Prevalence and factors associated with bacterial contamination of intraoperative salvaged blood in women with ruptured ectopic pregnancy at Mulago Hospital, Kampala, Uganda

Abstract

Introduction: Intra operative blood salvage in conditions like ruptured ectopic pregnancy can reduce the need for allogeneic blood which is scarce and expensive. Intra operative salvaged blood has been reported to be contaminated by bacteria which resultantly lead to post transfusion sepsis. The prevalence and factors influencing bacterial contamination of intra operative salvaged blood in women with ruptured ectopic pregnancy are not known. Objective:The objective of the study was to determine the prevalence and factors associated with bacterial contamination of intraoperative salvaged blood in women with ruptured ectopic pregnancies in Mulago hospital. Methods: This was a cross sectional study, conducted at Mulago hospital. A total of 204 participants with ruptured ectopic pregnancy participated in the study. Peritoneal blood was taken from participants at laparotomy, aseptically put in bactec broth media and sent to the laboratory for culture and microscopy to assess for the presence and identification of bacteria in the salvaged blood. A questionnaire was administered to the participants to assess for the factors associated with bacterial contamination of intraoperative salvaged blood. Data analysis:Data was coded and double entered in Epidata Version 3.1 and exported to STATA Version 12 for analysis. Proportions were calculated to determine the prevalence of bacterial contamination.History of infection factors were subjected to bivariate and multivariate analysis to determine their association with bacterial contamination of intra operative salvaged blood. P-value of ≤ 0.05was considered significant. xiii Results: The prevalence of bacterial contamination of intraoperative salvaged blood in women with ruptured ectopic pregnancy was 76.0%. More than half of the contaminating bacteria (59.4%) were Coagulase negative staphylococcus. Women who had cough were 4.72 times more likely to have bacterial contamination compared to those who did not have cough. Women who had urgency of passing urine were 5.78 times more likely to have bacterial contamination compared to those who did not have urgency of passing urine. Conclusion: Bacterial contamination of intra operative salvaged blood in women with ruptured ectopic pregnancy at Mulago hospital is common with skin normal flora being the major bacterial contaminant. Following statistical adjustment, having respiratory tract infection symptoms or urinary tract infection symptoms was associated with bacterial contamination at multivariate analysis. Study utility: This information will be vital for Uganda transfusion services and medical team to formulate a protocol for IBS for autologous transfusion. Patients will also use such information in order to give informed consent for autologous transfusion.