Abstract
Three years after a prospective study on wound infections in a rural hospital in Ghana revealed no emergence of carbapenem-resistant bacteria we initiated a new study to assess the prevalence of multidrug-resistant pathogens. Three hundred and one samples of patients with wound infections were analysed for the presence of resistant bacteria in the period August 2017 till March 2018. Carbapenem-resistant Acinetobacter (A.) baumannii were further characterized by resistance gene sequencing, PCR-based bacterial strain typing, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST “Oxford scheme”). A. baumanni was detected in wound infections of 45 patients (15%); 22 isolates were carbapenem-resistant. Carbapenemases NDM-1 and/or OXA-23 were detected in all isolates; two isolates harboured additionally OXA-420. PFGE and MLST analyses confirmed the presence of one A. baumannii strain in 17 patients that was assigned to the worldwide spread sequence type ST231 and carried NDM-1 and OXA-23. Furthermore, two new A. baumannii STs (ST2145 and ST2146) were detected in two and three patients, respectively. Within three years the prevalence of carbapenem-resistant A. baumannii increased dramatically in the hospital. The early detection of multidrug-resistant bacteria and prevention of their further spread are only possible if continuous surveillance and molecular typing will be implemented.
Highlights
Antibiotics are essential medicines whose use in human or veterinary medicine, no matter how prudent, is inevitably associated with accelerated development of antimicrobial resistance (AMR). β-lactams are still considered the most successful antibiotic classes
Wound infection (WI), chronic wound infection (CWI), and surgical site infection (SSI) was diagnosed in 144 (48%), 70 (23%), and 74 (25%) patients, respectively
A. baumannii was isolated in wound swabs of 45 patients
Summary
Antibiotics are essential medicines whose use in human or veterinary medicine, no matter how prudent, is inevitably associated with accelerated development of antimicrobial resistance (AMR). β-lactams are still considered the most successful antibiotic classes. Β-lactams are still considered the most successful antibiotic classes. With a proportion of almost two thirds of all antibiotic prescriptions they are even the most widely used antibacterial agents against infectious diseases [1]. The carbapenems have the broadest spectrum of activity against various bacteria and are widely regarded as the class of last resort for treatment of infections with multidrug-resistant pathogens [2]. Resistance to carbapenems has increased dramatically worldwide [3]. One reason for this resistance is the production of different carbapenem-hydrolyzing enzymes, the carbapenemases. In the last 20 years, the number of newly detected carbapenemases has increased continuously. The most prevalent carbapenemases in Enterobacterales are OXA-48, KPC, VIM and NDM; in Pseudomonas (P.) aeruginosa VIM and IMP have been frequently
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