1. Ann Clin Microbiol Antimicrob. 2020 Nov 25;19(1):54. doi: 
10.1186/s12941-020-00398-4.

Antimicrobial resistance in hospitalized surgical patients: a silently emerging 
public health concern in Benin.

Yehouenou CL(1)(2)(3), Kpangon AA(4), Affolabi D(5)(6)(7), Rodriguez-Villalobos 
H(8)(9), Van Bambeke F(10)(11), Dalleur O(10)(12), Simon A(8)(9).

Author information:
(1)Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute 
(LDRI), Université Catholique de Louvain UCLouvain, Brussels, Belgium. 
carine.yehouenou@uclouvain.be.
(2)Laboratoire de Référence des Mycobactéries (LRM), Cotonou, Benin. 
carine.yehouenou@uclouvain.be.
(3)Faculté des Sciences de La Santé (FSS), Université D'Abomey Calavi (UAC), 
01BP188, Cotonou, Benin. carine.yehouenou@uclouvain.be.
(4)Ecole Nationale des Techniciens Supérieurs en Santé Publique et Surveillance 
Epidémiologique, Université de Parakou, Parakou, Benin.
(5)Laboratoire de Référence des Mycobactéries (LRM), Cotonou, Benin.
(6)Centre National Hospitalier et Universitaire Hubert Koutoukou Maga 
(CNHU-HKM), Cotonou, Benin.
(7)Faculté des Sciences de La Santé (FSS), Université D'Abomey Calavi (UAC), 
01BP188, Cotonou, Benin.
(8)Microbiologie, Cliniques Universitaires Saint Luc, Université Catholique de 
Louvain, UCLouvain, Brussels, Belgium.
(9)Pôle de Microbiologie, Institut de Recherche Expérimentale et Clinique 
(IREC), Université Catholique de Louvain UCLouvain, Brussels, Belgium.
(10)Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute 
(LDRI), Université Catholique de Louvain UCLouvain, Brussels, Belgium.
(11)Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute 
(LDRI), Université Catholique de Louvain UCLouvain, Brussels, Belgium.
(12)Pharmacy, Clinique Universitaire Saint-Luc, Université Catholique de 
Louvain, UCLouvain, Brussels, Belgium.

BACKGROUND: Surgical site infections are related to high morbidity, mortality 
and healthcare costs. Because the emergence of multidrug-resistant bacteria in 
hospitals is becoming a worldwide challenge for surgeons who treat 
healthcare-associated infections, we wished to identify the causative agents 
involved in these infections and the rate of multidrug-resistant bacteria in six 
public hospitals in Benin.
METHODS: Using standard microbiological procedures, we processed pus specimens 
collected from obstetrics and gastrointestinal surgery wards. Mass spectrometry 
(MALDI-TOF) was used for confirmation. For the antibiotic susceptibility test, 
we first used the Kirby-Bauer disk diffusion method. The secondary test (by 
microdilution) used the Beckton Dickinson Phoenix automated system (Becton 
Dickinson Diagnostic, USA).
RESULTS: We included 304 patients, whose median length of stay was 9 days. A 
total of 259 wound swabs (85.2%) had positive aerobic bacterial growth. In 
obstetrics, S. aureus (28.5%, n = 42) was the most common isolate. In contrast, 
Gram-negative bacteria (GNB) were predominant in gastrointestinal surgery, the 
most dominant being E.coli (38.4%, n = 31). Overall, 90.8% (n = 208) of aerobic 
bacteria were multidrug resistant. Two-thirds of S. aureus (65.3%, n = 32) were 
methicillin-resistant Staphylococcus aureus (MRSA), three of which carried both 
MRSA and induced clindamycin resistance (ICR). GNB showed high resistance to 
ceftazidime, ceftriaxone and cefepime. Extended-spectrum beta-lactamases were 
presented by 69.4% of E.coli (n = 43/62) and 83.3% of K. pneumoniae (n = 25/30). 
Overall, twelve Gram-negative bacteria (5.24%) showed resistance to at least one 
carbapenem. No isolates showed a wild-type susceptible phenotype.
CONCLUSION: This study shows the alarming prevalence of multidrug-resistant 
organisms from surgical site infections in Benin hospitals. To reduce the spread 
of such bacteria in Benin, periodic surveillance of surgical site infections and 
strict adherence to good hand-hygiene practice are essential.

DOI: 10.1186/s12941-020-00398-4
PMCID: PMC7687776
PMID: 33239061

Conflict of interest statement: All authors declare that they have no conflicts 
of interests associated with the publication of this paper.