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While the incidence of post-CS SSI is estimated at 5\u201310% worldwide, increasing evidence suggests that women in low- and middle-income countries (LMIC) may be disproportionally affected. Due to the lack of access to routine microbiology and surveillance, data on bacterial pathogens and resistance are scarce for post-CS SSI from LMIC, and antibiotic treatment is largely empirical. Further research on common pathogens and resistance patterns is urgently needed, considering the rise of antimicrobial resistance (AMR) especially in sub-Saharan Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective observational study aimed to describe the bacterial pathogens, resistance profiles and clinical outcomes of women with post-CS SSI at the largest national maternity hospital in Kampala, Uganda. Women with clinical signs of post-CS SSI were eligible for inclusion. Blood and deep wound swab cultures were taken for bacterial species identification and antibiotic susceptibility testing upon enrolment. Clinical follow-up assessments were conducted on days 2, 4 and at discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From May 2021 to January 2022, 70 women were screened for study eligibility, of which 66 were enrolled and completed follow-up. The median age was 25 years (IQR 21\u201329), and 5 (7.6%) participants were HIV-infected. The median time between CS and diagnosis of SSI was 12.2 days (IQR 8\u201315). The majority of women required surgical treatment, predominantly debridement (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200951, 82%). A total of 80 bacterial pathogens were identified from deep wound swabs, of which the majority were Gram-negative (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200966, 82.5%). The most frequently isolated pathogens were\n                      <jats:italic>Acinetobacter<\/jats:italic>\n                      spp. (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200926, 32.5%),\n                      <jats:italic>Escherichia<\/jats:italic>\n                      (\n                      <jats:italic>E<\/jats:italic>\n                      .)\n                      <jats:italic>coli<\/jats:italic>\n                      (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918, 22.5%), and\n                      <jats:italic>Klebsiella<\/jats:italic>\n                      spp. (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915, 18.8%), the majority of which were highly resistant to third-generation cephalosporins (94\u2013100%). Additionally, a large proportion of\n                      <jats:italic>Acinetobacter<\/jats:italic>\n                      spp. isolates were resistant to carbapenems (65.4%), gentamycin (90.9%), and quinolones (85.0%). Blood cultures were negative for bacterial growth in all participants. After a median 10.7 days (IQR 5\u201314) of in-patient treatment, the majority of study participants made a complete recovery (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200959, 89.4%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Deep wound swabs from post-CS SSI predominantly identified multidrug resistant Gram-negative pathogens with limited antibiotic treatment options in this setting. Especially the large proportion of carbapenem-resistant\n                      <jats:italic>Acinetobacter<\/jats:italic>\n                      spp. may indicate hospital-acquisition of the infections and warrants the strengthening of infection prevention and control measures, as well as antibiotic stewardship.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12905-025-04101-7","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T11:37:49Z","timestamp":1761824269000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Multi-drug resistant surgical site infections following caesarean delivery: a prospective observational study from urban Uganda"],"prefix":"10.1186","volume":"25","author":[{"given":"Leah","family":"Mbabazi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Hahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Sserubiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patience","family":"Natukunda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amusa","family":"Wamawobe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Kajumbula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Nakate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"L\u00fcbbert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Musaazi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hawah","family":"Nabajja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holger","family":"Stepan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Nsibirwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrei","family":"von Braun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"4101_CR1","unstructured":"World Health Organization (WHO). 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