Aetiological Agents Of The Wound Infections And Their Antimicrobial Susceptibility Pattern
Wound infection is a major concern among health care practitioners, not only in terms of increased trauma to the patient but also in view of its burden on financial resources and the increasing requirement for cost effective management within the health care system. This study was therefore designed to determine the aetiological agents of the wound infections and their antimicrobial susceptibility pattern from a tertiary care hospital. The research was conducted at the general microbiology laboratory of the Nnamdi Azikiwe University, Awka from June to August, 2017. The microbiological characteristics were achieved by gram staining while the biochemical tests include the catalase, coagulase, methyl red, indole, citrate utilization, sugar fermentation, and oxidases tests. The cultured and identified organisms were tested for their susceptibilities against various commercially prepared antibiotics using Kirby Bauer disc diffusion method. Klebsiellapneumoniae and Pseudomonas aeruginosa were the most common causes of wound infection with Escherichia coli as the least. There is need for serious and urgent intervention to stem the spread and further evolution of this resistance. Hospitals should be provided with adequate diagnostic facilities and well trained health personnel.
The primary function of intact skin is to control microbial population that live on the skin surface and to prevent underlying tissue from becoming colonized and invaded by potential pathogens (Ndipet. al., 2007). Exposure of subcutaneous tissue following a loss of skin integrity (i.e. wound) provides a moist, warm and nutritious environment that is conducive to microbial colonization and proliferation.
A wound is defined as any injury that damages the skin and therefore compromises its protective function. An acute wound is generally caused by external damage to the skin, including abrasions, minor cuts, lacerations, puncture wounds, bites, burns and surgical incisions. A wound is a breakdown in the protective function of the skin; the loss of continuity of epithelium, with or without loss of underlying connective tissue (Leaper and Harding, 1998). Wounds can be accidental, pathological or post operative. All wounds contain bacteria but majority of the wounds do no get infected. There are many variables that can promote wound infection when there is a discontinuity of skin barrier. This include both host and organism related factors like bacterial load and type, immune competence of host co-morbid like diabetes mellitus, etc (Mir et. al., 2012). An infection of this breach in continuity constitutes wound infection. Wound infection is thus the presence of pus in a lesion as well as the general or local features of sepsis such as pyrexia, pain and indurations.
Wound infections are one of the most common hospital acquired infections and are an important cause of morbidity and account for 70-80% mortality (Gottrupet al., 2005; Wilson et al., 2004). Wound infections can be caused by different groups of micro organisms like bacteria, fungi and protozoa. However, different micro organisms can exist in polymicrobial communities especially in the margins of wounds and in chronic wounds (Percevil and Bowler, 2001). Infection is one of the major causes of morbidity and mortality in hospitalized patients irrespective of the cause as it delays healing (Pondeiet al., 2013). It also causes longer hospital stay and increased expenses. In order to recognise early signs and symptoms of infections in a wound, whether complicated or not, skilled and vigilant team of doctors and paramedical staff is required (Moore andRomanelli, 2006).
Wound infections have been a problem in the field of surgery for a long time. Advances in control of infections have not completely eradicated the problem because of development of resistance. Antimicrobial resistance can increase complications and costs associated with procedures and treatment. An infected wound complicates the postoperative course and results in prolonged stay in the hospital and delayed recovery. Most bacteria live on our skin, in the nasopharynx, gastrointestinal tract and other parts of the body with little potential for causing disease because of first line defence within the body. Surgical operation, trauma, burns, diseases, nutrition and other factors affect these defences. The skin barrier is disrupted by every skin incision, and microbial contamination is inevitable despite the best skin preparation.
Knowledge of the causative agents of wound infection in a specific geographic region will therefore will be useful in the selection of antimicrobial for empirical therapy. Antimicrobial resistance can increase complications and costs associated with procedures and treatment (Anguzu and Olila, 2007).
Statement of Research Problem
Wound infections have been a problem in the field of medicine for a long time. The presence of foreign materials increases the risk of serious infection even with relatively small bacterial inoculums (Rubins, 2006). Advances in control of infections have not completely eradicated the problem because of development of resistance. Antimicrobial resistance can increase complications and costs associated with procedures and treatment.
Aims and objectives of the Study
This study was therefore designed to determine the aetiological agents of the wound infections and their antimicrobial susceptibility pattern.
Wound is a major concern among health care practitioners, not only in terms of increased trauma to the patient but in view of its burden on financial resources and the increasing requirement for cost effective management within the health care system. Bacterial contamination of wounds is a serious problem in the hospital especially in surgical practice where the site of sterile operation can become contaminated and subsequently infected. The results of current study are important as it provided evidence of organisms causing wound infection and their sensitivity pattern from a tertiary care hospital.
This study demonstrated a high prevalence (83.3%) of pathogenic bacteria in wounds. This high figure is consistent with that obtained from similar studies in Nigeria (Wariso and Nwachukwu 2003; Shittuet al., 2002). It is also consistent with that obtained from studies by Kemebradikumoet al(2013) which reported a prevalence of 86.1% but different from another study in East Africa reporting a prevalence of 70.5% (Mulugeta and Bayeh, 2011). These differences may be due to study design. The rates might be equally high if only wounds with a high suspicion of infection are investigated as opposed to all wounds. There was no association between the type of wound and the type of micro organism isolated. This is consistent with the research studies carried out at the Niger Delta University Teaching Hospital by Kemebradikumoet alin 2013. However, two previous studies by Okesola and Kehinde (2008), and Otokunefor T (1990), had associated specific micro organism with particular wound type. More studies are required to clarify this observation.
Many studies have shown that there are more cases of Gram negative aerobes as compared to Gram positive bacteria in the infected wounds. I also noted in my study that Gram negative bacteria were more common cause of wound infection as compared to Gram positive. My observation of Klebsiellapneumoniaeas the most common pathogen in wound infections is consistent with that obtained from similar study in Western Nigeria (Suleet al., 2002). However, studies carried out in Delta state by Kemebradikumoet alin 2013 reported Pseudomonas aeruginosaas the most commonly isolated pathogen while studies carried out in different parts of Nigeria observed Staphylococcus aureusas the predominant pathogen (Wariso and Nwachukwu, 2003; Egbeet al., 2011; Shittu and Kolawole, 2002). This is evidence of the existence of local and regional variability and shows that each health facility has to determine the prevalent micro organisms and other associated indices.
Most of these studies, including mine, are limited by the fact that anaerobic cultures were not done for a variety of reasons, the main one being a lack of equipment and funds. Thus anaerobic bacteria which are also important in wound infections could not be isolated.
Antibiotic resistance by the isolates to commonly prescribed antibiotic was not too high as compared to Kemebradikumoet al., (2012) whose studies showed a high resistance to antibiotics. The absolute resistance to taravid and rocephin by the isolates were not expected. The poor availability of antibiotics as well as their unregulated use and misuse, has been shown to contribute to increasing antimicrobial resistance in developing country (Hart and Kariuki, 1998).
The lack of diagnostic facilities in these developing regions encourages empirical treatment and over treatment which contribute to the increased resistance.
There was a high prevalence of wound infection and severe antimicrobial resistance in wound infections was observed in NAUTH, Nnewi, Anambra State of Nigeria. Klebsiellapneumoniaeand Pseudomonas aeruginosa were the most common cause of wound infection with Escherichia coli as the least. There is need for serious and urgent intervention to stem the spread and further evolution of this resistance.
A rigorous infection control policy combined with rational drug use play an important role in the fight against antimicrobial resistance. Therefore, hospitals and health centres should adhere strictly to this policy. Individuals on their own part should avoid buying over the counter drugs when the cause of the infection is not yet known. Hospitals should be provided with adequate diagnostic facilities and well trained health personnel.
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