Ceftriaxone- and ceftazidime-resistant Klebsiella species, Escherichia coli, and methicillin-resistant Staphylococcus aureus dominate caesarean surgical site infections at Mulago Hospital, Kampala, Uganda.

Yvonne N Wekesa,Fatuma Namusoke,Musa Sekikubo,Freddie Bwanga,Dennis Wandera Mango

doi:10.1177/2050312120970719

Yvonne N Wekesa, Fatuma Namusoke + Show 3 more

Open Access

https://doi.org/10.1177/2050312120970719

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Abstract

Objectives:The aim of this study was to determine the proportion and mechanism of resistance to ceftriaxone and ceftazidime among Klebsiella species and Escherichia coli and examine the burden of methicillin-resistant Staphylococcus aureus from caesarean section surgical site infections in Uganda.Methods:Wound swabs from 109 caesarean section surgical site infections were cultured for pathogenic bacteria following standard microbiological procedures. The Kirby–Bauer disc diffusion technique was used for antimicrobial susceptibility testing. Methicillin-resistant S. aureus diagnosis was based on polymerase chain reaction testing for the mecA gene. Data were analysed using SPSS-IBM Statistics v.20.Results:A total of 118 pathogens were recovered from 93 (85%) of 109 surgical site infections swabs. Of the 118 pathogens, gram-negative bacteria were 69 (58.5%), including 44 (37.3%) Klebsiella species, 11 (9.3%) E. coli, 6 (5.1%) Citrobacter species, and 8 (6.8%) other gram-negative bacteria. In total, 49 of the 118 pathogens were gram-positive bacteria, including 34 (28.8%) S. aureus and 15 (12.7%) Enterococci species. Resistance to ceftriaxone was detected in all 11 (100%) of the E. coli and in 43 (97.7%) of the 44 Klebsiella species and to ceftazidime in all 11 (100%) of the E. coli and 40 (91%) of the 44 Klebsiella species. Extended-spectrum beta-lactamase explained resistance to ceftazidime in 10 (91%) of the 11 E. coli and 19 (48%) of the 40 Klebsiella species. Carbapenemase production explained 15 (38%) of the 40 ceftazidime-resistant Klebsiella species. Methicillin-resistant S. aureus was detected in 91% of S. aureus.Conclusion:Klebsiella species, E. coli, and S. aureus–majority methicillin-resistant S. aureus dominated the pathogens in caesarean section surgical site infections. Almost all of the E. coli and Klebsiella species were resistant to ceftriaxone or ceftazidime. Extended-spectrum beta-lactamase was the underlying resistance mechanism among almost all of the ceftriaxone- or ceftazidime-resistant E. coli. However, this mechanism accounted for less than half of ceftriaxone- or ceftazidime-resistant Klebsiella species, where carbapenemases accounted for 40% of the resistance, a finding previously unreported in Uganda.

Highlights

Our findings show that gram-negative bacteria (GNB) were the most common pathogenic bacteria in post-caesarean section (C/S) Surgical site infections (SSIs), causing 6 out of every 10 post-C/S SSIs with K. pneumoniae and E. coli being most prevalent
Klebsiella species, E. coli and S. aureus–majority methicillin-resistant Staphylococcus aureus (MRSA), dominated the pathogens involved in causation of C/S SSIs at the Mulago National Referral Hospital in Kampala, Uganda
extended-spectrum beta-lactamase (ESBL) was the underlying resistance mechanism among almost all the ceftriaxone- or ceftazidime-resistant E. coli, but this mechanism related to less than half of ceftriaxone- or ceftazidime-resistant Klebsiella species, where carbapenemase production caused closer to 40% of the resistance, a worrying finding previously unreported in Uganda

Summary

Introduction

Procedures performed globally.[1] Surgical site infections (SSIs), defined by not merely the presence of cultured microorganisms and clinical signs of infection within 30 days after the C/S, are some of the commonest complications of C/S procedures worldwide.[2] The worldwide incidence of SSI ranges from 0.5% to 26%.3–6. This wide variation in incidence of SSIs is reportedly due to varying infection control practices in the different global health facility settings. If the infection is caused by drugresistant pathogens, treatment with readily available antimicrobials may fail to eliminate the infection, potentially progressing to sepsis, a cause of maternal death in 10.7% and 30.9% of patients globally and in Uganda, respectively.[7,8]

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