Methicillin-Resistant Staphylococcus aureus (MRSA) Infection of Diabetic Foot Ulcers at a Tertiary Care Hospital in Accra, Ghana
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Pathogens
Abstract
Aim: This study investigated the spectrum of bacteria infecting the ulcers of individuals
with diabetes at the Korle Bu Teaching Hospital in Accra, Ghana, focusing on Staphylococcus aureus
(S. aureus) and methicillin-resistant S. aureus (MRSA), with respect to their prevalence, factors pre disposing to their infection of the ulcers, and antimicrobial resistance patterns. Methodology: This
cross-sectional study was conducted at The Ulcer Clinic, Department of Surgery, Korle Bu Teaching
Hospital, involving 100 diabetic foot ulcer patients. The ulcer of each study participant was swabbed
and cultured bacteriologically, following standard procedures. Antimicrobial susceptibility testing
was done for all S. aureus isolated, using the Kirby-Bauer method. Results: In total, 96% of the
participants had their ulcers infected—32.3% (n = 31) of these had their ulcers infected with one
bacterium, 47.9% (n = 46) with two bacteria, 18.8% (n = 18) with three bacteria, and 1.0% (n = 1) with
four bacteria. The prevalence of S. aureus and MRSA were 19% and 6%, respectively. The distribution
of the other bacteria was as follows: coagulase-negative Staphylococci (CoNS) (54%), Escherichia coli
(24%), Pseudomonas spp. (19%), Citrobacter koseri and Morganella morgana (12% each), Klebsiella oxytoca
(11%), Proteus vulgaris (8%), Enterococcus spp. (6%), Klebsiella pneumoniae (5%), Proteus mirabilis and
Enterobacter spp. (4%), Klebsiella spp. (2%), and Streptococcus spp. (1%). The resistance rates of S.
aureus decreased across penicillin (100%, n = 19), tetracycline (47.4%, n = 9), cotrimoxazole (42.1%,
n = 8), cefoxitin (31.6%, n = 6), erythromycin and clindamycin (26.3% each, n = 5), norfloxacin and
gentamicin (15.8% each, n = 3), rifampicin (10.5%, n = 2), linezolid (5.3%, n = 1), and fusidic acid (0.0%,
n = 0). The proportion of multidrug resistance was 47.4% (n = 9). Except for foot ulcer infection with
coagulase-negative Staphylococci, which was protective of S. aureus infection of the ulcers (OR = 0.029,
p = 0.001, 95% CI = 0.004–0.231), no predictor of S. aureus, MRSA, or polymicrobial ulcer infection
was identified. Conclusions: The prevalence of S. aureus and MRSA infection of the diabetic foot
ulcers were high, but lower than those of the predominant infector, coagulase-negative Staphylococci
and the next highest infecting agent, E. coli. Diabetic foot ulcers’ infection with coagulase-negative
Staphylococci protected against their infection with S. aureus. The prevalence of multidrug resistance
was high, highlighting the need to further intensify antimicrobial stewardship programmes.
Description
Research Article
Keywords
multidrug-resistant, Staphylococcus aureus, MRSA, infection, diabetic foot ulcer