Molecular Characterization and Antimicrobial Susceptibility Profile of Bacterial Isolates From Patients with Surgical Site Infection in Ethiopia: A Multicentre Prospective Cross-Sectional Study
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Date
2024-06-19
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Addis Ababa University
Abstract
Background: Globally, surgical site infections (SSI) are the most reported healthcare associated infections. The most common pathogens associated with surgical wound infection are Gram-negative bacteria, and Staphylococcus aureus. Antibiotic resistance is increasing annually, and a major challenge in the management of SSI. Despite several reports on phenotypic examinations of bacterial isolates, there are few data on the molecular characterstics and antimicrobial resistance genes of bacteri isolated patients with SSI in Ethiopia.
Objective: The aim of this study was to isolate and determine the antimicrobial susceptibility pattern; genes associated with drug resistance and identify risk factors associated with surgical site infection in Ethiopia
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 (Addis Ababa) parts of Ethiopia. A total of 752 clinically suspected patients who developed surgical site infection were enrolled at each study sitein the study., and Sample for bacterial culture SSI discharge culture was collected from the infection site and inoculated on different culture media that supports the growth of Gram positive and Gram-negative bacteria performed and positive cultures were characterized by colony characteristics, Gram stain, and conventional biochemical tests. Species identification each bacterial isolate was confirmed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). An antimicrobial susceptibility test (AST) was done on Mueller-Hinton agar using the disk diffusion method. The phenotypic detection of MRSA was made using cefoxitin (30μg), Extended-spectrum beta-lactamases (ESBL) production was determined by combination disc-diffusion test (CDT) on MHA by using ceftazidime (30μg CAZ) and cefotaxime (30μg CTX) alone and with ceftazidime + clavulanic acid (20/10μg) CAZ/CLA) and cefotaxime + clavulanic acid (20/10μg CTX/CLA) and carbapenemase production was determined phenotypically by modified Hodge test (MHT) including impemene (10μg) test. The MRSA, ESBL and carbapenem resistance determinants were further studied determined by polymerase chain reaction (PCR) and Whole Genome Sequencing (WGS). Logistic regression analysis was used. A p-value < 0.05 was c Conclusion: ESBL and carbapenemase producing GNB as well as S. aureus were the main pathogens responsible for SSIs in the different hospitals in Ethiopia. The co-existence of different ESBL genes and carbapenamase genes in a single bacterial pathogen reflects dissimnation of MDR. There was also ahigh prevalence of mecA carriage among Coagulase negative staphylococci (CoNS). As a multicenter study this implies SSI is a major problem in hospitals in Ethiopia
Keywords: Molecular epidemiology; surgical site infections aetiologies; ESBL; Carbapenemase producing; Multidrug resistance; Risk factors; Ethiopia onsidered statistically significant. Data were analysed using STATA 16 software.
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Molecular epidemiology surgical site infections aetiologies ESBL Carbapenemase producing Multidrug resistance Risk factors Ethiopia