Bacterial profile of surgical site infection and antimicrobial resistance patterns in Ethiopia: a multicentre prospective cross-sectional study

Abstract

Background Globally, surgical site infections (SSI) are the most commonly reported healthcare-associated infections. Methods A multicentre study was conducted among patients who underwent surgical procedures at four hospitals located in Northern (Debre Tabor), Southern (Hawassa), Southwest (Jimma), and Central (Tikur Anbessa) parts of Ethiopia. A total of 752 patients clinically studied for surgical site infection were enrolled. The number of patients from Debre Tabor, Hawassa, Jimma, and Tikur Anbessa, hospitals was 172, 184, 193, and 203, respectively. At each study site, SSI discharge culture was performed from all patients, and positive cultures were characterized by colony characteristics, Gram stain, and conventional biochemical tests. Each bacterial species was confirmed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI TOF). An antimicrobial susceptibility test (AST) was done on Mueller–Hinton agar using the disk diffusion method. Logistic regression analysis was used to assess associations of dependent and independent variables. A p-value < 0.05 was considered statistically significant. Data were analysed using STATA 16 software. Results Among 752 wound discharge cultures performed, 65.5% yielded growth. Among these, 57.9% and 42.1% were Gram-negative and Gram-positive isolates, respectively. In this study, a total of 494 bacteria were isolated; Staphylococcus aureus (31%), Escherichia coli (20.7%), and Klebsiella pneumoniae (9.8%) were the most common. Rare isolates (0.8% each) included Raoultella ornithinolytica, Stenotrophomonas maltophilia, Alcalignes faecalis, Pantoea ecurina, Bacillus flexus, and Paenibacillus tylopili. Enterobacteriaceae showed high levels of resistance to most of the tested antibiotics but lower levels of ertapenem (32.9%), amikacin (24.3%), imipenem (20.3%), and meropenem (17.6%) resistance. Multidrug-resistant (MDR) frequency of Enterobacteriaceae at Debre Tabor, Hawassa, Jimma, and Tikur Anbessa hospitals was 84.5%, 96.5%, 97.3%, and 94%, respectively. Ages ≥ 61 years (AOR = 2.83, 95% CI: 1.02–7.99; P 0.046), prolonged duration of hospital stay (AOR = 4.15, 95% CI: 2.87–6.01; P 0.000), history of previous antibiotics use (AOR = 2.83, 95% CI: 1.06–2.80; P 0.028), history of smoking (AOR = 2.35, 95% CI: 1.44–3.83; P 0.001), emergency surgery (AOR = 2.65, 95% CI: 1.92–3.66; P 0.000), and duration of operation (AOR = 0.27, 95% CI: 0.181–0.392; P 0.000) were significant risk factors. Conclusion The most prevalent isolates from Gram-positive and Gram-negative bacteria across all hospitals were S. aureus and E. coli, respectively. Many newly emerging Gram-negative and Gram-positive bacteria were identified. Variation between hospitals was found for both SSI etiology type and MDR frequencies. Hence, to prevent the emergence and spread of MDR bacteria, standard bacteriological tests and their AST are indispensable for effective antimicrobial stewardship.

Molecular characterization of carbapenemase and extended spectrum beta-lactamase producing Acinetobacter baumannii isolates causing surgical site infections in Ethiopia

“…Of the 40 MDR and ESBL-producing Acinetobacter species isolates according to our previous published work Worku S et al [ 17 ]. , only 12 (30%) A. baumannii isolates were carbapenemase gene positive in the multiplex PCR.…”

“…The purposively selected Hospitals Debre Tabor Comprehensive Specialized Hospital (DTCSH), Hawassa University Comprehensive Specialized Hospital (HUCSH), Jimma University Specialized Hospital (JUSH), and Tikur Anbessa Specialized Hospital (TASH) (Fig. 1 ) were briefly described in our previous published work by Worku S et al [ 17 ].…”

“…The bacterial suspension was swabbed on the MHA surface using a sterile swab, and then antibiotic discs were placed with sterile forceps at least 24 mm apart from one another [ 20 ]. All antibiotics disks were OXOID products (Oxoid Ltd, UK), and susceptibility of Gram-negative isolates was tested against: gentamicin (10 µg), amikacin (30 µg), ciprofloxacin (5 µg), ceftazidime (30 µg), cefotaxime (30 µg), ceftriaxone (30 µg), cefepime (30 µg), trimethoprim-sulfamethoxazole (1.25/23.75 µg), ampicillin-sulbactam (10/10µg), meropenem (10 µg), imipenem (10 µg), ertapenem (30 µg) as describes in our previous published work by Worku S et al [ 17 ].…”

From Polymeric Nanoformulations to Polyphenols—Strategies for Enhancing the Efficacy and Drug Delivery of Gentamicin

“…In the case of osteomyelitis, poor vascularization around bone tissues makes drug delivery to the site of infection very difficult [82]. For both surgical site infections and osteomyelitis, which are commonly caused by Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli, as well as more resistant strains like Methicillin-resistant Staphylococcus aureus, up to 6 weeks of the sustained delivery of gentamicin might be needed to eliminate the infections and their biofilms [66,83,84]. Although non-biodegradable bone cements, like poly (methyl methacrylate) (PMMA), possess several advantages for osteomyelitis treatment, the need for a second surgical intervention to remove them hinders their wider use [85,86].…”