A case for routine microbial diagnostics: Results from antimicrobial susceptibility testing in post-traumatic wound infections at a Ugandan tertiary care hospital.

Autor:	Jung L; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Leipzig University Medical Center, Leipzig, Germany., Kiwanuka J; Department of Orthopedics/Trauma, Mulago National Referral Hospital, Kampala, Uganda., Mbabazi L; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda., Nakate V; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda., Musaazi J; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda., Nabajja H; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda., Kajumbula H; Department of Medical Microbiology, Makerere University, Kampala, Uganda., Lübbert C; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Leipzig University Medical Center, Leipzig, Germany., Mwaka E; Department of Orthopedics/Trauma, Mulago National Referral Hospital, Kampala, Uganda., Nsibirwa S; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda., von Braun A; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Leipzig University Medical Center, Leipzig, Germany.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2023 Aug 15; Vol. 3 (8), pp. e0001880. Date of Electronic Publication: 2023 Aug 15 (Print Publication: 2023).
DOI:	10.1371/journal.pgph.0001880
Abstrakt:	The global spread of antimicrobial resistance (AMR) poses an increasing challenge for clinicians in Uganda, where microbiological diagnostics are not routinely available or accessible. The aim of this study was to determine pathogen prevalence and antibiotic resistance patterns in patients with wound infections following trauma at a national referral hospital in Kampala, Uganda. In addition, the suitability of currently used empirical treatment options in this setting was evaluated. This prospective, observational study analysed antimicrobial prescriptions, culture results and antimicrobial sensitivity testing (AST) of wound swabs and blood samples from patients with clinical signs of wound infections on the trauma ward. A total of 124 patients (n = 99, 79.8% male) with a median age of 30 years (IQR 23-39) were enrolled between October 2021 and January 2022. Wound infections were classified as nosocomial in 69% of the cases. Pathogens were isolated from 122 wound swabs, yielding 238 bacterial isolates. The most prevalent pathogens were gram-negative bacteria including Escherichia coli (n = 48, 20.2%) and Acinetobacter spp. (n = 43, 18.1%). Empiric treatment consisted of ceftriaxone and gentamicin which was administered to 67.2% (n = 78) and 62.1% (n = 72) of patients, respectively. High rates of antimicrobial resistance could be demonstrated across gram-negative and gram-positive species towards the most common empiric antibiotics. Following the AST results, over 95% (n = 111) of patients required a change of treatment. Our findings demonstrate that current empiric treatment for wound infections is missing its target in hospitalized patients in Kampala. To address the growing problem of AMR in Uganda, there is a pressing need to enhance diagnostic capacity and implement structured antimicrobial stewardship programs. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2023 Jung et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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