Carbapenem resistance among gram negative rods isolated from surgical site infections at Mulago and Kawempe National referral hospitals

Abstract

Background: Surgical site infections are becoming increasingly difficult to manage with the rise of drug resistance among causative bacteria. Contributing to this, the use of foreign implants in certain surgeries pauses an even higher risk of infection with these organisms. Carbapenems are normally effective against infections caused by drug resistant Gram-negative rods although, their use is now gravely threatened by the emergence of carbapenemase-producing strains. The epidemiology of carbapenem resistance has not been adequately explored in resource poor countries like Uganda and even less so in the hospital settings targeting Surgical Site Infections (SSIs). Objectives: The purpose of this study was to investigate the prevalence, antibiotic susceptibility profile and associated factors related to carbapenem resistant Gram-negative rods in surgical site infections of patients admitted on the surgical wards of Mulago and Kawempe National Referral Hospitals. Methods: A cross-sectional study was conducted at Mulago and Kawempe National Referral Hospitals. Wound swabs were processed for all bacterial pathogens using a standard protocol and gram-negative rods screened for susceptibility to carbapenems. Carbapenemase production was also screened using the modified carbapenem inactivation method. Clinical and demographic data was collected to determine the possible associated factors. Results:139 participants with SSIs were enrolled in the study. The median age of the participants was 31 years, IQR (38-25). A total of 152 Gram negative rods were isolated with Escherichia coli (28.9%) the most prevalent followed by Klebsiella pneumoniae (25.7%) and Acinetobacter species (15.8%). The isolates were more susceptible to Meropenem and Amikacin; and least susceptible to beta-lactam drugs and sulphonamides. The prevalence of Carbapenem resistance was 6.4%, (95% CI, 3.4-12.1). Drain insertion was 19.6 AOR (4.14-92.64) times more likely associated with carbapenem resistance while surgical antibiotic prophylaxis 0.31 (0.04-2.29) ORS and post-operative antibiotic given 4.96 (0.45-54.39) ORS were also significantly associated with carbapenem resistance. Conclusion: This study concludes that carbapenem resistance is still relatively low among pathogens of surgical site infections at Mulago and Kawempe National Referral Hospitals. Recommendation: The study recommends that drain insertion should be monitored with regular microbiological sampling to assess colonization of drain tubes with drug resistant organisms.