Patients having surgery in low-income countries are more likely to develop an infection than those in wealthier nations, which may be linked to drug-resistant bacteria, research led by the Universities of Birmingham, Edinburgh, and Warwick suggests.

Patients in low-income nations also have higher antibiotic use and are more likely to be infected with bacteria that are resistant to medicines, the study found.

The findings shed light on a link between antibiotic use and infection and highlight an urgent need to tackle surgical infection in low-income nations, scientists say.

Infection at the site of a surgical wound is a complication that prolongs recovery times for patients and can be fatal. Until now, the extent of the problem in low-income countries was unknown.

To address this, researchers looked at hospital records—from 66 low-, middle-, and high-income countries—for more than 12,000 patients undergoing surgery on the digestive system.

Patients in low-income countries were 60% more likely to have an infection in the weeks following an operation compared with high- and middle-income countries.

Those who developed a wound infection were more likely to die, although the infection was not necessarily the cause of death. Infected patients were also found to stay in hospital three times longer.

Drug-resistant bacteria do not respond to antibiotics, making it hard to treat infection. Their spread has been linked to overuse of antibiotics and is an urgent global health-care challenge.

The research was led from the Universities of Edinburgh, Birmingham, and Warwick as part of GlobalSurg Collaborative, an international network of doctors who gather health-care data by recruiting health-care centers through social media.

It is published in Lancet Infectious Diseases and was funded by the National Institute of Health Research (NIHR).