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High rates of multi-drug resistant gram-negative organisms associated with surgical site infections in a teaching hospital in Ghana

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BACKGROUND: There is limited data to guide the prevention and management of surgical site infections (SSI) in low- and middle-income countries. We prospectively studied aetiological agents associated with SSI and their corresponding antibiotic susceptibility patterns in a tertiary hospital in Ghana.

METHODS: As part of a cohort study carried out at the surgical department of the Korle Bu Teaching Hospital (KBTH) from July 2017 to April 2019, wound swabs were collected from patients diagnosed with SSI. Isolates cultured from the wound swabs were identified by MALDI TOF and susceptibility testing was conducted according to EUCAST 2020 guidelines. Clinical data were monitored prospectively.

RESULTS: Of 4577 patients, 438 developed an SSI and 352 microbial isolates were cultured. Isolates were predominantly Gram negative (286, 81%), a pattern seen for all kinds of surgery and all wound classes. The most common species included Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Acinetobacter baumannii. The majority of organisms were multi-drug resistant including 86% of E. coli, 52% of A. baumannii and 86% of K. pneumoniae; and 65% (17/26) of the cefotaxime-resistant K. pneumoniae were extended spectrum β-lactamase producing. One of 139 E. coli, 15 of 49 P. aeruginosa, and 6 of 23 A. baumannii were meropenem resistant, but no clonal pattern was found. There was a 1% (5/428) prevalence of methicillin-resistant S. aureus.

CONCLUSIONS: The predominance of Gram-negative organisms and the high level of multi-drug resistance indicate a need to re-evaluate antibiotic prophylaxis and treatment protocols in surgical practice in low- and middle-income countries.

Original languageEnglish
Article number890
JournalBMC Infectious Diseases
Volume20
Issue number1
Pages (from-to)890
ISSN1471-2334
DOIs
Publication statusPublished - 25 Nov 2020

    Research areas

  • Adult, Anti-Bacterial Agents/therapeutic use, Antibiotic Prophylaxis, Drug Resistance, Multiple, Bacterial/drug effects, Female, Ghana/epidemiology, Gram-Negative Bacteria/drug effects, Gram-Negative Bacterial Infections/drug therapy, Hospitals, Teaching, Humans, Male, Methicillin-Resistant Staphylococcus aureus/drug effects, Microbial Sensitivity Tests, Middle Aged, Prospective Studies, Staphylococcal Infections/drug therapy, Surgical Wound Infection/drug therapy, Multidrug resistant, Ghana, Gram-negative organisms, ESBL, Surgical site infection

ID: 62034331