Antimicrobial Resistance Surveillance of Skin and Soft Tissue Infections: Hospital-Wide Bacterial Species and Antibiograms to Inform Management at a Zonal Tertiary Hospital in Mwanza, Tanzania.
Baraka N Justine, Martha F Mushi, Vitus Silago, Zechariah Igembe, John Muyombe, Peter Peter Kishengena, Nyanda Shango Michael, Mathew Gabriel Maganga, Alicia Massenga, Francis Tegete, Fabian A Massaga, Jeremiah Seni
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Abstract
Purpose: The National Action Plan on antimicrobial resistance (NAP-AMR) in Tanzania is focused on blood stream infections and urinary tract infections despite skin and soft tissue infections (SSTIs) being common. This study assessed the proportion of laboratory-confirmed SSTIs, identify bacterial species involved, analyze AMR phenotypes, and investigate the risk factors associated with multidrug-resistant (MDR) SSTIs.
Patients and methods: Analytical cross-sectional study was conducted between January and June 2023, involving 614 patients with SSTIs. Patients' information was collected using standard AMR surveillance tools, and either pus swabs or pus aspirate or necrotic tissues were collected and analyzed using standard microbiological procedures, WHONET and STATA software programs.
Results: The median age (interquartile range) of patients was 34 (14-54) years with males accounting for 54.4%. Laboratory-confirmed SSTIs was 72.5% (445/614), yielding 586 bacterial isolates. The most frequent SSTIs types were surgical site infections (30.0%), chronic wounds (27.9%), and traumatic wounds (19.7%). The commonest pathogens were Staphylococcus aureus (17.1%), Escherichia coli (17.1%), and K. pneumoniae (16.0%). The AMR phenotypes identified were methicillin resistant Staphylococcus aureus, 29.0%; Extended-spectrum beta lactamase producing Gram-negative bacteria, 47.3%; and carbapenem resistant Gram-negative bacteria, 12.9%. The overall MDR SSTIs was 40.9% (251/614) and was significantly higher among inpatients compared to outpatients [OR (95% CI); p-value: 1.86 (1.33-2.59); p-value<0.001].
Conclusion: Approximately three-quarter of patients have laboratory-confirmed SSTIs caused predominantly by MDR pathogens. Revisiting SSTIs treatment guidelines at BMC and inclusion of SSTIs in the on-going AMR surveillance in Tanzania are recommended.
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ISSN: 1178-6973
Editor-in-Chief: Professor Suresh Antony
An international, peer-reviewed, open access journal that focuses on the optimal treatment of infection (bacterial, fungal and viral) and the development and institution of preventative strategies to minimize the development and spread of resistance.
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