Antibiotic resistance profiles of Acinetobacter baumannii isolates from surgical wound infections at Kamuzu Central Hospital in Malawi:a retrospective study
Keywords:Acinetobacter baumannii, Antibiotic resistance, surgical wounds
Background: Acinetobacter baumannii has emerged as one of the most significant pathogen due to its ability to develop antimicrobial resistance to a broad range of commonly available antibiotics. It represents a serious iatrogenic complication of modern healthcare, where patients acquire infections in healthcare facilities with limited treatment options, resulting in increased morbidity, mortality and health costs.
Methods: In this retrospective study, results of culture and antimicrobial susceptibility tests of samples collected from surgical wounds of patients from January to December 2017 were extracted from Laboratory information management system at Kamuzu Central Hospital (KCH) in Malawi.
Results: This study ranks A. baumannii as the fourth common cause of surgical wound infections at KCH, with a prevalence of 12.3%. Other most prevalent isolates were: E. coli (25.9%), S. aureus (25.9%) and Proteus species (17.5%). All A. baumannii isolates were resistant to Amoxicillin/Clavulanate and Ceftriaxone; 96.4% were resistant to Ampicillin; 92.9% were resistant to Gentamycin, Ceftazidime and Sulphamethoxazole-trimethoprim; 89.3% were resistant to Ciprofloxacin; and 85.7% were resistant to Cefuroxime and Piperacillin/Tazobactam; while 17.9% were resistant to Meropenem. A total of 82% of the A. baumannii isolates were Multi-Drug Resistant (MDR), while 14% were Extremely Drug Resistant (XDR).
Conclusion: The emergence of MDR and XDR A. baumannii at KCH calls for rational use of available antibiotics and regular monitoring of antimicrobial resistance patterns to prevent dissemination of current strains and emergence of new resistant strains.
Anguzu JR, Olila D. Drug sensitivity patterns of bacterial isolates from septic post-operative wounds in a regional referral hospital in Uganda. Afr Heal Sci. 2007;7(3):148-54.
Mistry JB, Naqvi A, Chughtai M, Gwam C, Thomas M, Higuera CA, et al. Decreasing the Incidence of Surgical-Site Infections After Total Joint Arthroplasty. Am J Orthop Belle Mead NJ. 2017;46(6):E374-87.
Vargas-Alzate CA, Higuita-Gutiérrez LF, López-López L, Cienfuegos-Gallet AV, Jiménez Quiceno JN. High excess costs of infections caused by carbapenem-resistant Gram-negative bacilli in an endemic region. Int J Antimicrob Agents. 2018 Apr;51(4):601-7.
Andhoga J, Macharia AG, Maikuma IR, Wanyonyi ZS, Ayumba BR, Kakai R. Aerobic pathogenic bacteria in post-operative wounds at Moi Teaching and Referral Hospital. East Afr Med J. 2002 Dec;79(12):640-4.
Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis Off Publ Infect Dis Soc Am. 2009 Jan1;48(1):1-12.
Rumbo C, Gato E, López M, Ruiz de Alegría C, Fernández-Cuenca F, Martínez-Martínez L, et al. Contribution of efflux pumps, porins, and β-lactamases to multidrug resistance in clinical isolates of Acinetobacter baumannii. Antimicrob Agents Chemother. 2013 Nov;57(11):5247-57.
Kettani AE, Maaloum F, Diawara I, Katfy K, Harrar N, Zerouali K, et al. Prevalence of Acinetobacter baumannii bacteremia in intensive care units of Ibn Rochd University Hospital, Casablanca. Iran J Microbiol.2017;9(6):318-23.
Dramowski A, Cotton MF, Rabie H, Whitelaw A. Trends in paediatric bloodstream infections at a South African referral hospital. BMC Pediatr. 2015 Apr 2;15:33.
Reddy D, Morrow BM, Argent AC. Acinetobacter baumannii infections in a South African paediatric intensive care unit. J Trop Pediatr. 2015 Jun;61(3):182-7.
Osei Sekyere J. Current State of Resistance to Antibiotics of Last-Resort in South Africa: A Review from a Public Health Perspective. Front Public Health. 2016;4:209.
Swe Swe-Han K, Mlisana KP, Pillay M. Analysis of clinical and microbiological data on Acinetobacter baumannii strains assist the preauthorization of antibiotics at the patient level for an effective antibiotic stewardship program. J Infect Public Health. 2017 Oct;10(5):608-16.
Mengesha RE, Kasa BG-S, Saravanan M, Berhe DF, Wasihun AG. Aerobic bacteria in post-surgical wound infections and pattern of their antimicrobial susceptibility in Ayder Teaching and Referral Hospital, Mekelle, Ethiopia. BMC Res Notes. 2014 Aug 27;7:575.
Akinkunmi EO, Adesunkanmi AR, Lamikanra A. Pattern of pathogens from surgical wound infections in a Nigerian hospital and their antimicrobial susceptibility profiles. Afr Health Sci. 2014 Dec;14(4):802-9.
Mulu W, Kibru G, Beyene G, Damtie M. Postoperative Nosocomial Infections and Antimicrobial Resistance Pattern of Bacteria Isolates among Patients Admitted at Felege Hiwot Referral Hospital, Bahirdar, Ethiopia. Ethiop J Health Sci. 2012 Mar;22(1):7-18.
Amenu D, Belachew T, Araya F. Surgical site infection rate and risk factors among obstetric cases of jimma university specialized hospital, southwest ethiopia. Ethiop J Health Sci. 2011;21(2):91-100.
Dinda V, Gunturu R, Kariuki S, Hakeem A, Raja A, Kimang’a A. Pattern of pathogens and their sensitivity isolated from surgical site infections at the Aga Khan University Hospital, Nairobi, Kenya. Ethiop J Health Sci. 2013 Jul;23(2):141-9.
Manyahi J, Matee MI, Majigo M, Moyo S, Mshana SE, Lyamuya EF. Predominance of multi-drug resistant bacterial pathogens causing surgical site infections in Muhimbili National Hospital, Tanzania. BMC Res Notes. 2014 Aug 7;7:500.
Musicha P, Cornick JE, Bar-Zeev N, French N, Masesa C, Denis B, et al. Trends in antimicrobial resistance in bloodstream infection isolates at a large urban hospital in Malawi (1998-2016): a surveillance study. Lancet Infect Dis. 2017 Oct;17(10):1042-52.
Mahmood A. Bacteriology of surgical site infections and antibiotic susceptibility pattern of the isolates at a tertiary care hospital in Karachi. JPMA J Pak Med Assoc. 2000 Aug;50(8):256-9.
Hui DS, Ip M, Ling T, Chang S-C, Liao CH, Yoo C-G, et al. A multicentre surveillance study on the characteristics, bacterial aetiologies and in vitro antibiotic susceptibilities in patients with acute exacerbations of chronic bronchitis. Respirol Carlton Vic. 2011Apr;16(3):532-9.
Ghaith DM, Zafer MM, Al-Agamy MH, Alyamani EJ, Booq RY, Almoazzamy O. The emergence of a novel sequence type of MDR Acinetobacter baumannii from the intensive care unit of an Egyptian tertiary care hospital. Ann Clin Microbiol Antimicrob. 2017 May10;16(1):34.
Grochowalska A, Kozioł-Montewka M, Sobieszczańska A. Analysis of Acinetobacter baumannii resistance patterns in patients with chronic obstructive pulmonary disease (COPD) in terms of choice of effective empiric antibiotic therapy. Ann Agric Environ Med AAEM. 2017 Jun 12;24(2):307-11.
Chen CT, Wang YC, Kuo SC, Shih FH, Chen TL, How CK, et al. Community-acquired bloodstream infections caused by Acinetobacter baumannii: A matched case-control study. J Microbiol Immunol Infect Wei Mian Yu Gan Ran Za Zhi. 2018 Oct;51(5):629-35.
Villar M, Cano ME, Gato E, Garnacho-Montero J, Miguel Cisneros J, Ruíz de Alegría C, et al. Epidemiologic and clinical impact of Acinetobacter baumannii colonization and infection: a reappraisal. Medicine (Baltimore). 2014 Jul;93(5):202-10.
Güven T, Yilmaz G, Güner HR, Kaya Kalem A, Eser F, Taşyaran MA. Increasing resistance of nosocomial Acinetobacter baumannii: are we going to be defeated? Turk J Med Sci. 2014;44(1):73-8.