title: Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Uganda.
abstract: BACKGROUND
  Surgical site infections (SSIs) are difficult to treat and are associated with substantially longer hospital stay, higher treatment cost, morbidity and mortality, particularly when the etiological agent is multidrug-resistant (MDR). To address the limited data in Uganda on SSIs, we present the spectrum of bacteria isolated from hospitalized patients, the magnitude and impact of MDR bacterial isolates among patients with SSIs.
  
  
  METHODS
  A descriptive cross sectional study was conducted from September 2011 through April 2012 involving 314 patients with SSIs in the obstetrics & gynecology, general surgery and orthopedic wards at Mulago National Hospital in Kampala, Uganda. Wound swabs were taken and processed using standard microbiological methods. Clinico-demographic characteristics of patients were obtained using structured questionnaires and patients' files.
  
  
  RESULTS
  Of the 314 enrolled patients with SSIs (mean age 29.7 ±13.14 years), 239 (76.1%) were female. More than half of the patients were from obstetrics and gynecology (62.1%, 195/314). Of 314 wound swabs taken, 68.8% (216/314) were culture positive aerobically, yielding 304 bacterial isolates; of which 23.7% (72/304) were Escherichia coli and 21.1% (64/304) were Staphylococcus aureus. More than three quarters of Enterobacteriaceae were found to be extended spectrum beta lactamase (ESBL) producers and 37.5% of S. aureus were Methicillin resistant S. aureus (MRSA). MDR occurred in 78.3% (238/304) of the isolates; these were more among Gram-negative bacteria (78.6%, 187/238) compared to Gram-positive bacteria (21.4%, 51/238), (p-value < 0.0001, χ2 = 49.219). Amikacin and imepenem for ESBL-producing Enterobacteriacea and vancomycin for MRSA showed excellent performance except that they remain expensive drugs in Uganda.
  
  
  CONCLUSIONS
  Most SSIs at Mulago National Hospital are due to MDR bacteria. Isolation of MRSA and ESBL-producing Enterobacteriaceae in higher proportions than previously reported calls for laboratory guided SSIs- therapy and strengthening of infection control surveillance in this setting.
authors.affiliation: Department of Medical Microbiology, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda. senijj80@gmail.com
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Seni
authors.forename: Christine F
authors.initials: CF
authors.lastname: Najjuka
authors.forename: David P
authors.initials: DP
authors.lastname: Kateete
authors.forename: Patson
authors.initials: P
authors.lastname: Makobore
authors.forename: Moses L
authors.initials: ML
authors.lastname: Joloba
authors.forename: Henry
authors.initials: H
authors.lastname: Kajumbula
authors.forename: Antony
authors.initials: A
authors.lastname: Kapesa
authors.forename: Freddie
authors.initials: F
authors.lastname: Bwanga
mesh_terms: D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000494:pharmacology*; D004352:Drug Resistance, Microbial; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008297:Male; D008826:Microbial Sensitivity Tests; D013514:Surgical Procedures, Operative; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
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