Background: Antimicrobial resistance is associated with increased morbidity in secondary infections and is a global threat owning to the ubiquitous nature of resistance genes in the environment. Recent estimates put the deaths associated with bacterial antimicrobial resistance in 2019 at 4.95 million worldwide. Lymphatic filariasis (LF), a Neglected Tropical Disease, is associated with the poor living in the tropical regions of the world. LF patients are prone to developing acute dermatolymphangioadenitis (ADLA), a condition that puts them at risk of developing secondary bacterial infections due to skin peeling. ADLA in particular, worsens the prognosis of patients, but also leads to the usage of antibiotics as a therapeutic intervention. This may result in inappropriate usage of antibiotics due to self-medication and non-compliance, thereby exacerbating antimicrobial resistance in LF patients. In this perspective, we assessed the antimicrobial resistance in LF patients. We focused on antibiotic usage, antibiotic resistance in Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa isolates and looked at genes coding for resistance in multi-drug resistant (MDR) bacteria isolates.
Results: Amoxacillin (54%) and chloramphenicol (22%) were the most frequently used antibiotics by participants for self-medication. This is representative of the resistance profiles of the bacteria isolates. Penicillin and erythromycin were respectively the highest and least antibiotic that Staphylococcus aureus was resistant to. All Escherichia coli isolates were sensitive to meropenem, while they were all resistant to antibiotics such as tetracycline and ampicillin. Pseudomonas aeruginosa were least resistant to ciprofloxacin, gentamicin and ceftazidime. The incidence of multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA), cephalosporin resistant E. coli and carbapenem resistant P. aeruginosa are respectively 15.38% (n=4), 40% (n=2) and 25% (n=2) in LF patients. Extended-spectrum betalactamase [ESBL] (blaxCTX-M) and mecA genes were implicated in the resistance mechanism of E. coli and MRSA, respectively.
Conclusion: Our findings have shown presence of MDR isolates from filarial pathology patients presenting with chronic wounds and; thus, the need to prioritize antimicrobial resistance of multi-drug resistant bacteria into treatment strategies optimizing the morbidity management protocols. The findings in this study can potentially guide the choice of antibiotics for treating individuals presenting with filarial pathologies with wounds.