High rates of multi-drug resistant gram-negative organisms associated with surgical site infections in a teaching hospit
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(2020) 20:890
RESEARCH ARTICLE
Open Access
High rates of multi-drug resistant gramnegative organisms associated with surgical site infections in a teaching hospital in Ghana Antoinette A. A. Bediako-Bowan1,2,3,4* , Jørgen A. L. Kurtzhals5,6, Kåre Mølbak3,4, Appiah-Korang Labi5,6,7, Enid Owusu8 and Mercy J. Newman9
Abstract Background: There is limited data to guide the prevention and management of surgical site infections (SSI) in lowand 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. Keywords: Multidrug resistant, Surgical site infection, Gram-negative organisms, ESBL, Ghana
* Correspondence: [email protected] 1 Department of Surgery, University of Ghana Medical School, University of Ghana, P. O. Box 4356, Accra, Ghana 2 Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intende
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