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Background  There is limited data to guide the prevention and management of surgical site infections (SSI) in low- and middle-income countries. We prospectively studied aetiological agents associated with SSI and their corresponding antibiotic susceptibility patterns in a tertiary hospital in Ghana.    Methods  As part of a cohort study carried out at the surgical department of the Korle Bu Teaching Hospital (KBTH) from July 2017 to April 2019, wound swabs were collected from patients diagnosed with SSI. Isolates cultured from the wound swabs were identified by MALDI TOF and susceptibility testing was conducted according to EUCAST 2020 guidelines. Clinical data were monitored prospectively.    Results  Of 4577 patients, 438 developed an SSI and 352 microbial isolates were cultured. Isolates were predominantly Gram negative (286, 81%), a pattern seen for all kinds of surgery and all wound classes. The most common species included  Escherichia coli ,  Pseudomonas aeruginosa ,  Klebsiella pneumoniae ,  Staphylococcus aureus  and  Acinetobacter baumannii . The majority of organisms were multi-drug resistant including 86% of  E. coli , 52% of  A. baumannii  and 86% of  K. pneumoniae;  and 65% (17/26) of the cefotaxime-resistant  K. pneumoniae  were extended spectrum β-lactamase producing. One of 139  E. coli , 15 of 49  P. aeruginosa , and 6 of 23  A. baumannii  were meropenem resistant, but no clonal pattern was found. There was a 1% (5/428) prevalence of methicillin-resistant  S. aureus .    Conclusions  The predominance of Gram-negative organisms and the high level of multi-drug resistance indicate a need to re-evaluate antibiotic prophylaxis and treatment protocols in surgical practice in low- and middle-income countries.

High rates of multi-drug resistant gram-negative organisms associated with surgical site infections in a teaching hospital in Ghana