Epidemiology of Staphylococcus aureus in a burn unit of a tertiary care center in Ghana

Abstract

BackgroundIn developing countries, hospitalized burn victims are at high risk of nosocomial infections caused by Staphylococcus aureus. Risk factors include poor infection control practices, prolonged hospitalisation and limited capacity for laboratory microbiological analyses. These problems are compounded by widespread use of antibiotics that drives the spread of multi-drug resistant bacteria.MethodsDuring the study period (November 2014-June 2015), nasal and invasive S. aureus isolates were collected consecutively from patients and healthcare workers (HCWs) within the burn unit of the Reconstructive Plastic Surgery and Burn Center of Korle Bu Teaching Hospital in Ghana. Antibiotic prescription, antibiotic susceptibility and bacterial typing were used to assess antibiotic pressure, antibiotic resistance, and possible transmission events among patients and HCWs.ResultsEighty S. aureus isolates were obtained from 37 of the 62 included burn patients and 13 of the 29 HCWs. At admission, 50% of patients carried or were infected with S. aureus including methicillin resistant S. aureus (MRSA). Antibiotic use per 100 days of hospitalization was high (91.2 days), indicating high selective pressure for resistant pathogens. MRSA isolates obtained from 11 patients and one HCW belonged to the same spa-type t928 and multi-locus sequence type 250, implying possible transmission events. A mortality rate of 24% was recorded over the time of admission in the burn unit.ConclusionThis study revealed a high potential for MRSA outbreaks and emergence of resistant pathogens amongst burn patients due to lack of patient screening and extended empirical use of antibiotics. Our observations underscore the need to implement a system of antibiotic stewardship and infection prevention where microbiological diagnostics results are made available to physicians for timely and appropriate patient treatment.

Colonization with Multidrug‐Resistant Enterobacteriaceae is Associated with Increased Mortality Following Burn Injury in Sub‐Saharan Africa

“…Limited evidence from Nigeria, Ghana, and Malawi suggests that bacterial antibiotic resistance is common among burn wound cultures. [21–24] Several evaluations of burn wound microbiology in middle or low-income countries outside of this region have demonstrated similar findings. [25–33] However from the published literature, the relationship between burn wound colonization with MDR bacteria and patient outcomes in LMICs is unclear.…”

Highly Resistant Staphylococcus aureus Isolated from Patients Attending a Tertiary Hospital, South Western Uganda

“…The overall prevalence of S. aureus infection of burn wounds was 80% with majority of the isolates being MRSA. This is much higher than previously reported in tertiary care health care facilities of Ethiopia [31] and Ghana [32]. Bed sores are more strongly associated with prolonged hospital stays [33].…”

Antibiotics resistance patterns of Panton-Valentine leukocidin-positive methicillin-resistant staphylococci isolated from clinical samples in Abidjan, Cte dIvoire

“…In Ghana, Saba et al (2017) isolated MRSA (17%) from handles and other points of contact in a public hospital environment. In the Burn Center of Korle Bu Teaching Hospital in Ghana, 50% of patients were infected with S. aureus including MRSA (Amissah et al, 2017). In Côte d'Ivoire, previous studies have reported the occurrence of S. aureus strains harboring PVL gene.…”

“…In other sub-Saharan Africa countries, the frequency of PVL-positive S. aureus in clinical samples is high. In Ghana, PVL-encoding genes were detected in 75% (42/56) of S. aureus blood culture (Dekker et al, 2016) and in 27% (17/62) of carriage of PVL-positive S. aureus in burn patients (Amissah et al, 2017). This gene carriage rate was higher (90.7%; 68/75) in communityacquired-S. aureus isolated in Mozambique (van der Meeren et al, 2014), in the Democratic Republic of the Congo (49.1%) (Vandendriessche et al, 2017) and in Nigeria (33.3%; 17/51) in clinical infections (Shittu et al, 2012).…”