Ackam Nancy, Akenten Charity Wiafe, Boadi Abigail Opoku, Agbanyo Abigail, Abass Kabiru Mohammed, Amofa George, Ofori Elizabeth, Azabire Joseph, Sylverken Augustina, Obiri-Danso Kwasi, Wansbrough-Jones Mark, Thye Thorsten, Dekker Denise, Amoako Yaw Ampem, Phillips Richard Odame
Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana.
Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
PLoS Negl Trop Dis. 2025 May 27;19(5):e0013140. doi: 10.1371/journal.pntd.0013140. eCollection 2025 May.
We previously showed that the presence of secondary bacteria influences clinical outcome in Buruli ulcer (BU) patients. Despite this, there is limited data on the antimicrobial resistance of these bacterial isolates within BU lesions. To gain understanding of antimicrobial resistance in BU, we longitudinally profiled antimicrobial resistance in frequently isolated bacterial organisms from these lesions.
METHODOLOGY/PRINCIPAL FINDINGS: Between August 2021 and June 2024, we assessed the antimicrobial resistance of pathogenic bacterial isolates within lesions of laboratory confirmed BU patients in Ghana. Wound swabs were collected longitudinally. The bacteria were identified and their antibiotic susceptibility tested using the VITEK 2 compact. Of the 166 bacterial isolates, eight bacterial species were identified comprising 56.9% Gram negative bacilli and 43.1% Gram positive cocci. We found the presence of pathogenic bacteria with varying levels of resistance to commonly used antibiotics in BU lesions before, during and after BU-specific antibiotic treatment. At baseline, all bacterial isolates were resistant to at least one antibiotic. Notably, Extended Spectrum Beta-Lactamase (ESBL) production was detected in 30% of Gram-negative isolates tested while 50% of the Staphylococcus aureus isolates tested positive for MRSA. There was a decline in the ESBL positive isolates over time (from 30% to 0) whereas MRSA positive isolates increased after treatment in the lesions (from 50% to 60%).
Results from this study highlight a concerning prevalence of antimicrobial resistant bacteria, including multi drug resistant (MDR), ESBL-positive and Methicillin-resistant Staphylococcus aureus (MRSA) pathogens, in Buruli ulcer lesions. These findings underscore the urgent need for the development of integrated guidelines to guide surveillance and treatment of secondary bacterial infections to further improve outcomes in BU.
我们之前的研究表明，继发细菌的存在会影响布鲁里溃疡（BU）患者的临床结局。尽管如此，关于这些从BU病变中分离出的细菌菌株的抗菌药物耐药性的数据仍然有限。为了了解BU中的抗菌药物耐药性，我们纵向分析了从这些病变中频繁分离出的细菌的抗菌药物耐药性。
方法/主要发现：在2021年8月至2024年6月期间，我们评估了加纳实验室确诊的BU患者病变内病原菌分离株的抗菌药物耐药性。纵向收集伤口拭子。使用VITEK 2 compact鉴定细菌并测试其抗生素敏感性。在166株细菌分离株中，鉴定出8种细菌，其中革兰氏阴性杆菌占56.9%，革兰氏阳性球菌占43.1%。我们发现在进行BU特异性抗生素治疗之前、期间和之后，BU病变中存在对常用抗生素具有不同耐药水平的病原菌。在基线时，所有细菌分离株对至少一种抗生素耐药。值得注意的是，在测试的革兰氏阴性分离株中，30%检测到超广谱β-内酰胺酶（ESBL）产生，而在测试的金黄色葡萄球菌分离株中，50%对耐甲氧西林金黄色葡萄球菌（MRSA）呈阳性。随着时间的推移，ESBL阳性分离株有所下降（从30%降至0），而病变中MRSA阳性分离株在治疗后有所增加（从50%升至60%）。
本研究结果突出了布鲁里溃疡病变中包括多重耐药（MDR）、ESBL阳性和耐甲氧西林金黄色葡萄球菌（MRSA）病原体在内的抗菌药物耐药细菌的令人担忧的流行情况。这些发现强调迫切需要制定综合指南，以指导继发性细菌感染的监测和治疗，从而进一步改善BU的治疗效果。
