Mapping sources and transmission of antibiotic resistant bacteria in post cesarean infections in Benin

The role of environmental reservoirs in antibiotic-resistant pathogens causing post-cesarean SSIs in low-resource settings remains unclear. This study assessed the sources of antibiotic-resistant bacteria linked to SSIs in a Beninese district hospital. Samples ( n = 164) were collected from surgical wounds, patient and healthcare worker hands, dressing materials, and hospital surfaces. Bacteria were identified, and their antimicrobial resistance was assessed using disk diffusion tests. Logistic regression was used to determine infection-associated factors ( p < 0.05). PCR was conducted to detect antibiotic resistance genes. Cluster analysis of the phenotypic characteristics of the isolates was performed. A total of 97 bacterial strains were isolated, including Gram-positive cocci ( n = 45) and Gram-negative bacilli ( n = 52). Gram-negative isolates showed high resistance to amoxicillin and amoxicillin-clavulanate (92.10%), while 71.74% of Gram-positive strains were resistant to amoxicillin and cefoxitin. PCR detected bla CTXM−15 in 44.23% ( n = 23) of Gram-negative strains and blaZ in 48.8% ( n = 12) of Gram-positive isolates. Cluster analysis suggests potential transmission of Coagulase-Negative Staphylococcus (CoNS), and Enterobacter cloacae between wound sites and the hospital environment or patients’ hands, based on shared resistance profiles. This study suggests possible links between environmental and patient reservoirs contributing to the circulation of resistant bacteria in the maternity ward, underscoring the need to address these potential transmission pathways in infection-control strategies.