Wounds, Antimicrobial Resistance and Challenges of Implementing a Surveillance System in Myanmar: A Mixed-Methods Study.

Win-Pa Sandar,Ajay M V Kumar,Bienvenu Salim Camara,Myint-Myint Sein,Saw Saw

doi:10.3390/tropicalmed6020080

Abstract

Wound infections with drug-resistant bacteria lead to higher mortality and morbidity and increased healthcare costs. We aimed to describe the spectrum of bacterial pathogens, isolated from wound cultures in Yangon General Hospital in 2018, and their antimicrobial resistance (AMR) patterns and to understand the challenges in implementing an AMR surveillance system in Myanmar. We conducted a concurrent mixed-methods study involving analysis of surveillance data and in-depth interviews with nine key personnel involved in AMR surveillance. Of 1418 wound specimens processed, 822 (58%) were culture-positive. The most common Gram-positive bacteria were coagulase-negative staphylococci (23.3%) and Staphylococcus aureus (15.1%). Among Gram-negative bacteria, Escherichia coli (12.5%) and Pseudomonas aeruginosa (10.1%) were common. Staphylococcus aureus isolates were resistant to penicillin (98%), oxacillin (70%) and tetracycline (66%). Escherichia coli showed resistance to ampicillin (98%). Lack of dedicated and trained staff (microbiologist, technician, data entry operator), lack of computers at sentinel sites and non-uniform and non-standardized data capture formats were the major challenges in implementing AMR surveillance. These challenges need to be addressed urgently. We also recommend periodic analysis and sharing of antibiograms at every hospital to inform the treatment regimens used in wound management.

Highlights

Antimicrobial resistance (AMR) has become a growing threat to human life globally, especially in developing countries [1]
One of the most frequent indications for antimicrobial treatment is wound infection, which is very common in settings with poor infection prevention and control (IPC) measures [5,6]
Other studies conducted in Nigeria and Tanzania reported that bacterial growth was observed in the majority of wound swabs (91.4% and 83.1%) [21,22]

Summary

Introduction

Antimicrobial resistance (AMR) has become a growing threat to human life globally, especially in developing countries [1]. In the United States, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35,000 people die as a result [3]. One of the most frequent indications for antimicrobial treatment is wound infection, which is very common in settings with poor infection prevention and control (IPC) measures [5,6]. The burden of antibiotic-resistant infections across different wound types and care settings has been increasing in these settings [7]. The predominant bacterial isolates from the infected wounds include Staphylococcus aureus, Escherichia coli, Proteus species, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii [8,9,10,11]

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Discussion

Conclusion