Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar 6;2(Suppl 4):e000475.
doi: 10.1136/bmjgh-2017-000475. eCollection 2017.

Epidemiology of antibiotic-resistant wound infections from six countries in Africa

Peggy S Lai  1   2   3 , Lisa M Bebell  4   5 , Carron Meney  3 , Linda Valeri  2 , Michelle C White  3
Affiliations

Epidemiology of antibiotic-resistant wound infections from six countries in Africa

Peggy S Lai et al. BMJ Glob Health. .

Abstract

Introduction: Little is known about the antimicrobial susceptibility of common bacteria responsible for wound infections from many countries in sub-Saharan Africa.

Methods: We performed a retrospective review of microbial isolates collected based on clinical suspicion of wound infection between 2004 and 2016 from Mercy Ships, a non-governmental organisation operating a single mobile surgical unit in Benin, Congo, Liberia, Madagascar, Sierra Leone and Togo. Antimicrobial resistant organisms of interest were defined as methicillin-resistant Staphylococcus aureus (MRSA) or Enterobacteriaceae resistant to third-generation cephalosporins. Generalised mixed-effects models accounting for repeated isolates in a patient, potential clustering by case mix for each field service, age, gender and country were used to test the hypothesis that rates of antimicrobial resistance differed between countries.

Results: 3145 isolates from repeated field services in six countries were reviewed. In univariate analyses, the highest proportion of MRSA was found in Benin (34.6%) and Congo (31.9%), while the lowest proportion was found in Togo (14.3%) and Madagascar (14.5%); country remained a significant predictor in multivariate analyses (P=0.002). In univariate analyses, the highest proportion of third-generation cephalosporin-resistant Enterobacteriaceae was found in Benin (35.8%) and lowest in Togo (14.3%) and Madagascar (16.3%). Country remained a significant predictor for antimicrobial-resistant isolates in multivariate analyses (P=0.009).

Conclusion: A significant proportion of isolates from wound cultures were resistant to first-line antimicrobials in each country. Though antimicrobial resistance isolates were not verified in a reference laboratory and these data may not be representative of all regions of the countries studied, differences in the proportion of antimicrobial-resistant isolates and resistance profiles between countries suggest site-specific surveillance should be a priority and local antimicrobial resistance profiles should be used to guide empiric antibiotic selection.

Keywords: diseases; disorders; epidemiology; hospital-based study; infections; injuries.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

References

    1. Laxminarayan R, Matsoso P, Pant S, et al. . Access to effective antimicrobials: a worldwide challenge. Lancet 2016;387:168–75. 10.1016/S0140-6736(15)00474-2 - DOI - PubMed
    1. O’Neill J. Tackling drug-resistant infections globally: final report and recommendations: review on antimicrobial Resistance, 2016.
    1. Murray CJ, Vos T, Lozano R, et al. . Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2197–223. 10.1016/S0140-6736(12)61689-4 - DOI - PubMed
    1. World Health Organization (WHO). Antimicrobial resistance: global report on surveillance. Geneva, Switzerland, 2014.
    1. Petti CA, Polage CR, Quinn TC, et al. . Laboratory medicine in Africa: a barrier to effective health care. Clin Infect Dis 2006;42:377–82. 10.1086/499363 - DOI - PubMed

LinkOut - more resources