Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Benin

Abstract

Background: Surgical site infections are related to high morbidity, mortality and healthcare costs. Because the emergence of multidrug-resistant bacteria in hospitals is becoming a worldwide challenge for surgeons who treat healthcare-associated infections, we wished to identify the causative agents involved in these infections and the rate of multidrug-resistant bacteria in six public hospitals in Benin. Methods: Using standard microbiological procedures, we processed pus specimens collected from obstetrics and gastrointestinal surgery wards. Mass spectrometry (MALDI-TOF) was used for confirmation. For the antibiotic susceptibility test, we first used the Kirby-Bauer disk diffusion method. The secondary test (by microdilution) used the Beckton Dickinson Phoenix automated system (Becton Dickinson Diagnostic, USA). Results: We included 304 patients, whose median length of stay was 9 days. A total of 259 wound swabs (85.2%) had positive aerobic bacterial growth. In obstetrics, S. aureus (28.5%, n=42) was the most common isolate. In contrast, Gram-negative bacteria (GNB) were predominant in gastrointestinal surgery, the most dominant being E. coli (38.4%, n=31). Overall, 90.8% (n=208) of aerobic bacteria were multidrug resistant. Two-thirds of S. aureus (65.3%, n= 32) were methicillin-resistant Staphylococcus aureus (MRSA), three of which carried both MRSA and induced clindamycin resistance (ICR). GNB showed high resistance to ceftazidime, ceftriaxone and cefepime. Extended-spectrum beta-lactamases were presented by 69.4% of E.coli (n=43/62) and 83.3% of K. pneumoniae (n=25/30). Overall, twelve Gram-negative bacteria (5.24%) showed resistance to at least one carbapenem. No isolates showed a wild-type susceptible phenotype. Conclusion: This study shows the alarming prevalence of multidrug-resistant organisms from surgical site infections in Benin hospitals. To reduce the spread of such bacteria, periodic surveillance of surgical site infections and strict adherence to good hand-hygiene practice are essential.

Characterization of Virulent Bacterial Isolates Associated with Multi-Drug Resistance among Patients with Surgical Site Infections in Selected Specialist Hospitals in Calabar, Nigeria

“…This is consistent with a report in a previous study in Alexandria that in a sub-set of 65 isolates from SSI, half of the Gram-negative bacteria especially P. aeruginosa, Acinetobacter baumannii, and K. pneumoniae were resistant to carbapenem antibiotics [13]. The result from this study supports the trends reported on antibiotic resistance and indicates reduction efficacy of several classes of antibiotics including carbapenems, second and third generation cephalosporins, fluoroquinolones against gram negative bacilli, and extended-spectrum betalactamase inhibitor resistance amongst others [13].…”

“…The threat posed by antibiotic resistance in the treatment of SSI remains a huge challenge to surgical patients as this contributes significantly to increased treatment cost, hospitalization time, as well as morbidity and mortality [13,14]. Many studies have reported that microbial virulence as well as host factor are very crucial determinants of surgical site infections [15,16].…”

A review of some medicinal plants with the potential to defeat antimicrobial resistance: Cases of Benin, Togo, Ghana, Burkina Faso, and Cape Verde

“…Fofana et al [33] showed that AMR is the origin of important and continuous viral replication in children infected with HIV in Benin [34]. The question is more alarming when studies have shown multidrug-resistant strains involved in nosocomial infections in Benin [35,36]. A high rate of resistance to antibiotics commonly used for the treatment of infections has also been demonstrated [37].…”