# Surgical Site Infections in Mozambique: A Literature Review of Incidence, Antimicrobial Resistance, Risk Factors, and Surveillance Practices

## TL;DR

This paper reviews surgical site infections in Mozambique, highlighting their high burden, common pathogens, antimicrobial resistance, and the need for better surveillance and infection control.

## Contribution

The study is the first to systematically review SSI incidence, risk factors, and AMR patterns in Mozambique, revealing critical gaps in surveillance and IPC.

## Key findings

- Common pathogens include MRSA, Klebsiella pneumoniae, and E. coli with high MRSA prevalence (15-42%).
- Risk factors include poor hygiene, sterilization issues, HIV, and malnutrition.
- National SSI surveillance is nearly absent, with only one hospital reporting AMR data to WHO GLASS.

## Abstract

Background: Surgical site infections (SSIs) are among the most common healthcare-associated infections worldwide and impose a disproportionate burden in low- and middle-income countries (LMICs). In Mozambique, persistent health system constraints—including limited infection prevention and control (IPC) capacity, weak surveillance infrastructure, and rising antimicrobial resistance (AMR)—likely amplify this burden. This review synthesizes available evidence on SSI incidence, etiology, antimicrobial resistance patterns, risk factors, and surveillance practices in Mozambican healthcare settings.

Methods: A structured literature search was conducted in PubMed, Embase, Scopus, Web of Science, WHO Global Index Medicus, and Google Scholar for studies published between 2000 and September 2025. Eligible studies reported SSI incidence or prevalence, causative pathogens, AMR profiles, or associated risk factors in Mozambique. Additional data were retrieved from WHO reports, Joint External Evaluations (JEEs), and national surveillance assessments.

Results: Published evidence remains scarce and fragmented, with no comprehensive national estimates of SSI incidence identified. The most commonly reported pathogens were Staphylococcus aureus (including MRSA), Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp., and Escherichia coli. MRSA prevalence in hospital settings ranged from 15% to 42%. Gram-negative isolates frequently demonstrated extended-spectrum β-lactamase (ESBL) production, suggesting substantial antimicrobial pressure. Reported risk factors were consistent with regional findings and included inadequate hand hygiene, suboptimal sterilization practices, prolonged lab or, malnutrition, HIV infection, and perioperative anemia. National SSI surveillance is largely absent, and only one hospital currently reports AMR data to the WHO Global Antimicrobial Resistance Surveillance System (GLASS).

Conclusions: SSIs represent a significant yet underrecognized public health challenge in Mozambique. Despite increasing multidrug resistance, systematic data collection and coordinated national surveillance remain limited. Strengthening IPC programs, establishing structured SSI surveillance, expanding microbiological laboratory capacity, and implementing antibiotic stewardship initiatives are urgent priorities to improve surgical outcomes and reinforce national health security.