Prevalence of Multidrug-Resistant Bacteria Responsible for Human Infections at the Dedougou Regional Hospital Center (RHC), Burkina Faso ()
1. Introduction
Bacterial infections have become widespread in recent years and are becoming increasingly difficult to prevent, diagnose and treat. This situation is particularly worrying in the hospital environment, as the number of resistant bacteria continues to rise, leading to the emergence of new drug-resistant strains [1]. Antibiotic resistance is one of the biggest threats to public health worldwide [2] [3]. This threat is also real on the African continent. Burkina Faso has undoubtedly not been immune to this multidrug resistance phenomenon. Several studies have reported variable data on the prevalence of bacteria that are multidrug-resistant to antibiotics, mainly Enterobacteriaceae producing extended-spectrum betal-actamases (E-ESBL) [4]-[6] and methicillin-resistant Staphylococcus aureus (MRSA) [7] [8]. Studies carried out in urban hospitals in Ouagadougou and Bobo Dioulasso, Burkina Faso, have reported the presence of multidrug-resistant bacteria in patients with varying frequencies [9]-[13]. Recent studies in rural areas have focused on the multidrug resistance of Salmonella enterica and E. coli isolates and have also looked at resistance mechanisms through the molecular characterization of resistance genes to conventional antibiotics [14]-[17]. However, the Dedougou Regional Hospital Center (RHC) garnered our interest due to its substantial patient population and the absence of prior research addressing the issue of multidrug resistance. This study was carried out with the aim of assessing the prevalence of multidrug-resistant bacteria isolated from pathological samples in this RHC, aiming to enhance the antibiotic resistance monitoring program in Burkina Faso.
2. Material and Methods
2.1. Study Setting
This study was conducted in the Dedougou Regional Hospital Center, located in Dedougou, the capital of the “Boucle du Mouhoun” region in western Burkina Faso (Figure 1). It consists of clinical and medico-technical departments, including the biomedical analysis laboratory where this study was conducted.
2.2. Study Type, Period, and Sample Collection
This was a prospective study performed from October to December 2021. The
Figure 1. Study site.
study population comprised patients, irrespective of sex or age, seeking an etiological diagnosis of bacterial infection at the medical biology laboratory at Dedougou Regional Hospital. Each patient was sent to the laboratory by the attending clinician with a note indicating the cytobacteriological examination to be performed. For stool and urine samples, the collection method was clearly explained to the patient or their caregiver so that they could collect the samples themselves using aseptic techniques and transported them to the laboratory within two hours after collecting, to avoid contaminating the samples. On the other hand, Pus samples and vaginal swabs were collected by a health professional and were transported directly in the laboratory. Other Pus samples were collected in sterile tubes or containers by puncture. A total of 300 clinical samples, including urine (n = 165), stools (n = 81), pus (n = 38), and vaginal swabs (n = 16) were collected and analyzed in this study.
2.3. Inclusion and Exclusion Criteria
This study included samples from both hospitalized patients across the various departments of the Dedougou Regional Hospital Centre (RHC) and outpatients referred from surrounding health facilities, regardless of age or sex. Eligibility was determined based on the presence of a properly completed laboratory request form and the collection of samples under appropriate and standardized conditions.
Exclusion criteria comprised incomplete or poorly documented request forms, samples of inadequate quality, specimens contaminated with parasites or fungi, and those exhibiting highly heterogeneous bacterial flora (defined by the presence of multiple morphologically distinct colony types) upon initial diagnostic evaluation.
2.4. Isolation and Identification of Bacterial Strains
All biological samples received underwent macroscopic and microscopic examination, followed by inoculation on Cystine Lactose Electrolyte Deficient Agar (CLED; Conda-Lab, Spain), Eosin Methylene Blue (EMB; Liofilchem, Italy), Hektoen agar (HIMEDIA, India), and Chapman media (Liofilchem, Italy), incubated at 37˚C for 24 hours. The oxidase test, which yielded a negative result, was performed on colonies suspected to be Enterobacteriaceae. Full identification of these suspect colonies was carried out using the API 20E identification system (BioMérieux, France). The catalase test was performed on colonies suspected to be Staphylococcus species. Colonies that tested catalase-positive, grew on Chapman agar, and fermented mannitol were inoculated into rabbit plasma (BIO-RAD, France) contained in a haemolysis tube and incubated at 37˚C for 24 hours. The presence of Staphylococcus aureus was indicated by the formation of a clot at the bottom of the tube. Staphylococcus aureus ATCC 25923 was used as the positive control. The identification of all bacterial strains was confirmed through mass spectrometry using a MALDI-TOF system (Microflex, Bruker Daltonics, Bremen, Germany) at the Microbiology Research Unit (PMIC) of the Pasteur Institute in Dakar, Senegal.
2.5. Antibiotic Susceptibility Testing and Detection of Different Resistance Phenotypes
Antimicrobial susceptibility testing was performed using the standard Mueller-Hinton agar (Liofilchem, Italy) disk diffusion method and interpreted based on the 2018 guidelines of the Antibiogram Committee of the French Society of Microbiology (CA-SFM). Antibiotic discs were selected to target specific resistance phenotypes. Results were categorized as sensitive (S) or resistant (R) for each antibiotic. The antibiotics tested included ampicillin (10 μg), amoxicillin + clavulanic acid (30 μg), cefoxitin (30 μg), cefotaxime (30 μg), ticarcillin (75 μg), oxacillin (5 μg), imipenem (10 μg), gentamycin (10 μg), ciprofloxacin (5 μg), erythromycin (15 μg), lincomycin (2 μg), azithromycin (30 μg) and trimethoprim + sulfamethoxazole (25 μg).
The double synergy method was used for the systematic detection of ESBL-producing strains on Mueller-Hinton agar inoculated with a bacterial suspension adjusted to 0.5 McFarland. Antibiotic discs were placed on the agar, including an amoxicillin + clavulanic acid (AMC) disc positioned at 20 to 30 mm from third-generation cephalosporin discs (3GC = cefotaxime, ceftazidime), followed by incubation at 37˚C for 24 hours. The presence of ESBLs was indicated by the appearance of a very characteristic “champagne cork”-shaped synergy image around the 3GC discs, with an expanded inhibition zone facing the AMC disc.
The detection of Staphylococcus aureus resistance to methicillin was carried out using cefoxitin (30 μg). A bacterial inoculum adjusted to 0.5 McFarland was seeded onto Mueller-Hinton agar. A set of antibiotic discs, including cefoxitin, was then placed on the agar, followed by incubation at 37˚C for 24 hours. S. aureus isolates were considered methicillin-resistant when the cefoxitin inhibition zone diameters were strictly less than 22 millimetres (EUCAS-CASFM, 2018). For non-fermentative bacteria, they were considered resistant (likely to produce a carbapenemase) in the face of any reduction in critical diameters to imipenem (diameter less than 22 mm) according to the recommendations established by EUCAS-CASFM (2018).
In addition, any bacteria of medical interest that showed resistance to at least three antibiotics from different classes were multidrug resistant (MDR).
2.6. Data Processing and Analysis
The variables considered included socio-demographic factors (age group, gender, hospitalization status, and type of sample) and bacteriological parameters (bacterial species, antibiotic susceptibility, nature of multidrug-resistant bacteria, and resistance phenotypes). Data entry was performed using Epi Info 7.2.3.0, while statistical analyses were conducted using Python 3.9.1. The chi-square test was used to measure association between the different proportions, with a value of p < 0.05 considered as statistical significance.
2.7. Ethical Considerations
The study was approved by the National Ethics Committee of Burkina Faso and the hospital authorities of the Régional Hospitalier Centre of Dedougou (Reference Code: N˚2021-168/MS/SG/CHR-DDG/DG/DSIO, date: 14 September 2021). Informed verbal consent was obtained from all participants or, in the case of minors under 18 years of age, from their parents or legal guardians. The study adhered to the principles outlined in the Declaration of Helsinki.
3. Results
3.1. Socio-Demographic Characteristics of Patients
This study analyzed 300 clinical samples, 56.66% (170/300) from male patients and 43.34% (130/300) from female patients. The patients’ average age was 34.46 ± 22.27, ranging from 0 to 95 years. Outpatients were the most represented 70.66% (212/300) and most affected by infections. Urine samples represented the largest proportion of samples, accounting for over half (55%, 165/300) of the total (Table 1).
Table 1. Distribution of socio-demographic characteristics.
Characteristics |
Number of
patients n (%) |
95% CI Limits |
Age range |
≤5 |
49 (16.33) |
12.12 - 20.78 |
6 - 17 |
29 (9.67) |
6.61 - 13.68 |
18 - 65 |
186 (62) |
56.31 - 67.61 |
>65 |
36 (12) |
8.61 - 16.33 |
Gender |
Male |
170 (56.66) |
51.01 - 62.15 |
Female |
130 (43.34) |
37.85 - 48.99 |
Patient status |
Hospitalized |
88 (29.34) |
23.53 - 33.68 |
External |
212 (70.66) |
66.42 - 76.47 |
Type of
samples |
Urine |
165 (55) |
49.02 - 60.58 |
Stools |
81 (21) |
22.13 - 32.51 |
Pus |
38 (12.66) |
09.15 - 17.02 |
Vaginal swabs |
16 (5.34) |
03.09 - 08.54 |
3.2. Overall Distribution of Bacteria Isolated
Of all the samples, 31.67% [95/300; 95% CI = 26.66 - 37.13] of the cultures were positive, including 4.21% (4/95) of stools, 13.68% (13/95) vaginal swabs, 25.26% (24/95) pus and 56.84% (54/95) of urine. Based on cultural, morphological, and biochemical characteristics, 95 bacterial strains were isolated from all samples. Of these, 65.26% (62/95) were Gram-negative bacilli while 34.74% (33/95) were Gram-positive cocci. Among the bacteria isolated, identification showed 58.95% [56/95; 95% CI = 48.38 - 68.94] of Enterobacteriaceae, 34.74% [33/95; 95% CI = 25.26 - 45.20] of cocci and 6.32% [6/95; 95% CI = 2.35 - 13.24] of non-fermentative bacilli. The most frequently species found in urine were Escherichia coli, Klebsiella sp., and Staphylococcus sp. with 40.74% [22/54; 95% CI = 27.57 - 54.97] and 14.81% [22/54; 95% CI = 6.62 - 27.12] respectively and 25.93% [14/54; 95% CI = 14.96 - 39.65]. Only four bacterial strains were isolated from stool samples, including three Escherichia coli strains and one Salmonella sp. Next, 13 bacterial strains were isolated from vaginal swabs, including Escherichia coli (30.77%) [4/13; 95% CI = 9.09 - 61.43], followed by Staphylococcus aureus (38.46%) [5/13; 95% CI = 13.86 - 68.42]. Furthermore, of all bacterial species isolated from pus samples, Escherichia coli accounted for 20.83% [5/24; 95% CI = 7.13 - 42.15], followed by 41.67% Staphylococcus aureus [10/24; 95% CI = 22.11 - 63.36]. Table 2 shows the number of species isolated in each sample. As for the clinical departments requesting bacteriological diagnoses, samples from outpatient departments accounted for 25.26% of positive cases, compared with 74.74% from the CHR’s in-house departments (p = 0.093), of which 42.10% (40/95) came from surgery and 12.63% (12/95) from medical emergencies. This shows that most infections detected occurred in hospitalized patients, which may indicate a higher prevalence of nosocomial (hospital-acquired) infections. Furthermore, the surgical department appears to be the most affected, which is consistent with known risk factors such as invasive procedures, medical devices (catheters, probes, etc.).
3.3. Antibiotic Susceptibility
The most notable aspect of this study is the high rate of resistance to beta-lactam antibiotics. The best efficiencies in this study were obtained with the use of gentamicin and imipenem. Resistance to amoxicillin and amoxicillin + clavulanic acid was detected in 92.85% (52/56) and 78.57% (44/56) of all Enterobacteriaceae,
Table 2. Distribution of bacteria isolated by type of samples.
Samples |
Bacteria |
Urine
n (%) |
Stools
n (%) |
Pus
n (%) |
Vaginal swabs n (%) |
Total
n (%) |
p value |
Enterobacteriacea |
E. coli |
22 (64.71) |
3 (8.82) |
5 (14.71) |
4(11.76) |
34 (35.79) |
0.0194 |
Klebsiella sp. |
8 (80.00) |
0 (0) |
1 (10.00) |
1(10.00) |
10 (10.53) |
Citrobacter sp. |
4 (100) |
0 (0) |
0 (0) |
0 (0) |
4 (4.21) |
Enterobacter sp. |
2 (50.00) |
0 (0) |
1 (25.00) |
1(25.00) |
4 (4.21) |
Proteus sp. |
1 (100.00) |
0 (0) |
0 (0) |
0 (0) |
1 (1.05) |
Salmonella sp. |
0 (0) |
1 (100.00) |
0 (0) |
0 (0) |
1 (1.05) |
Serratia sp. |
0 (0) |
0 (0) |
1 (50.00) |
1 (50.00) |
2 (2.11) |
Cocci |
Staphylococcus sp. |
14 (48.28) |
0 (0) |
10 (34.48) |
5(17.24) |
29 (30.53) |
0.0194 |
Streptococcus sp. |
1 (25.00) |
0 (0) |
3 (75.00) |
0 (0) |
4 (4.21) |
Non-fermentative
bacteria |
A. baumannii |
1 (25.00) |
0 (0) |
2 (50.00) |
1 (25.00) |
4 (4.21) |
0.0194 |
P. aeruginosa |
1 (50.00) |
0 (0) |
1 (50.00) |
0 (0) |
2 (2.11) |
respectively. Concerning the use of third-generation cephalosporins, resistance rates of 58.92% (33/56) and 57.14% (32/56) to cefotaxime and ceftazidime were observed in all Enterobacteriaceae, respectively (Figure 2), with an appearance of 19.64% (11/56) of extended-spectrum beta-lactamase-producing Enterobacteriaceae (E-ESBL) as shown in Figure 3. Moreover, carbapenems, classified as last resort beta-lactam antibiotics, showed 0% resistance in all Enterobacteriaceae after a test with imipenem (Figure 2). As for the use of antibiotics from other families, all Enterobacteriaceae showed a high level of resistance, ranging from 76.78% (43/56) to trimethoprim-sulfamethoxazole, and from 64.28% (36/56) to ciprofloxacin (Figure 2). High resistance of 100% (4/4) and 50% (1/2) to ticarcillin were observed in Acinetobacter baumannii and Pseudomonas aeruginosa respectively. Resistance to imipenem was detected in 50% (2/4) of Acinetobacter baumannii and 50% (1/2) of Pseudomonas aeruginosa (Figure 4). Among isolated Gram-positive cocci, high resistances to penicillin G, erytromicin and doxyciclin were also observed in Staphylococcus aureus (Figure 2).
3.4. Prevalence of Isolated Multidrug-Resistant Bacteria
Out of all the microorganisms found in this investigation, 55.79 percent [53/95; 95% CI = 45.23 - 65.98] of multidrug-resistant bacteria (MDR) were isolated 64.15% [34/53; 95% CI = 49.80 - 76.86] of the total multidrug-resistant bacteria were recovered as Enterobacteriaceae, followed by 28.30% [15/53; 95% CI = 16.79 - 42.35] of cocci and 7.55% [4/53; 95% CI = 2.09 - 18.21] non-fermentative bacteria. The prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae was 19.64% [11/56; 95% CI = 10.23 - 32.43]. Escherichia coli accounted for 45.45% of the extended-spectrum beta-lactamase-producing Enterobacteriaceae (E-BLSE), followed by Klebsiella sp. (36.36%) and Citrobacter diversus (18.18%), in that order. The incidence of E. coli was 14.71% [5/34; 95% CI
(a)
(b)
Figure 2. Antibiotics resistance in Enterobacteriaceae and Staphylococcus aureus.
= 4.95 - 31.06] and 40% Klebsiella sp. [4/10; 95% CI = 12.16 - 73.76], when species were taken into consideration MRSA accounted for 31.03 percent [9/29; 95% CI = 13.30 - 45.52] of the multidrug-resistant cocci that were isolated Acinetobacter baumannii and Pseudomonas aeruginosa were found to be 50% and 25% of the non-fermentative (imipenem-resistant) bacteria, respectively. Urine, which contained 100% E-BLSE and 55.56% MRSA, clearly predominated the epidemiological profile of the samples collected for our investigation Pus, which had 25% BMR isolates, including 33.33% MRSA isolates, came next. Patients between the ages of 18 and 65 and those over 65 years had higher isolation rates of multidrug-resistant bacteria, with 56.86% [95% CI = 42.25 - 70.65; 6/11 ESBL and 8/12 MRSA] and 25.49% [95% CI = 14.33 - 39.63; 5/11 ESBL], respectively.
Figure 3. Positive synergy test of ESBL.
Figure 4. Antibiotics resistance in Acinetobacter baumannii and Pseudomonas aeruginosa.
4. Discussion
Today, meticillin-resistant Staphylococcus aureus and ESBL-producing Enterobacteriaceae are the main multi-resistant bacteria threatening public health worldwide. The fundamental aim of our study was to determine the frequency of multi-resistant bacteria involved in various infections at the Dedougou regional hospital.
All bacteria isolated from samples (most commonly vaginal swabs, urine, stools, pus, etc.) collected at the CHR’s medical analysis laboratory in Dedougou were included in the current investigation. All bacteria isolated from samples (usually urine, pus, stool, vaginal swabs, etc.) taken at the medical analysis laboratory of the Dedougou RHC were included in the present survey. A total of 300 pathological samples were included. According to the socio-demographic and epidemiological characteristics of the patients, 70.66% of them were outpatients, compared with 29.34% of inpatients, p = 0.093. With a sex ratio of 0.7 (F/M), males were more likely than females to be infected, with 58.95% of cases being positive, p = 0.587. The two age groups most impacted were those over 65 (20%) and those between 18 and 65 (62.11%). Our study’s findings are consistent with those of research conducted in Burkina Faso by Dembélé et al. [18] and in Mali by Kalambry et al. [6]. Enterobacteriaceae (Escherichia coli, Klebsiella sp., Citrobacter diversus, etc.) were the primary bacteria that were isolated. These findings are comparable to those published by Kpoda et al. [10] and Ky et al. [11] in Burkina Faso, by Gadou et al. [19] in Côte d’Ivoire and Toudji et al. [4] in Togo. Other isolated bacteria, including non-fermentative bacteria (Acinetobacter baumannii and Pseudomonas aeruginosa) and Staphylococcus aureus and coagulase negative Staphylococcus (CNS), were also clarified by this investigation. Our results are consistent with a study conducted in Burkina Faso and published by Ky et al. [11]. Additionally, our findings are consistent with research conducted by Bouguenoun et al. [20] on clinical samples in Algeria. Every antibiotic that was studied had high activity in terms of antibiotic resistance. Except for carbapenems (imipenem), betalactam antibiotics were actually not very inefficient against Enterobacteriaceae. All Enterobacteriaceae showed high levels of resistance to amoxicillin (92.85%) and amoxicillin/clavulanic acid (78.57%), whereas E-ESBL showed 100% resistance. These findings are comparable to those that have been documented in Burkina Faso before [10] [11]. Cefotaxime resistance was found to be 100% in E-ESBL and 58.92% in all Enterobacteriaceae. These findings are consistent with findings from Burkina Faso [10] and Morocco [21] in 2018, and Togo [4] in 2017. The quick and simple availability of these antibiotics, which are frequently provided without a prescription, may account for the Enterobacteriaceae resistance to penicillin and cephalosporins in this investigation. Additionally, the decreased activity of betalactamase inhibitors, such as clavulanic acid (which produces oxacillinase and high-level cephalosporinase), and the frequent and insufficient use of third-generation cephalosporins (injectable ceftriaxone) by nursing staff as part of probabilistic treatment as soon as the patient enters the various internal clinical departments of healthcare facilities may also account for this cephalosporin resistance [21]. This may be the source of the selection of resistant bacteria, which produce inactivating enzymes as one of their defense mechanisms after evading the effects of these chemicals. A low resistance rate of 0% was also seen in all Enterobacterales when imipenem was used. This overall carbapenem sensitivity was comparable to the findings of Ky et al. [11] and Kpoda et al. [10] in Burkina Faso, who discovered no imipenem resistance Morocco [21] and Togo [4] have reported comparable outcomes with low imipenem resistance rates. In terms of cocci’s susceptibility to beta-lactam, our study found that Staphylococcus aureus had a 90.91% resistance to penicillin G and a 31.03% resistance to cefoxitin, whereas MRSA had a 100% resistance to both. In Burkina Faso, Ky et al. [11] reported that 32% of Staphylococcus aureus isolates were resistant to methicillin. Abdoulaye et al. [8] reported similar betalactam resistance findings in other countries, including Niger, where they identified 83% resistance to oxacillin and 88.6% resistance to penicillin G. Similarly, Ould Salem et al. [7] and Sapkota et al. [22] have found 100% penicillin resistance in Mauritania and Nepal, respectively. The unregulated and insufficient use of these compounds, self-medication, and public ignorance of the issues of antibiotic resistance may all contribute to MRSA resistance to this subfamily of beta-lactam antibiotics (penicillin). All Enterobacterales and E-ESBL showed resistance rates of 32.14% and 50% to aminoglycosides (gentamicin), respectively, as compared to the other antibiotic families included in our investigation Some studies conducted in Burkina Faso by Ouedraogo et al. [9] and Kpoda et al. [10], in Togo by Toudji et al. [4], and Côte d’Ivoire by Gadou et al. [19] showed better findings. The authors of this research reported that 89%, 82.24%, and 93.2% of E-ESBLs were resistant to gentamicin, respectively. Subsequently, ciprofloxacin and trimethoprim-sulfamethoxazole resistance were observed in 64.28% and 76.78% of Enterobacteriaceae, respectively E-ESBL-associated resistance rates were respectively 93.76% for trimethoprim-sulfamethoxazole and 90% for ciprofloxacin. These resistance rates are consistent with those seen in Burkina Faso [9] [10], Togo [4], and Côte d’Ivoire [23], as well as other earlier investigations conducted in 2017 and 2019. The MRSA that was found had resistances to gentamycin, ciprofloxacin, and trimethoprim-sulfamethoxazole of 57.14%, 85.71%, and 100%, respectively. Results were similar in Mauritania, where some scientists [7] found that 77% of MRSA were co-resistant to trimethoprim-sulfamethoxazole. In contrast, authors [22] [24] reported reduced MRSA resistance rates in Nepal in their 2018 and 2019 research projects, respectively, in connection with these various antibiotic families. The comparatively high rate of resistance to these compounds in our study may, in fact, be explained by the fact that these antimicrobials are very inexpensively available in tablet form in our nation, which promotes self-medication. Additionally, in our nation, trimethoprim-sulfamethoxazole was added to the algorithm for opportunistic illnesses in PL-HIV. Following antibiotic sensitivity testing, the prevalence of isolation of multidrug-resistant bacteria was estimated at 55.79%. The majority of the 64.15% of Enterobacterales found were Escherichia coli (55.9%), followed by Klebsiella sp. (26.5%). Of all the Enterobacteriaceae, 19.64% were extended-spectrum beta-lactamase (E-ESBL) producing Studies conducted in Burkina Faso [9]-[11] and Togo [4] revealed higher prevalences. However, other authors in Burkina Faso [12], Morocco [21] and Mali [6] reported low prevalences (12%, 12.2%, 12.5%). According to ESBL production by species, Escherichia coli accounted for 45.45% of cases, followed by Klebsiella sp. with 36.36% and Citrobacter diversus with 18.18%. Similar results were found in Togo [4] and Côte d’Ivoire [23], showing a predominance of E. coli followed by Klebsiella sp. Nevertheless, a study carried out in Mauritania [25] showed that among ESBL-producing strains, Klebsiella sp. led the way with 20.4%, followed by E. coli with 10.4%. MRSA were accounted 31.03% among for Gram-positive cocci. Slightly higher results were found in Burkina Faso and Mauritania with 32% and 34% respectively [7] [11]. However, it is still less than the 83% recorded in Niger (8) 7.55% of the non-fermentative bacteria, including 75% (3/4) Acinetobacter baumannii and 25% (1/4) Pseudomonas aeruginosa, were imipenem resistant. Similar outcomes were observed in Algeria in 2017 [20]. In order to counteract the high degree of resistance to multi-drug-resistant strains in the Boucle of Mouhoun region of Burkina Faso, the phenomena need to draw the attention of local health authorities and the affected community. Urine topped the isolation matrices, containing 55.55% of MRSA isolates and 100% of ESBL-producing Enterobacterales. With 33.33 percent of MRSA isolated, Pus finished in second. Our findings contradict those of a 2017 study conducted in Togo [4], which found that ESBLs were recovered from pus more often than from urine and other samples. This runs counter to the findings of a study conducted in Burkina Faso [10], which revealed that ESBL Enterobacterales were more frequently isolated from urine (23.9%) than from pus (10.5%). Our findings are consistent with those of Mauritania [7], whose authors reported a higher prevalence (34.3%) in urine exam for MRSA Furthermore, adults between the ages of 18 and 65 and those above 65 had a noticeably greater prevalence of multi-resistant bacterial isolates. These findings align with the research conducted by Ouedraogo and colleagues [9].
5. Conclusion
Since multidrug-resistant bacteria have emerged and proliferated, antibiotic resistance has emerged as a significant global public health concern, especially in Burkina Faso. This study found that methicillin-resistant Staphylococcus aureus, imipenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii, and extended-spectrum beta-lactamase-producing Enterobacterales were all present in this reference regional health center. High levels of resistance to beta-lactams and other antibiotics (aminoglycosides, quinolones, sulphonamides, etc.) were observed in these various strains of multidrug-resistant bacteria. In order to strengthen the antibiotic resistance-monitoring program at the regional and national levels, health safety precautions and actions must be adopted in response to the high degree of antibiotic resistance found in our study. This would require informing the regional health authorities.
Acknowledgements
We thank the hospital authorities for their agreement and the staff of the laboratory department of both the RHC-Dedougou and University Joseph KI ZERBO of Ouagadougou for their support and technical advice.
Contributions of the Authors
The design of the study, data analysis, writing and editing of the document were all overseen by all authors, who also agreed to be responsible for all aspects of the work. The final manuscript was read and approved by all authors.