Antibiogram Of Wound Isolates Of Patients Attending Rivers State University Teaching Hospital
Surgical wounds are one of the major sources through which bacteria pathogens gain access into internal tissues. The study is therefore aimed at determining the antibiogram of wound isolates of patients attending Rivers State University Teaching Hospital. Fifty samples were collected from the patient using sterile swab stick, inoculated on the prepared nutrient agar, incubated for 24 hours, morphologically observed, biochemically characterized and investigated for antibiotic sensitivity. The result for the proximate analysis indicated that thirty samples were contaminated with bacteria. Out of the 30 positive samples, three Gram negative bacteria which include Pseudomonas aeruginosa, Escherichia coli and Klebsiella ozaenae, and four Gram positive bacteria which include Staphylococcus aureus, Streptococcus pyogenes, Streptococcus agalactiae and Clostridium perfringens were isolated. The result revealed that Staphylococcus aureus has the highest prevalence, isolated from 14 samples (46.67%) followed by Pseudomonas aeruginosa, isolated from 6 samples (20%), both Streptococcus agalactiae and Streptococcus pyogenes were isolated from 3 (10%) different samples each, Escherichia coli was isolated only from 2 samples (6.67%), whereas Clostridium perfringens and Klebsiella ozaenae were isolated from just a sample (3.33%) each. From the susceptibility analysis, Klebsiella ozaenae showed the highest percentage of susceptibility and resistance to the antibiotic disk among the Gram negative while Clostridium perfringens showed the highest percentage of the sensitivity to the antibiotic disc out of the Gram positive bacteria isolates.
Table of Content
- 1.1 Background to the Study
- 1.2 Statement of the Problem
- 1.3 Objectives of the Study
- 1.4 Research Question
- 1.5 Research Hypothesis
- 1.6 Significance of the Study
- 1.7 Scope of Study
- 1.8 Limitation of the Study
- 1.9 Definition of Terms
- 1.10 Organisation of the Study
2.0 Literature Review
- 2.1 Conceptual Framework
- 2.2 The Wound Healing Process
- 2.3 Factors Influencing Delayed Wound Healing Among Surgical Patients
- 2.4 Post-Operative Wound Infection
- 2.5 Influence of Micro-Organisms in Wound
- 2.6 The Role of Microbes in Chronic Wounds
- 2.7 Infection Status of Chronic Wounds
- 2.8 Antimicrobial Treatment of Chronic Wounds
- 2.9 Recommendations for Antibiotic Treatment
- 2.9.1 Antibiotic use in Clinical Practice
3.0 Materials and Methods
- 3.1 Study Design and Area
- 3.2 Sample Collection
- 3.3 Serial Dilution
- 3.4 Inoculation of Sample on Media
- 3.5 Morphology Characteristics
- 3.6 Characterization and Identification of Bacteria Isolates
- 3.7 Antibiotic Susceptibility Test
4.0 Results and Discussion
- 4.1 Result
- 4.2 Discussion of Findings
5.0 Summary, Conclusion and Recommendation
- 5.1 Summary
- 5.2 Conclusion
- 5.3 Recommendation
1.1 Background to the Study
The skin is one of the major impediments to the establishment of infections by bacteria pathogens in internal tissues (first line of defense) meanwhile wounds results in physical disruption of the skin, creating a medium through which these pathogens can access the internal tissues (Mehta et al., 2007). The most common underlying event for all wound is trauma. Trauma may be accidentally (accidents) or intentionally (hospital acquired wounds) induced never the less, wound infections are grouped according to how they are acquired. Wound infection is increasingly becoming a serious problem due to the current increase and spread of multi-drug resistant organisms (especially bacteria pathogens). Surgical Site Infection (SSI) has long been recognized to cause serious threat in the field of surgery, as surgical interventions has often resulted to infection, thus, patient mortality was almost becoming inevitability. This has necessitated the need to minimize direct and indirect contamination of the surgical equipments and environments. More so, developing infection control systems, new and safer surgical procedures and techniques, antibiotics and the understanding of the body’s immunological response to bacterial infection has greatly minimized SSI and consequently reduced patient mortality (Bouchillon, Johnson, & Hoban, 2004). However, post operation wound infections still remains an issue. Opportunistic bacterial and normal body flora has been discovered to play significant role in contamination of surgical wounds infections creating favourable environments for other pathogens and parasites. Some of the notable Gram positive bacteria are the β-hemolytic streptococcus, Streptococcus pyogenes and Staphylococcus aureus. Nevertheless the establishment of infection on surgical wounds depends greatly on the complex interaction of many factors such as microbial virulence, patient risk factor like diabetes, cigarette smoking, obesity and coincident remote site infection or colonization (Altekruse, McGlynn, & Reichman, 2009) and operation-like risk factors including prolonged hospital stay before surgery, duration of the operation, tissue trauma, poor homeostasis and foreign materials in the wound.
Post-operation wound infections in most cases are hospital acquired (nosocomial infection) and sometime from other surgical complications (Masaadeh, & Jaran, 2009). The spread and increase in antibiotic resistance among pathogenic organisms associated with surgical site infection is also becoming a very serious challenge to the field of surgery (Akinjogunla, Inam, & Aseel, 2011). The pattern and mode of antibiotic resistance is a worldwide challenge, especially in developing countries making antimicrobial agent increasingly less effective thereby, increasing multiple drug resistant pathogens in hospitals and community, increasing morbidity, decreasing treatment success, reducing hospital turn-over rate as well as increasing cost of patient care (Alebachew, Sogebi, & Fatugase, 2013). High incident was recorded as children surgical patients in Nigeria reported high surgical wound infection.
1.2 Statement of the Problem
A myriad of substances such as antibiotics, synthetic drugs are used in the hospitals for treatment (Akubuenyi et al., 2011) in addition to formulated drugs. Ruseel and Path (2001) are of the opinion that acquired resistance to antibiotics may arise by cellular mutation or by acquisition of genetic elements in the form of plasmids. According to Akubuenyi et al. (2011), the occurrence of strongly selective environments such as hospitals promotes not only the growth of resistant bacteria, but also leads to an increase in the frequency of resistance bacterial genes and genetic elements such as plasmids.
There is dearth of information on the antibiogram profile of bacteria isolated from wounds of patients visiting hospitals in Anyigba, a University town of over 130,000 populations (National Population Commission, NPC, 2006). Bacterial resistance creates clinical problems for physicians (Phol, 2007). The aim of this study therefore, was to identify the bacterial isolates found in wounds and establishes their antibiogram profile with a view to provide information for health workers, managers and administrators of health centres in Anyigba and environs. Thus, this research study is conducted to determine the antibiogram of wound isolates of patients attending Rivers State University Teaching Hospital.
1.3 Objectives of the Study
The aim of this study is to determine the antibiogram of wound isolates of patients attending Rivers State University Teaching Hospital.
Specifically, the objectives of the study include to;
- To determine the prevalence and antibiotic susceptibility pattern of bacteria isolated from infected surgical wounds of patients
- To carry out isolation and morphological identification of bacteria isolated from such surgical wounds
- To identifying and investigate the antibiotic sensitivity of bacteria by Gram staining biochemical test, culturing and use of sensitivity test discs
1.4 Research Question
The following research questions are formulated to guide this research:
- What is the prevalence and antibiotic susceptibility pattern of bacteria isolated from infected surgical wounds of patients?
- What is the isolation and morphological identification of bacteria isolated from such surgical wounds?
- What is the antibiotic sensitivity of bacteria through Gram staining biochemical test, culturing and use of sensitivity test discs?
1.5 Research Hypothesis
- HO1 There is no prevalence and antibiotic susceptibility pattern of bacteria isolated from infected surgical wounds of patients attending Rivers State University Teaching Hospital
- HA1 There is prevalence and antibiotic susceptibility pattern of bacteria isolated from infected surgical wounds of patients attending Rivers State University Teaching Hospital
1.6 Significance of the Study
An antibiogram is an overall profile of antimicrobial susceptibility testing results of a specific microorganism to a battery of antimicrobial drugs. Only results for antimicrobial drugs that are routinely tested and clinically useful should be presented to clinicians. The result of this study will help guide the clinician and pharmacist in selecting the best empiric antimicrobial treatment in the event of pending microbiology culture and susceptibility results as it pertains to post-operative wounds among patients. It will also help in detecting and monitoring trends in antimicrobial resistance.
Furthermore, through the results of the antibiogram in this study it will help in fighting antibiotic-resistant organisms and identifying problematic pathogens in wound isolates.
1.7 Scope of Study
This study was carried out in Rivers State University teaching hospital. The target population were patients attending there. The study was limited to antibiogram of wound isolates of patients attending Rivers State University teaching hospital.
1.8 Limitation of the Study
Despite being a commonly-used, non-invasive and cost effective method, swabs might provide a poor specimen as compared to needle aspiration or tissue biopsy if not collected appropriately. Improper specimen collection affects the results obtained, often by reflecting normal skin flora and colonizing organisms, making it difficult to decide which organisms are the true pathogens. However, our results are not likely to be affected by this since the wound was cleansed thoroughly prior to swab collection. Moreover, the small sample size did not allow us to conduct advanced statistical analyses which could have potentially strengthened this study.
1.9 Definition of Terms
Is an overall profile of antimicrobial susceptibility testing results of a specific microorganism to a battery of antimicrobial drugs.
An injury to living tissue caused by a cut, blow, or other impact, typically one in which the skin is cut or broken..
Are bacterial species detected in wound.
Is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, psychologist, dentist, veterinarian, or other health care provider.
1.10 Organisation of the Study
This research work is organized in five chapters, for easy understanding it is broken down as follows:
- Chapter one kicks off with the introduction, which consists of the background of the study, statement of the problem, objectives of the study, research hypothesis, scope and significance of the study.
- Chapter two begins with the conceptual framework on which the study is based, the theoretical literatures and also the empirical literature and thus the review of related literature.
- Chapter three deals on the materials and methods used for the study.
- Chapter four concentrate on the data collection and analysis, interpretation and presentation of finding.
- Chapter five gives summary, conclusion, and recommendations made of the study.
5.0 Summary, Conclusion and Recommendation
Fifty wound swabs were analyzed within the period of two month, August to September 2021. The Table 1 shows the biochemical result of the isolated bacteria species, which revealed that only thirty out of the fifty wound samples that were analyzed showed the presence of bacterial. Out of the 30 samples that showed the presence of bacteria, three bacteria were Gram negative bacteria which include Pseudomonas aeruginosa, Escherichia coli and Klebsiella ozaenae. While four other bacteria were Gram positive which include Staphylococcus aureus, Streptococcus pyogenes, Streptococcus agalactiae and Clostridium perfringens. The Table 2 shows the colony forming units (cfu/mL) count of the isolate bacteria from plate count of the dilution factor. This revealed that sample 28 has the highest mean (cfu/mL) of 9.9×106 followed by sample 12 which has a mean of 9.3×106 while sample 4 has the least mean (cfu/mL) of 1.2×106. The percentage occurrence of the different bacteria isolated as presented in Table 3 below indicated that Staphylococcus aureus was the most frequent with 14 (46.67%) isolates, this is followed by P. aeruginosa with 6 (20%) isolates. Clostridium perfringens and Klebsiella ozaenae which occurred least with 1 (3.33%) isolates. The Table 4 shows the susceptibility pattern of the Gram negative bacterial isolates to selected antibiotics, the table revealed that Pseudomonas aeruginosa showed 87.5% susceptibility each to Tarivid and Ceporax, 75% susceptibility to Ampicilin, Nalidixic acid and Reflacine but resistance to Ciprofloxacin and Augmentin (25%). E. coli on the other hand showed high susceptibility to most of the antibiotic used in this study Augmentin (90%), Septrin (90%), Tarivid (80%) Reflacine (70%), Nalidixicacid (70%) except for Ciprofloxacin which was slightly less effective (40%). However, Klebsiella ozanae exhibited 100% susceptibility to Tarivid, Reflacine, Gentamycin, and Septrin, but showed 0% susceptibility to Ampicillin and Ciprofloxacin. Table 5 shows the susceptibility pattern of the Gram positive bacteria. Staphylococcus aureus isolated is highly susceptible to Streptomycin (96%), Erythromycin (92.4%) and Levofloxacin (88%) but resistant to Gentamycin (80.7%), Choloramphenicol (82%) and Ampiclox (76.9%). In the case of Streptococcus pyogenes, the isolate exhibited 100% susceptibility to Ciprofloxacin and Levofloxacin and resisted Rifampicin (75%). Streptococcus agalactiae is 100% susceptible to Amoxicillin and Streptomycin. As observed in Streptococcus pyogenes, Streptococcus agalactiae was also 75% resistant to Rifampicin, Lastly, Clostridium perfringens is highly susceptible to Ciprofloxacin and Norfloxacin (100%) and as in the case of Streptococcus agalactiae, Clostridium perfringens was also sensitive to Amoxicillin (90%) and Streptomycin (40%) but at 90% susceptibility.
In Conclusion, the infection of surgical wound of patient in Rivers State University Teaching Hospitalis associated with Staphylococcus aureus and Pseudomonas aeruginosa as they were the most isolated bacteria from the samples studied, as this could have been acquired from the hospital, partly because most of the patients from whom this sample was collected had been admitted for at least 8 days and partly due to the fact that Staphylococcus aureus is one of the main flora on the skin and in the environment while Pseudomonas aeruginosa versatile characteristics allow it to be found in a variety of conditions and plates. As such it could be recommendation that due to high resistance of the organisms to antibiotic, sensitivity test should be regularly carried out to enhance rational use of antibiotic.
Choice should be made based on the sensitivity patterns, ability to penetrate tissue, low toxicity and no allergic reactions. The prescribed antibiotics should have the dose and duration clearly indicated and upon administration, it should be clearly marked on the patient’s treatment sheet. More so, treatment guideline for use of antibiotics should be formulated based on the hospital formulary and the sensitivity patterns. This should be reviewed frequently to ensure the rational use of antibiotics. Furthermore, prolonged hospitalization should be avoided to reduce the risk of hospital acquired infections.
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