DIAGNOSTIC CHARACTERIZATION OF MULTIDRUG-RESISTANT PATHOGENS IN CHRONIC WOUNDS AT MERU TEACHING AND REFERRAL HOSPITAL, KENYA

Abstract

Chronic wound infections remain a significant public health concern, driven by trauma, diabetes, and inadequate hygiene, often with polymicrobial colonization and rising antibiotic
resistance. This study at Meru Teaching and Referral Hospital, in Kenya, used a crosssectional design to analyse 68 wound swabs from 293 patients (8 months) for outlining bacteria in chronic wound infections to identify and understand both known and new pathogens, thereby enhancing diagnosis, treatment, and expanding knowledge of infectious
agents, using standard culture and automated identification/AST, with ethics approvals from
all relevant ethical committees.The findings revealed that the highest infection rates were
among patients aged 21–30 years (22%) and 51–60 years (19.2%). The most frequently isolated organism was Staphylococcus aureus (26.6%), followed by Pseudomonas aeruginosa
(13.2%) and Escherichia coli (10.3%). Less common but clinically significant multidrugresistant (MDR) isolates included Klebsiella pneumoniae, Proteus hauseri, Morganella
morganii, Acinetobacter baumannii, and Enterococcus faecalis. Despite clinical signs of
infection, 20.5% of the wound samples had no bacterial growth. This could be as a result of
non-infectious causes or fastidious organisms that were not detectable with the media used,
though other bacterial or microbial agents that have not been identified may also be at play.
This study demonstrates 50% of Staphylococcus aureus strains are resistant to beta-lactams
and fluoroquinolones, while resistance in Meropenem ranges from 0% to 11%. E. coli recorded 78% resistance to ciprofloxacin and 100% resistance to ampicillin/sulbactam and
amoxicillin/clavulanate. Despite exhibiting 50–100% resistance, Klebsiella sp. and Pseudomonas sp. are still mostly sensitive to meropenem, a reserve antibiotic. Meropenem resistance was rare in coagulase-negative staph; however, it ranged from 60% to 100%. Morganella was resistant to ciprofloxacin and trimethoprim/sulfamethoxazole (%?? respectively), whereas Proteus exhibited 40–60% resistance. These findings highlight the complexity
and resistance of persistent wound infections, the high prevalence of antibiotic resistance,
and the pressing need for advanced diagnostic instruments to guarantee precise pathogen
identification. Strengthening diagnostic abilities, endorsing antibiotic stewardship, and implementing regular regional surveillance are essential to combat resistant infections effectively, guide suitable therapy, and improve patient outcomes in resource-limited settings.