Epidemiology of antibiotic-resistant wound infections from six countries in Africa

Abstract

IntroductionLittle is known about the antimicrobial susceptibility of common bacteria responsible for wound infections from many countries in sub-Saharan Africa.MethodsWe performed a retrospective review of microbial isolates collected based on clinical suspicion of wound infection between 2004 and 2016 from Mercy Ships, a non-governmental organisation operating a single mobile surgical unit in Benin, Congo, Liberia, Madagascar, Sierra Leone and Togo. Antimicrobial resistant organisms of interest were defined as methicillin-resistant Staphylococcus aureus (MRSA) or Enterobacteriaceae resistant to third-generation cephalosporins. Generalised mixed-effects models accounting for repeated isolates in a patient, potential clustering by case mix for each field service, age, gender and country were used to test the hypothesis that rates of antimicrobial resistance differed between countries.Results3145 isolates from repeated field services in six countries were reviewed. In univariate analyses, the highest proportion of MRSA was found in Benin (34.6%) and Congo (31.9%), while the lowest proportion was found in Togo (14.3%) and Madagascar (14.5%); country remained a significant predictor in multivariate analyses (P=0.002). In univariate analyses, the highest proportion of third-generation cephalosporin-resistant Enterobacteriaceae was found in Benin (35.8%) and lowest in Togo (14.3%) and Madagascar (16.3%). Country remained a significant predictor for antimicrobial-resistant isolates in multivariate analyses (P=0.009).ConclusionA significant proportion of isolates from wound cultures were resistant to first-line antimicrobials in each country. Though antimicrobial resistance isolates were not verified in a reference laboratory and these data may not be representative of all regions of the countries studied, differences in the proportion of antimicrobial-resistant isolates and resistance profiles between countries suggest site-specific surveillance should be a priority and local antimicrobial resistance profiles should be used to guide empiric antibiotic selection.

Antimicrobial resistance profile among bacteria isolated from patients presenting with wounds at Kabale Regional Referral Hospital, South western Uganda

“…Penicillins used in the current study. Such susceptibility pattern of these isolates is in agreement with other previous reports across Africa [30] . Multidrug resistance among Gram negative bacteria resistant to commonly used antimicrobials in wound infections is a serious concern [31,17] .…”

Antimicrobial Resistance in Hospitalized Surgical Patients: a Silently Emerging Public Health Concern in Benin.

“…Upreti and Shrestha in Nepal found the same rate of MRSA [28,29]. In a retrospective single center study conducted in 2016 by Mercy Ship during surgical outreaches in six sub-Saharan African countries (Benin,Togo, Liberia, Madagascar, Congo and Sierra-leone) Lai PS et al found the highest rates of MRSA in Benin (34.6%) and Congo (31.9%) and the lowest rate in Togo (14.3%) and Madagascar (14.5%) [30]. The difference in the rates of isolation of MRSA between studies may be due to different levels of inappropriate use of antibiotic but also to the effectiveness of hygiene programs.…”

“…Upreti et al have reported that 25% of E.coli and 40% of K. pneumoniae are ESBL producers. In 2016, Benin was found to have the highest rate of third generation cephalosporin resistant enterobacterales of six sub-Saharan African countries [30]. Almost all ESBL producers isolates showed co-resistance to other class of antibiotics such as aminoglycosides, quinolones, and trimethoprim-sulfamethoxazole.…”

“…Antibiotics were purchased from BioRad (Marnes-la-coquette, France) and included for S. aureus: ampicillin (10 , cefotaxime (30 g), cefoxitin (30 , gentamicin (10 ,amikacin (30 ), cipro oxacin (5 ), trimethoprim + sulfamethoxazole (25 g), tetracycline (30 g) and chloramphenicol (30 g). The Gramnegative organisms were tested for ampicillin 10 , piperacillin 100 g, cefotaxime (30 ), cefoxitin (30 ), ceftriaxone (30 g), gentamicin (10 ), tobramycin (10 ), amikacin (30 g), cipro oxacin (5 , trimethoprim + sulfamethoxazole (25 g), imipenem (10 , and meropenem (10 . For non-fermentative Gram-negative bacteria, the discs used included ceftriaxone (30 , ceftazidime (30 , gentamicin (10 ), cipro oxacin and meropenem (10 g).…”

Assessing the need for surgical treatments in Sierra Leone

“…Although Buruli ulcers would need goal directed therapy with rifampicin/streptomycin and or surgical debridement and skin grafting, most ulcers are treated with over-the-counter available antibiotics. A study from Lai et al, who provided care on a ship, anchoring at six coastal West African countries, showed considerable resistance to common antibiotics (31). From clinical experiences at Masanga Hospital, a referral centre for patients with large wounds, it is known that most patients visited a traditional healer -and have started treatment (herbs and or antibiotics) -before seeking care in this rural hospital in Sierra Leone.…”