A cross-sectional study on the impact of herbal medicine on the prevalence of bacterial and fungal pathogens in wound infections and surgical site infections in rural Ghana

by Mathieu Monnheimer
Doctoral thesis
Date of Examination:2025-03-12
Date of issue:2025-02-06
Advisor:Prof. Dr. Uwe Groß
Referee:Prof. Dr. Uwe Groß
Referee:Prof. Dr Arndt Schilling
Referee:Prof. Dr. Jorge Alberto Frank
Persistent Address: http://dx.doi.org/10.53846/goediss-11056

 

 

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Abstract

English

This study was performed to get a better understanding about the use of traditional herbal medicine on wound infection in Ghana, and to analyze possible effects on wound pathogen composition and pathogen resistance. Our results demonstrate that traditional herbal medicine is still widely used in rural Ghana. This includes the use of medical plants described previously, especially Alchornea cordifolia. There was a significant effect on pathogen prevalence in wounds treated with traditional herbal medicine with regard to key bacterial and fungal pathogens, but no general difference in pathogen distribution. Herbal medicine products were often contaminated with bacterial and fungal pathogens, which may trigger infection of wounds. With 94.6 %, a high prevalence of wound infections resulting from bacterial and fungal pathogens could be determined. Although infection rates were highest in chronic wounds, a high prevalence (24.9 %) of hospital-acquired surgical-site infections was also demonstrated. Infected wounds were mainly of polymicrobial composition. With more than 60 %, the majority of pathogens were gram-negative bacteria consisting of Enterobacterales and non-fermenters. Nearly every third wound was infected with grampositive bacteria. The majority of S. aureus was shown to produce the virulence factor PVL. Together with the already high rates of combined fluoroquinolone and cephalosporin resistance in most gram-negative bacterial species found in wound infections, the novel appearance of PVL-positive MRSA and new emergence and nosocomial spread of carbapenem-resistant A. baumannii in the study region are worrying. Anaerobic and fungal pathogens requiring challenging polymicrobial diagnostics were detected in small numbers, including metronidazole-resistant B. fragilis. While sequence typing has revealed new A. baumannii strains, it can only be assumed that lack of diagnostics, improper treatment and widely available over-the-counter antibiotics are contributing factors to the rise of new antibiotic resistances. Together, these results emphasize the importance of permanent availability of local microbial diagnostics and continuous surveillance of the local resistance situation. Still not completely resolved is the precise reason for the emergence of new antibiotic resistances. Finally, access to effective antibiotic drugs according to specific resistance profile needs to be established.
Keywords: Microbiology; Antimicrobial resistance; Herbal medicine; Wound infection; Ghana; AMR; Carbapenemase; MRSA; Acinetobacter baumannii; Clinical Microbiology; Tropical medicine; Alchornea cordifolia; Polymicrobial infection; PVL; chronic wounds; traditional medicine