Assessment of Antibiotic Resistance Patterns among Patients Presenting with Wound Infection at the Ho Teaching Hospital in the Volta Region of Ghana: A Six (6) -Year Retrospective Study

Abstract

Introduction: Antibiotics are the backbone of the treatment of infections in wounds. Its resistance is problematic. Information on the prevalence and antibiotic susceptibility of common bacteria responsible for wound infections in the Volta region and to a large extent the whole country of Ghana is scanty. Objective: To assess antibiotic resistance patterns among patients presenting with wound infection at the Ho Teaching Hospital in the Volta Region of Ghana. Methods: We performed a retrospective descriptive study using data collected on bacterial Isolates from wounds based on clinical suspicion of wound infection between January 1st 2018 and June 30th 2023. Bacteria were cultured on both enrichment and selective media including blood agar supplemented with 5% sheep blood and MacConkey agar, and identified by Gram stain, routine biochemical tests and VITEK 2 system. Data on routine culture and sensitivity tests performed on bacterial isolates from patients samples were retrieved from the hospital’s health information system. Data were then entered into and analysed using IBM Statistical Package for Social Sciences Version 26 (IBM SPSS; Armonk, New York). Results: A total of 1065 bacterial isolates were identified from wounds of patients suspected of wound infection between 2018 and 2023 at the facility representing a wound infection prevalence of 63.94% among the 1,665 suspected cases. Pseudomonas aeruginosa accounts for 21.3% of the total isolates identified. This was followed by Escherichia coli (18.1%), Pseudomonas spp (11.5%), Staphylococcus aureus (9.4%), Klebsiella spp (8.8%) and Proteus mirabilis (5.8%) which represented the top six (6) most isolated wound pathogen in the facility. Trends and patterns in ABR saw meropenem drastic reduction to resistant, from an alarming 91.67% in 2018 to a much-improved 11.90% in 2023. Cotrimoxazole resistance exhibited a cyclical pattern while Chloramphenicol, Ampicillin, and Ciprofloxacin, resistance remained relatively stable over the study period. Conclusion/Recommendations: The study uncovers high antibiotic-resistant wound infection rates influenced by demographics and climate, with Pseudomonas aeruginosa as a significant pathogen. While meropenem resistance shows a positive trend, challenges persist, notably in cotrimoxazole resistance. Recommendations emphasize the importance of antibiotic stewardship, surveillance, targeted awareness campaigns for males, seasonal preparedness, customized treatment guidelines, genetic research on resistance mechanisms, individualized antibiotic selection, and regular guideline updates.