HIGH BURDEN AND WARD-SPECIFIC PATTERNS OF MULTIDRUG RESISTANCE IN BACTERIA FROM CHRONIC WOUND INFECTIONS AT MERU TEACHING AND REFERRAL HOSPITAL, KENYA

Abstract

The emergence of multidrug-resistant (MDR) bacterial pathogens in chronic wounds presents escalating therapeutic challenges, particularly in resource-limited settings such as
Kenya, where ward-level resistance surveillance data remain scarce. This study aimed to
investigate multiple antibiotic resistance patterns among bacterial isolates from chronic
wound infections at Meru Teaching and Referral Hospital. A cross-sectional study analyzed
68 bacterial isolates from chronic wound infections collected between October 2024 to June
2025. A bimodal age distribution (21 - 30 years: 22%; 51 - 60 years: 19.2%) and near-equal
gender prevalence (53% male, 47% female) were observed. Identification and antimicrobial
susceptibility testing were performed using standard microbiological methods and the VITEK 2 system according to CLSI guidelines. Multiple Antibiotic Resistance (MAR) indices
were calculated, with values >0.2 indicating high-risk resistance sources. Findings revealed
marked resistance heterogeneity, with MAR indices ranging from 0.00 to 1.00. Klebsiella
pneumoniae (MAR = 0.76–1.00) and Acinetobacter baumannii (MAR = 1.00) exhibited the
highest resistance levels, predominantly in burn units. Enterococcus faecalis (MAR = 0.65)
and Morganella morganii (MAR = 0.75) were also highly resistant across multiple wards.
The burn unit recorded the highest resistance burden, while the wound clinic displayed the
widest MAR spectrum (0.0–1.0). These results underscore the urgent need for ward-specific
antimicrobial stewardship and infection control interventions, particularly in burn and
wound care units, to prevent further resistance escalation.