A case for routine microbial diagnostics: Results from antimicrobial susceptibility testing in post-traumatic wound infections at a Ugandan tertiary care hospital

<strong>ABSTRACT</strong> The global spread of antimicrobial resistance (AMR) is an increasing challenge for clinicians in Uganda, where microbiological diagnostics are not routinely available. The aim of this study was to determine pathogen prevalence and antibiotic resistance patterns in patients with wound infections following trauma at a national referral hospital in Kampala, Uganda. In addition, the suitability of currently used empirical treatment options in this setting was evaluated. This prospective, observational study analysed antimicrobial prescriptions, culture results and antimicrobial sensitivity testing (AST) of wound swabs and blood samples from patients with clinical signs of wound infections on the trauma ward. A total of 124 patients (n=99, 79.8% male) with a median age of 30 years (IQR 23-39) were enrolled between October 2021 and January 2022. Wound infections were classified as nosocomial in 69% of the cases. Pathogens were isolated from 122 wound swabs, yielding 238 bacterial isolates. The most prevalent pathogens were gram-negative bacteria including <em>Escherichia coli </em>(n=48, 20.2%) and <em>Acinetobacter </em>spp. (n=43, 18.1%). Empiric treatment consisted of ceftriaxone and gentamicin which was administered to 67.2% (n=78) and 62.1% (n=72) of patients, respectively. High rates of antimicrobial resistance could be demonstrated across gram-negative and gram-positive species towards the most common empiric antibiotics. Following the AST results, over 95% (n=111) of patients required a change of treatment. Our findings demonstrate that current empiric treatment for wound infections is missing its target in hospitalized patients in Kampala. Increased diagnostic capacity and structured antimicrobial stewardship are necessary to tackle the growing problem of AMR in Uganda.