Antibiotic susceptibility patterns at the Médecins Sans Frontières (MSF) Acute Trauma Hospital in Aden, Yemen: a retrospective study from January 2018 to June 2021

Abstract

Background: Antimicrobial resistance (AMR) is an urgent global health concern, especially in countries facing instability or conflicts, with compromised healthcare systems. Médecins Sans Frontières (MSF) established an acute trauma hospital in Aden, Yemen, treating mainly war-wounded civilians, and implemented an antimicrobial stewardship (AMS) programme. This study aimed to describe clinical characteristics and identify antibiotic susceptibility patterns representative of patients treated with antibiotics.

Methods: Retrospective cross-sectional study using routinely collected data from all patients treated with antibiotics in the MSF-Aden Acute Trauma hospital between January 2018 and June 2021. Routine clinical data from patients' files was entered into an AMS electronic database and microbiological data were entered into WHONET. Both databases were imported and merged in REDCap and analysed using RStudio.

Results: Three hundred and sixty-three of 481 (75%) included patients were injured by violence-related trauma. Most were men aged 19-45 years (n = 331; 68.8%). In total, 598 infections were diagnosed and treated. MDR organisms were identified in 362 (60.5%) infections in 311 (65%) patients. Skin and soft-tissue infections (SSTIs) (n = 143; 24%) were the most common, followed by osteomyelitis (n = 125; 21%) and intra-abdominal-infections (IAIs) (n = 116; 19%), and 111 (19%) secondary bloodstream infections were identified. Escherichia coli was the most frequently identified pathogen, causing IAI (n = 87; 28%) and SSTI (n = 43; 16%), while Staphylococcus aureus caused mainly osteomyelitis (n = 84; 19%). Most Gram-negatives were ESBL producers, including E. coli (n = 193; 81.4%), Klebsiella pneumoniae (n = 72; 77.4%) and Enterobacter cloacae (n = 39; 50%) while most S. aureus were methicillin resistant (n = 93; 72.6%).

Conclusions: High rates of MDR were found. This information will facilitate a comprehensive review of the empirical antibiotic treatment guidelines.

Figure 1.

Frequency of 598 infections by diagnosis and MDR status at the MSF Aden Acute Trauma Hospital, Yemen, January 2018—June 2021.

Figure 2.

Incidence of 111 BSIs by infection diagnosis at the MSF Aden Acute Trauma Hospital, Yemen, January 2018—June 2021.

Figure 3.

Frequency of the types of the 129 infections diagnosed within 48 h of admission by MDR status at the MSF Aden Acute Trauma Hospital, Yemen, January 2018—June 2021.

Figure 4.

Distribution of the 598 infections diagnosed according to time of diagnosis and MDR status at the MSF Aden Acute Trauma Hospital, Yemen, January 2018—June 2021.