Ceftriaxone- and ceftazidime-resistant species, , and methicillin-resistant dominate caesarean surgical site infections at Mulago Hospital, Kampala, Uganda.

OBJECTIVES

The aim of this study was to determine the proportion and mechanism of resistance to ceftriaxone and ceftazidime among species and and examine the burden of methicillin-resistant from caesarean section surgical site infections in Uganda.

METHODS

Wound swabs from 109 caesarean section surgical site infections were cultured for pathogenic bacteria following standard microbiological procedures. The Kirby-Bauer disc diffusion technique was used for antimicrobial susceptibility testing. Methicillin-resistant diagnosis was based on polymerase chain reaction testing for the gene. Data were analysed using SPSS-IBM Statistics v.20.

RESULTS

A total of 118 pathogens were recovered from 93 (85%) of 109 surgical site infections swabs. Of the 118 pathogens, gram-negative bacteria were 69 (58.5%), including 44 (37.3%) species, 11 (9.3%) , 6 (5.1%) species, and 8 (6.8%) other gram-negative bacteria. In total, 49 of the 118 pathogens were gram-positive bacteria, including 34 (28.8%) and 15 (12.7%) species. Resistance to ceftriaxone was detected in all 11 (100%) of the and in 43 (97.7%) of the 44 species and to ceftazidime in all 11 (100%) of the and 40 (91%) of the 44 species. Extended-spectrum beta-lactamase explained resistance to ceftazidime in 10 (91%) of the 11 and 19 (48%) of the 40 species. Carbapenemase production explained 15 (38%) of the 40 ceftazidime-resistant species. Methicillin-resistant was detected in 91% of .

CONCLUSION

species, , and -majority methicillin-resistant dominated the pathogens in caesarean section surgical site infections. Almost all of the and species were resistant to ceftriaxone or ceftazidime. Extended-spectrum beta-lactamase was the underlying resistance mechanism among almost all of the ceftriaxone- or ceftazidime-resistant However, this mechanism accounted for less than half of ceftriaxone- or ceftazidime-resistant species, where carbapenemases accounted for 40% of the resistance, a finding previously unreported in Uganda.