Antimicrobial resistance patterns of WHO priority pathogens at general hospital in Southern Ethiopia during the COVID-19 pandemic, with particular reference to ESKAPE-group isolates of surgical site infections.

Abstract

Background: Antimicrobial resistance represents a significant public health challenge, resulting in an estimated 4.95 million deaths annually. In response to the global escalation of antimicrobial resistance in prevalent hospital-acquired infections such as surgical site infections (SSIs), the World Health Organization (WHO) has identified critical and priority pathogens necessitating research and development. Nevertheless, there remains a paucity of data from numerous developing nations. Therefore this study was conducted to evaluate the prevalence of SSIs, examine the microbial profile, and identify factors associated with SSIs, with a particular emphasis on WHO-priority pathogens during the COVID-19 pandemic at a general hospital in southern Ethiopia.

Methods: A cross-sectional study was conducted on 207 adult patients clinically suspected of SSIs from September 1, 2019, to November 2022. Demographic data, clinical characteristics, and surgery-related variables were collected using pre-tested, structured, interviewer-administered questionnaires and patient chart reviews. Wound samples (swabs and/or pus) were collected aseptically from each participant following standard microbiological procedures and processed for isolation and identification of pathogens by conventional culture and biochemical testing. Bacterial isolates subjected to antimicrobial susceptibility testing, including the detection of extended-spectrum beta-lactamase (ESBL) and methicillin-resistant Staphylococcus aureus (MRSA), by the standard Kirby-Bauer disk diffusion method in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed by Statistical Packages for Social Science (SPSS) version 25, and bivariable and multivariable logistic regression was done to determine the associations between dependent and independent variables. Adjusted odds ratio with 95% confidence interval (CI) was reported, and P-value < 5% was considered statistically significant.

Results: The overall prevalence of culture-confirmed SSIs among adult patients who underwent major surgery was 76.8% (95% CI: 71.0, 82.6). Among the 178 pathogens recovered, 58.5% were Gram-negative, 40.4% were Gram-positive, and 1.1% were Candida spp. The ESKAPE pathogens comprised 65.3% of the isolates, with S. aureus being the most common species, accounting for 43.5%, followed by K. pneumoniae (33.9%). Multidrug resistance (MDR) was observed in 84.37% of ESKAPE pathogens, with ESBL-producing and MRSA-producing isolates accounting for 88% and 76.5%, respectively. A. baumannii showed the highest MDR rate at 100%, followed by MRSA (90%) and K. pneumoniae (88.23%). Amikacin, meropenem, and piperacillin-tazobactam were effective agents against Gram-negatives, while linezolid, clindamycin, and gentamicin were most effective against Gram-positive bacteria. SSIs was significantly associated with emergency surgery (P < 0.001), prolonged surgery waiting time (P = 0.004), and clean-contaminated surgery (P = 0.008).

Conclusion: The high prevalence of MDR-ESKAPE pathogens is concerning, highlighting the need for improved infection prevention practices and antimicrobial stewardship programs.