections occurring during surgeries or post-operative care are a major concern, adding to the increasing global threat of antibiotic resistance.


    Initially established as an emergency project, L’Arche Kigobe Trauma Center quickly expanded services to meet a growing surgical demand. 4,157 surgical interventions took place in 2019 alone, despite a persisting lack of personnel, medical, and laboratory resources.

    The increasing number of surgical interventions however also led to a surge in related health complications. Daunting estimates show that in low-resource settings like Burundi, one in ten patients will develop a surgical site infection. These infections occur after surgery in both postoperative care at the hospital or once a patient is discharged, and in severe cases can result in lifelong disability or death.

    Surgical site infections are directly linked to the rapidly growing threat of antibiotic resistance. With more and more bacteria showing resistance against traditional antibiotics, the preventive treatment for patients is no longer effective. By using newer antibiotics, doctors in turn risk the bacteria developing new resistance to them, having fewer and fewer options for treatment down the line.

    At the L’Arche Kigobe Trauma Center, an initial review of patient data showed the most frequent sources of surgical site infections occurred with the use of external fixators, a set of metal rods and screws stabilizing complex fractures through the skin.

    In order to improve tracking of surgical site infections, the old manual paper register was updated to a digital database, and the reporting forms and notification system aligned with latest international guidelines. The new surveillance system also ensures patients are followed up with by health promotion staff or by phone after they leave the hospital.

    Ten months into the launch of the new surveillance system, nearly 200 patients were systematically followed up over the course of 30 days, and 20 cases of surgical site infections and respective treatment were identified. The collected data is further used to continuously improve infection prevention, as well as control practices and identify potential treatment failures.

    Antibiotic resistance is a major threat to global health, and an increasingly important research focus of health and humanitarian actors around the world. Several evidence gaps persist on contributing factors such as resistance patterns, overprescription of antibiotics, patients not complying with instructions and the use of antibiotics in the agricultural sector.

    To facilitate thematic research in MSF projects, in late 2020 LuxOR will be launching a dedicated Structured Operational Research Training Initiative (SORT IT). In three course modules, field and medical staff plan, implement and publish a research project with direct operational relevance to their projects and missions.

    Anita Williams

    Operational Research Advisor

    MSF and other health actors need to start engaging in the fight against antibiotic resistance. Even where we face access or resource challenges, there are things we can do to tackle resistance, through better infection and control practices and improved surveillance systems. Facing the tremendous global health challenge that is antibiotic resistance is an ongoing battle.