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Background  The role of hospital water systems in the development of  Pseudomonas aeruginosa  ( P. aeruginosa ) surgical site infections (SSIs) in low-income countries is barely studied. This study characterized  P. aeruginosa  isolates from patients and water in order to establish possible epidemiological links.    Methods  Between December 2014 and September 2015, rectal and wound swabs, and water samples were collected in the frame of active surveillance for SSIs in the two Tanzanian hospitals. Typing of  P. aeruginosa  was done by multi-locus sequence typing.    Results  Of 930 enrolled patients, 536 were followed up, of whom 78 (14.6%, 95% CI; 11.6–17.5) developed SSIs.  P. aeruginosa  was found in eight (14%) of 57 investigated wounds .  Of the 43 water sampling points, 29 were positive for  P. aeruginosa . However, epidemiological links to wound infections were not confirmed. The  P. aeruginosa  carriage rate on admission was 0.9% (8/930). Of the 363 patients re-screened upon discharge, four (1.1%) possibly acquired  P. aeruginosa  during hospitalization. Wound infections of the three of the eight  P. aeruginosa  SSIs were caused by a strain of the same sequence type (ST) as the one from intestinal carriage. Isolates from patients were more resistant to antibiotics than water isolates.    Conclusions  The  P. aeruginosa  SSI rate was low. There was no evidence for transmission from tap water. Not all  P. aeruginosa  SSI were proven to be endogenous, pointing to other routes of transmission.

antimicrobial resistance and infection control

Surveillance of surgical site infections by Pseudomonas aeruginosa and strain characterization in Tanzanian hospitals does not provide proof for a role of hospital water plumbing systems in transmission