Bacterial profile of surgical site infection and antimicrobial resistance patterns in Ethiopia: a multicentre prospective cross-sectional study
Tóm tắt
Globally, surgical site infections (SSI) are the most commonly reported healthcare-associated infections. 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 (Tikur Anbessa) parts of Ethiopia. A total of 752 patients clinically studied for surgical site infection were enrolled. The number of patients from Debre Tabor, Hawassa, Jimma, and Tikur Anbessa, hospitals was 172, 184, 193, and 203, respectively. At each study site, SSI discharge culture was performed from all patients, and positive cultures were characterized by colony characteristics, Gram stain, and conventional biochemical tests. Each bacterial species was confirmed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI TOF). An antimicrobial susceptibility test (AST) was done on Mueller–Hinton agar using the disk diffusion method. Logistic regression analysis was used to assess associations of dependent and independent variables. A p-value < 0.05 was considered statistically significant. Data were analysed using STATA 16 software. Among 752 wound discharge cultures performed, 65.5% yielded growth. Among these, 57.9% and 42.1% were Gram-negative and Gram-positive isolates, respectively. In this study, a total of 494 bacteria were isolated; Staphylococcus aureus (31%), Escherichia coli (20.7%), and Klebsiella pneumoniae (9.8%) were the most common. Rare isolates (0.8% each) included Raoultella ornithinolytica, Stenotrophomonas maltophilia, Alcalignes faecalis, Pantoea ecurina, Bacillus flexus, and Paenibacillus tylopili. Enterobacteriaceae showed high levels of resistance to most of the tested antibiotics but lower levels of ertapenem (32.9%), amikacin (24.3%), imipenem (20.3%), and meropenem (17.6%) resistance. Multidrug-resistant (MDR) frequency of Enterobacteriaceae at Debre Tabor, Hawassa, Jimma, and Tikur Anbessa hospitals was 84.5%, 96.5%, 97.3%, and 94%, respectively. Ages ≥ 61 years (AOR = 2.83, 95% CI: 1.02–7.99; P 0.046), prolonged duration of hospital stay (AOR = 4.15, 95% CI: 2.87–6.01; P 0.000), history of previous antibiotics use (AOR = 2.83, 95% CI: 1.06–2.80; P 0.028), history of smoking (AOR = 2.35, 95% CI: 1.44–3.83; P 0.001), emergency surgery (AOR = 2.65, 95% CI: 1.92–3.66; P 0.000), and duration of operation (AOR = 0.27, 95% CI: 0.181–0.392; P 0.000) were significant risk factors. The most prevalent isolates from Gram-positive and Gram-negative bacteria across all hospitals were S. aureus and E. coli, respectively. Many newly emerging Gram-negative and Gram-positive bacteria were identified. Variation between hospitals was found for both SSI etiology type and MDR frequencies. Hence, to prevent the emergence and spread of MDR bacteria, standard bacteriological tests and their AST are indispensable for effective antimicrobial stewardship.
Tài liệu tham khảo
Forrester JD, Maggio PM, Tennakoon L. Cost of health care-associated infections in the United States. J Patient Saf. 2022;18(2):e477–9.
Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784–91.
Borchardt RA, Tzizik D. Update on surgical site infections: the new CDC guidelines. Jaapa. 2018;31(4):52–4.
Lewis SS, Moehring RW, Chen LF, Sexton DJ, Anderson DJ. Assessing the relative burden of hospital-acquired infections in a network of community hospitals. Infect Control Hosp Epidemiol. 2013;34(11):1229–30.
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;7(1):575.
Raza MS, Chander A, Ranabhat A. Antimicrobial susceptibility patterns of the bacterial isolates in post-operative wound infections in a tertiary care hospital, Kathmandu, Nepal. Open J Med Microbiol. 2013;3(3):159.
Godebo G, Kibru G, Tassew H. Multidrug-resistant bacterial isolates in infected wounds at Jimma University Specialized Hospital, Ethiopia. Ann Clin Microbiol Antimicrob. 2013;12:17.
Halawi E, Assefa T, Hussen S. Pattern of antibiotics use, incidence and predictors of surgical site infections in a Tertiary Care Teaching Hospital. BMC Res Notes. 2018;11(1):538.
Misha G, Chelkeba L, Melaku T. Bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Ethiopia: a prospective cohort study. Ann Clin Microbiol Antimicrob. 2021;20(1):33.
Spagnolo A, Ottria G, Amicizia D, Perdelli F, Cristina ML. Operating theatre quality and prevention of surgical site infections. J Prev Med Hyg. 2013;54(3):131.
National Institute for Health and Care Excellence: Clinical Guidelines. Surgical site infections: prevention and treatment. London: National Institute for Health and Care Excellence (NICE). Copyright © NICE 2020. 2020.
Moradali MF, Ghods S, Rehm BHA. Pseudomonas aeruginosa lifestyle: a paradigm for adaptation, survival, and persistence. Front Cell Infect Microbiol. 2017;7:39.
Isibor JO, Oseni A, Eyaufe A, Turay A. Incidence of aerobic bacteria and Candida albicans in post-operative wound infections. Afr J Microbiol Res. 2008;2(11):288–91.
Organization WH. Global guidelines for the prevention of surgical site infection. Geneva: WHO; 2016.
Biadglegne F, Abera B, Alem A, Anagaw B. Bacterial isolates from wound infection and their antimicrobial susceptibility pattern in Felege Hiwot referral Hospital North West Ethiopia. Ethiop J Health Sci. 2009;19(3).
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;22(1):7–18.
Munckhof W. Antibiotics for surgical prophylaxis. Aust Prescr. 2005;28(2).
Ranjan KP, Ranjan N, Bansal SK, Arora D. Prevalence of Pseudomonas aeruginosa in post-operative wound infection in a referral hospital in Haryana, India. J Lab Phys. 2011;2(2):129–32.
Li B, Webster TJ. Bacteria antibiotic resistance: new challenges and opportunities for implant-associated orthopedic infections. J Orthop Res. 2018;36(1):22–32.
Fadeyi A, Adigun I, Rahman G. Bacteriological pattern of wound swab isolates in patients with chronic leg ulcer. Int J Health Res. 2008. https://doi.org/10.4314/ijhr.v1i4.55375.
Iskandar K, Sartelli M, Tabbal M, Ansaloni L, Baiocchi GL, Catena F, et al. Highlighting the gaps in quantifying the economic burden of surgical site infections associated with antimicrobial-resistant bacteria. World J Emerg Surg. 2019;14(1):50.
Abayneh M, Asnake M, Muleta D, Simieneh A. Assessment of bacterial profiles and antimicrobial susceptibility pattern of isolates among patients diagnosed with surgical site infections at Mizan-Tepi University Teaching Hospital, Southwest Ethiopia: a prospective observational cohort study. Infect Drug Resist. 2022;15:1807–19.
Bitew Kifilie A, Dagnew M, Tegenie B, Yeshitela B, Howe R, Abate E. Bacterial profile, antibacterial resistance pattern, and associated factors from women attending postnatal health service at University of Gondar Teaching Hospital, Northwest Ethiopia. Int J Microbiol. 2018;2018:3165391.
Birhanu Y, Endalamaw A. Surgical site infection and pathogens in Ethiopia: a systematic review and meta-analysis. Patient Saf Surg. 2020;14:7.
Mengesha RE, Kasa BG, 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;7:575.
Garner JS. Hospital Infection Control Practice Advisory Committee. Guideline for isolation precaution in hospitals. Infection control and hospital epidemiology. Infect Control Hosp Epidemiol. 1996;17:53–80.
Cheesbrough M. District laboratory practice in tropical countries part II. 2nd ed. New York: Cambridge University Press; 2006. p. 45–58.
Clinical Laboratory Standard Institute. Performance standards for antimicrobial susceptibility testing; 30th ed. CLSI document M100. CLSI. 2021;M100.
Awoke N, Arba A, Girma A. Magnitude of surgical site infection and its associated factors among patients who underwent a surgical procedure at Wolaita Sodo University Teaching and Referral Hospital, South Ethiopia. PLoS ONE. 2019;14(12): e0226140.
Narula H, Chikara G, Gupta P. A prospective study on bacteriological profile and antibiogram of postoperative wound infections in a tertiary care hospital in Western Rajasthan. J Fam Med Prim Care. 2020;9(4):1927–34.
Ayala D, Tolossa T, Markos J, Yilma MT. Magnitude and factors associated with surgical site infection among mothers underwent cesarean delivery in Nekemte town public hospitals, western Ethiopia. PLoS ONE. 2021;16(4): e0250736.
Lubega A, Joel B, Justina LN. Incidence and etiology of surgical site infections among emergency postoperative patients in Mbarara regional referral hospital, South Western Uganda. Surg Res Pract. 2017. https://doi.org/10.1155/2017/6365172.
Shiferaw WS, Aynalem YA, Akalu TY, Petrucka PM. Surgical site infection and its associated factors in Ethiopia: a systematic review and meta-analysis. BMC Surg. 2020;20(1):1–15.
Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect. 2017;96(1):1–15.
Misha G, Chelkeba L, Melaku T. Incidence, risk factors and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia: prospective cohort study. Ann Med Surg (Lond). 2021;65: 102247.
Costa T, Medeiros P, Salles M. Smoking increases the risk of surgical site infection after hydrocelectomy in adults: a retrospective cohort study in Brazil. J Infect Dev Ctries. 2018;11:950.
Jiang C, Chen Q, Xie M. Smoking increases the risk of infectious diseases: a narrative review. Tob Induc Dis. 2020;18:60.
Vasundhara Devi P, Sreenivasulu Reddy P, Shabnum M. Microbial profile and antibiotic susceptibility pattern of orthopedic infections in a tertiary care hospital: a study from South India. Int J Med Sci Public Health. 2017;6(5):838–41.
Asres GS, Legese MH, Woldearegay GM. Prevalence of multidrug resistant bacteria in postoperative wound infections at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. Arch Med. 2017;9 (4):0.
Asres GS, Legese MH, Woldearegay GM. Prevalence of multidrug resistant Bacteria in postoperative wound infections at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. Archives of Medicine. 2017;9(4).
Mohammed A, Adeshina GO, Ibrahim YK. Incidence and antibiotic susceptibility pattern of bacterial isolates from wound infections in a tertiary hospital in Nigeria. Trop J Pharm Res. 2013;12(4):617–21.
Khanam RA, Islam MR, Sharif A, Parveen R, Sharmin I, Yusuf MA. Bacteriological profiles of pus with antimicrobial sensitivity pattern at a teaching hospital in Dhaka City. Bangladesh J. 2018. https://doi.org/10.3329/bjid.v5i1.37710.
Dessie W, Mulugeta G, Fentaw S, Mihret A, Hassen M, Abebe E. Pattern of bacterial pathogens and their susceptibility isolated from surgical site infections at selected referral hospitals, Addis Ababa, Ethiopia. Int J Microbiol. 2016. https://doi.org/10.1155/2016/2418902.
Bitew Kifilie A, Dagnew M, Tegenie B, Yeshitela B, Howe R, Abate E. Bacterial profile, antibacterial resistance pattern, and associated factors from women attending postnatal health service at University of Gondar Teaching Hospital, Northwest Ethiopia. Int J Microbiol. 2018. https://doi.org/10.1155/2018/3165391.
Kalayu AA, Diriba K, Girma C, Abdella E. Incidence and bacterial etiologies of surgical site infections in a Public Hospital, Addis Ababa, Ethiopia. Open Microbiol J. 2019. https://doi.org/10.2174/1874285801913010301.
Szaniawski MA, Spivak AM. Recurrent Paenibacillus infection. Oxf Med Case Rep. 2019;2019(5):omz034.
Tena D, Fernández C, Lago MR. Alcaligenes faecalis: an unusual cause of skin and soft tissue infection. Jpn J Infect Dis. 2015;68(2):128–30.
Patterson SB, Mende K, Li P, Lu D, Carson ML, Murray CK, et al. Stenotrophomonas maltophilia infections: clinical characteristics in a military trauma population. Diagn Microbiol Infect Dis. 2020;96(2): 114953.
de With K, Allerberger F, Amann S, Apfalter P, Brodt HR, Eckmanns T, et al. Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases. Infection. 2016;44(3):395–439.
Ali KM, Al-Jaff BM. Source and antibiotic susceptibility of Gram-negative bacteria causing superficial incisional surgical site infections. Int J Surg Open. 2021;30:100318.
Mora-Guzmán I, Rubio-Perez I, Maqueda González R, Domingo Garcia D, Martín-Pérez E. Surgical site infection by carbapenemase-producing Enterobacteriaceae. A challenge for today's surgeons. Cir Esp (Engl Ed). 2020;98(6):342–9.
Ma F, Xu S, Tang Z, Li Z, Zhang L. Use of antimicrobials in food animals and impact of transmission of antimicrobial resistance on humans. Biosaf Health. 2021;3(1):32–8.