When First-Line Therapies Fail: Surgical Site Infections and the Declining Antimicrobial Utility in a...

Area of Science:

• Infectious Diseases
• Public Health
• Microbiology

Background:

• Antimicrobial resistance (AMR) presents a significant challenge to surgical care, especially in resource-limited settings.
• Surgical site and wound infections are common complications that can be exacerbated by AMR.

Purpose of the Study:

• To describe the epidemiology of AMR in surgical site and wound infections in Belize.
• To analyze temporal-spatial trends of key resistant pathogens from 2018 to 2024.

Main Methods:

• Retrospective analysis of national laboratory data for Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus.
• Evaluation of resistance phenotypes (ESBL, MRSA), susceptibility profiles, and antibiotic consumption patterns.

Main Results:

• Extended-spectrum beta-lactamase (ESBL) production in Enterobacteriaceae more than doubled (25% to >45%), while Methicillin-resistant Staphylococcus aureus (MRSA) remained high (55%-65%).
• Over one-third of ESBL isolates were resistant to both oral and intravenous antibiotics, creating critical treatment gaps.
• ESBL infections were concentrated in central Belize and post-cesarean sections; MRSA was prevalent in diabetic amputations. Antibiotic consumption correlated with resistance approximately 6 months prior.

Conclusions:

• AMR is highly prevalent in Belize, characterized by rapidly increasing ESBL rates and significant therapeutic limitations.
• Urgent interventions are required, including updated treatment guidelines, targeted antimicrobial stewardship, and enhanced infection control in high-burden areas.