The challenge of antibiotic resistance in post-war Mosul, Iraq: an analysis of 20 months of microbiological samples from a tertiary orthopaedic care centre

Abstract

Iraq has suffered unrest and conflicts in the past decades, leaving behind a weakened healthcare system. In 2018, Médecins Sans Frontières (MSF) opened a tertiary orthopaedic care centre in Mosul providing reconstructive surgery with access to microbiological analysis. A retrospective cross-sectional analysis of microbiological and clinical data of patients admitted between April 2018 and December 2019. There were 174 patients who were included in this study; there were more males than females (135 to 38, respectively), and the mean age was 32.6 y. Of the 174 patients, the majority had more than one bacterial isolate detected (n=122, 70.1%); 141 (81.0%) had at least one multidrug-resistant (MDR) isolate detected during their hospital stay. Staphylococcus aureus (n=197, 48.2%) was the most common organism isolated. Overall, most isolates detected were MDR (n=352, 86%), mostly methicillin-resistant S. aureus (n=186, 52.8%) or extended-spectrum beta-lactamase-producing Enterobacterales (n=117, 33.2%). Among patients admitted to the operating department (n=111, 63.7%), 81.1% (n=90) were admitted for violent trauma injuries. Patients who had more than one procedure performed per surgery had significantly increased odds of having at least one MDR organism isolated (OR 8.66, CI 1.10-68.20, P=0.03). This study describes a high prevalence of antibiotic resistance in patients with trauma-related wounds in Mosul, Iraq. It highlights the importance of microbiological analysis and ongoing surveillance to provide optimal treatment. Additionally, it underscores the importance of infection prevention and control measures as well as antibiotic stewardship.