Lwigale Fahad, Kibombo Daniel, Kasango Simon Dembe, Tabajjwa Dickson, Atuheire Collins, Kungu Joseph, Kalule John Bosco, Otita Morgan, Kakooza Francis, Nabukenya Immaculate, Mayito Jonathan, Rwego Innocent B
Global Health Security Program, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.
PLOS Glob Public Health. 2024 Aug 2;4(8):e0003582. doi: 10.1371/journal.pgph.0003582. eCollection 2024.
Skin and soft-tissue infections (SSTI) are common cases of hospital-acquired infections with aetiological agents exhibiting antimicrobial resistance (AMR). This is a global public health predicament responsible for a high burden of infectious diseases and threatens the achievement of Sustainable Development Goals (SDGs), especially in Low- and Middle-Income countries (LMICs). This study determined the prevalence of SSTI, proportion of laboratory-investigated cases, AMR-profiles, and factors associated with SSTI and multi-drug resistance (MDR). This was based on records of patients suspected of SSTI for the period of 2019-2021 at Jinja Regional Referral Hospital. The analysis involved 268 randomly selected patient reports using WHONET 2022 and Stata 17 at the 95% confidence level. The prevalence of SSTI was 66.4%. Cases that involved laboratory testing were 14.1%. Staphylococcus aureus (n = 51) was the most isolated organism. MDR pathogens explained 47% of infections. Methicillin-resistant Staphylococcus aureus (MRSA) was up to 44%. In addition, 61% of Gram-negatives had the potential to produce extended-spectrum beta-lactamases (ESBL), while 27% were non-susceptible to carbapenems. Ward of admission was significantly associated with infection (aPR = 1.78, 95% CI: 1.00-3.18, p-value = 0.04). Age category (19-35) was an independent predictor for MDR infections (aPR = 2.30, 95%CI:1.02-5.23, p-value = 0.04). The prevalence of SSTI is high with MDR pathogens responsible for almost half of the infections. Gentamicin and ciprofloxacin can be considered for empirical management of strictly emergency SSTI cases suspected of Staphylococcus aureus. Given the high resistance observed, laboratory-based diagnosis should be increased to use the most appropriate treatment. Infection Prevention and Control (IPC) strategies should be heightened to reduce the prevalence of SSTI. Recognizing SSTI under the Global Antimicrobial resistance Surveillance System (GLASS) would lead to improved preparedness and response to AMR.
皮肤和软组织感染(SSTI)是医院获得性感染的常见病例,其病原体表现出抗菌药物耐药性(AMR)。这是一个全球公共卫生难题,导致传染病负担沉重,并威胁到可持续发展目标(SDGs)的实现,尤其是在低收入和中等收入国家(LMICs)。本研究确定了SSTI的患病率、实验室检查病例的比例、AMR谱以及与SSTI和多重耐药(MDR)相关的因素。这是基于金贾地区转诊医院2019 - 2021年期间疑似SSTI患者的记录。分析涉及使用WHONET 2022和Stata 17在95%置信水平下随机选择的268份患者报告。SSTI的患病率为66.4%。涉及实验室检测的病例为14.1%。金黄色葡萄球菌(n = 51)是最常分离出的病原体。MDR病原体导致了47%的感染。耐甲氧西林金黄色葡萄球菌(MRSA)高达44%。此外,61%的革兰氏阴性菌有产生超广谱β-内酰胺酶(ESBL)的潜力,而27%对碳青霉烯类药物不敏感。入院病房与感染显著相关(aPR = 1.78,95%CI:1.00 - 3.18,p值 = 0.04)。年龄组(19 - 35岁)是MDR感染的独立预测因素(aPR = 2.30,95%CI:1.02 - 5.23,p值 = 0.04)。SSTI的患病率很高,MDR病原体导致了几乎一半的感染。对于疑似金黄色葡萄球菌的严格紧急SSTI病例的经验性治疗可考虑使用庆大霉素和环丙沙星。鉴于观察到高耐药性,应增加基于实验室的诊断以采用最合适的治疗方法。应加强感染预防与控制(IPC)策略以降低SSTI的患病率。在全球抗菌药物耐药监测系统(GLASS)下识别SSTI将有助于提高对AMR的防范和应对能力。