Onsando Samson, Masanta Wycliffe, Nyerere Andrew, Njire Moses, Moriasi Gervason
Kisii Teaching and Referral Hospital, Kisii, Kenya.
Department of Medical Microbiology, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
PLoS One. 2025 Jun 17;20(6):e0326048. doi: 10.1371/journal.pone.0326048. eCollection 2025.
Antimicrobial resistance (AMR) poses a growing threat to global health, with wound infections serving as significant reservoirs for multidrug-resistant bacteria. Understanding the socio-demographic, clinical, and microbiological characteristics of wound infections is critical for effective intervention strategies in resource-limited settings. Thus, this study aimed to evaluate the diversity, bacterial profiles, and resistance patterns of wound infections at Kisii Teaching and Referral Hospital. To do this, a total of 118 bacterial isolates from wound swabs were collected from 149 patients who met the eligibility criteria, from May to November 2024. These samples were cultured and analysed using standard microbiological techniques and antibiotic susceptibility testing according to the Clinical and Laboratory Standards Institute guidelines. Resistance genes associated with Vancomycin resistance in Staphylococcus aureus and Staphylococcus xylosus were also investigated using polymerase chain reaction (PCR) with appropriate primers and agarose gel electrophoresis. The results revealed a predominance of male patients (n = 79; 53.02%), avulsions (n = 50; 34.00%), and wounds on lower limbs (n = 63; 42.29%). Escherichia coli (n = 33; 27.97%), Enterobacter gergoviae (n = 20; 16.95%), Staphylococcus aureus (n = 18; 15.25%), and Staphylococcus xylosus (n = 18; 15.25%) were the most frequently isolated pathogens. Alarmingly high resistance rates were observed against ACCESS antibiotics, including Cotrimoxazole-Trimethoprim (n = 114; 97%), Ampicillin (n = 109; 92%), and Streptomycin (n = 100; 85%). Resistance to Watch and Reserve antibiotics, including Vancomycin (n = 11; 29%) and Ceftriaxone (n = 27; 33%), was also documented, particularly among Gram-positive isolates such as Staphylococcus aureus and Gram-negative pathogens like Pseudomonas aeruginosa. Resistance genes (VanA, VanB, VanC) were detected in S. aureus and S. xylosus, underscoring the role of genetic mechanisms in resistance propagation. These findings highlight the critical need for targeted antimicrobial stewardship programmes and strengthened infection prevention measures in high-burden hospital settings, such as Kisii Teaching and Referral Hospital. This study underscores the importance of local resistance data in guiding empirical therapy and informs policies to mitigate AMR in resource-limited contexts. Moreover, enhanced surveillance and research into alternative therapies are crucial to safeguarding the efficacy of life-saving antibiotics and improving patient care outcomes.
抗菌药物耐药性（AMR）对全球健康构成了日益严重的威胁，伤口感染是多重耐药菌的重要储存库。了解伤口感染的社会人口学、临床和微生物学特征对于资源有限环境下的有效干预策略至关重要。因此，本研究旨在评估基西教学与转诊医院伤口感染的多样性、细菌谱和耐药模式。为此，在2024年5月至11月期间，从149名符合入选标准的患者的伤口拭子中总共收集了118株细菌分离株。这些样本按照临床和实验室标准协会的指南，采用标准微生物技术和抗生素敏感性试验进行培养和分析。还使用聚合酶链反应（PCR）及合适的引物和琼脂糖凝胶电泳研究了金黄色葡萄球菌和木糖葡萄球菌中与万古霉素耐药性相关的耐药基因。结果显示男性患者占多数（n = 79；53.02%），撕裂伤（n = 50；34.00%），以及下肢伤口（n = 63；42.29%）。大肠埃希菌（n = 33；27.97%）、格高维肠杆菌（n = 20；16.95%）、金黄色葡萄球菌（n = 18；15.25%）和木糖葡萄球菌（n = 18；15.25%）是最常分离出的病原体。观察到对常用抗生素的耐药率高得惊人，包括复方新诺明（n = 114；97%）、氨苄西林（n = 109；92%）和链霉素（n = 100；85%）。对监测和储备抗生素的耐药情况也有记录，包括万古霉素（n = 11；29%）和头孢曲松（n = 27；33%），尤其是在革兰氏阳性分离株如金黄色葡萄球菌和革兰氏阴性病原体如铜绿假单胞菌中。在金黄色葡萄球菌和木糖葡萄球菌中检测到耐药基因（VanA、VanB、VanC），这突出了遗传机制在耐药传播中的作用。这些发现凸显了在基西教学与转诊医院等高负担医院环境中实施有针对性的抗菌药物管理计划和加强感染预防措施的迫切需要。本研究强调了当地耐药数据在指导经验性治疗以及为资源有限环境下减轻AMR制定政策方面的重要性。此外，加强监测和对替代疗法的研究对于保障救命抗生素的疗效和改善患者护理结果至关重要。
