Prevalence of wound infections and related antimicrobial resistance in Goma, Democratic Republic of the Congo: a multicenter cross-sectional study

BACKGROUND: The morbidity and mortality related to wound infections and microbial resistance are real public health concern in low-income settings where data are lacking, empirical antibiotic use is common and microbiological diagnostics are limited. This study aimed to describe the prevalence and antimicrobial resistance (AMR) patterns resulting from wound infections. METHODS: We conducted a one-year multicenter cross-sectional study across hospitals in Goma, Democratic Republic of the Congo. Consecutive patients with clinically infected wounds were enrolled. Wound swabs were processed using standard culture and susceptibility testing. Firth’s bias-reduced logistic regression was used to assess factors associated with surgical site infection (SSI) and AMR, with analyses stratified by Gram staining. RESULTS: Most patients were below 40 years old, with a median age of 27 years (IQR: 22–39), predominantly males (64.5%). Gunshot injuries (33.2%), road traffic accidents (24.5%) and cesarean section (14.8%) were the leading cause of wounds. SSIs accounted for 21.25% of all clinically diagnosed infected wounds; they were significantly associated with female sex (OR = 3.65, 95% CI: 1.18–11.92, p = 0.03) and abdominal surgery (OR = 272.92, 95% CI: 85.66–1208.58, p < 0.001). In female patients, a high rate of SSIs was observed following cesarean section (86.8%). Overall microbial swab cultures were negative in 21.0%. Among 18 isolated species, Gram-negative bacteria were predominant with Proteus mirabilis (24.1%), Pseudomonas aeruginosa (13.6%), and Escherichia coli (12.7%), as the leading pathogens. In Gram-stratified Firth models, empirical antibiotic therapy was not independently associated with increased in vitro AMR. Amikacin showed a protective association among Gram-negative isolates, while estimates for Gram-positive cocci were imprecise due to small sample size. Pseudomonas aeruginosa exhibited reduced susceptibility to multiple drug classes. CONCLUSION: Wound infections in Goma are largely linked to trauma and cesarean deliveries, with Gram-negative microorganisms dominating. The microbial ecology comprises ESKAPE pathogens and species known for their emerging resistance patterns such as Proteus mirabilis, Pseudomonas aeruginosa and Escherichia coli. Empirical antibiotic therapy was not independently associated with AMR after adjustment. These findings underscore the urgent need for enhanced diagnostic strategies, strengthened infection prevention measures, and effective antimicrobial stewardship in this resource-limited and conflict-affected setting.