Antibiotics Susceptibility Pattern Of Different Bacteria Associated With Wound Sepsis (A Case Study Of University Of Ilorin Teaching Hospital)

Antibiotics Susceptibility Pattern Of Different Bacteria Associated With Wound Sepsis (A Case Study Of University Of Ilorin Teaching Hospital)
Abstract
This work investigated the antibiotic susceptibility profile of bacterial associated with wound sepsis of patients attending University of Ilorin, Ilorin, Teaching Hospital. Wound swabs were collected from a total number of Hundred patients with different kinds of wound (surgical wound, burn, ulcers and pressure sores) and cultured, of which 72 samples showed bacterial growth. Six different species of bacteria were isolated. Staphylocococcus aureus (47.2%) Pseudomonas aeruginosa (19.5%), Klebsiella pneumonia (6.85%), Escherichia coli (15.3%), Staphylococcus epidemidis (5.6%) and Streptococcus pyogenes (5.6%). The antibiotics susceptibility test of these bacterial isolate was performed using the Kirby- bauer dist diffusion method. Gantamycin and Sreptomycin shows high effectiveness to all the isolate except Staphylococcus epidermis and Klebsiella with pefloxacin and ceftadine respectively showing sensitivity to them. Resistance were shown amongst Ampicillin, contrimoxazole and Tetracycline. This study has revealed Gentamycin as the only antibiotic to which most bacterial isolate from infected wounds were sensitive to. Ampicillin and penicillin were effective against Streptococcus pygenes while zinacef and ceftazidime shows high effectiveness against Klebsiella pneumonia.
KEYWORDS: wound infection: antibiotics susceptibility profile: staphylococcus aureus: gentamycin.
Table of Content
- Tile Page
- Approval Page
- Dedication
- Acknowledgment
- Table of Content
- List of Figures
- List of Table
- Abstract
Chapter One
1.0 Introduction
- 1.1 Background of the Study
- 1.2 Problem Statement
- 1.3 Justification
- 1.4 Aims and Objective
- 1.5 Significance
- 1.6 Limitations
Chapter Two
2.0 Literature Review
Chapter Three
3.0 Materials and Method
- 3.1 Sterilization of Materials
- 3.2 Sample Size
- 3.3 Collection and Processing Sample
- 3.4 Culture Media
- 3.5 Isolation of Cultures
- 3.6 Characterization of Bacteria Isolates
- 3.7 Colonial Morphology
- 3.8 Cellular Morphology
- 3.9 Biochemical Characterization
- 3.10 Antibiotics Sensitivity Test
Chapter Four
4.0 Results
Chapter Five
5.0 Discussion, Conclusion and Recommendation
- 5.1 Discussion
- 5.2 Conclusion
- 5.3 Recommendation
- References
List of Figures
- Figure 1: Frequency of Occurrence of bacterial from Wound Infection patient in University of Ilorin Teaching Hospital.
- Figure 2: Bacterial Isolate from patient with diabetic ulcers in University of Ilorin Teaching Hospital.
- Figure 3: Bacterial Isolated from patients with surgical wound in University of Ilorin Teaching Hospital.
- Figure 4: Bacterial Isolated from patients with burns in University of Ilorin Teaching Hospital.
- Figure 5: bacterial Isolated from patient with pressure sore in University of Ilorin Teaching Hospital.
List of Table
- Table 1: Morphological Characteristics, Staining Reaction and Biochemical Test
- Table 2: Frequency of Occurrence of bacteria from Wound Infection patient in University of Ilorin Teaching Hospital.
- Table 3: Bacteria pathogens causing wound infection in patients with Diabetic ulcers.
- Table 4: Bacteria pathogens causing wound infection in patients with Surgical Wound.
- Table 5: Bacteria pathogens causing wound infection in patients with Burns.
- Table 6: Bacteria pathogens causing wound infection in patients with Pressure Sore.
- Table 7: Antibiotic susceptibility Patterns of Staphylococcus aureus isolated from wound patients in UITH
- Table 8: Antibiotics susceptibility pattern of Pseudomonas aeruginosa isolated from wound in UITH
- Table 9: Antibiotic susceptibility pattern of Staphylococcus epidermidis in UITH.
- Table 10: Antibiotic Susceptibility pattern of Escherichia coli isolated from wound patients in UITH.
- Table 11: Antibiotic Susceptibility pattern of Streptococcus pyogenes isolated from wound patients in UITH.
- Table 12: Antibiotic Susceptibility pattern of Klebsiella pneumoniae isolated from wound patients in UITH.
Chapter One
1.0 Introduction
1.1 Background of the Study
A wound results following disruption of the skin which can be intentional or accidental (Giacometti, 2000).Wound infections cause a burden of disease and morbidity for both the patient and the health services. To the patient it causes pain, discomfort, inconvenience, disability, financial drain, and even death due to complications such as septicemia. It causes financial strain on the health services due to the required high cost of hospitalization and management of the patients.
A number of factors contribute to wound infection; however microorganisms are the major cause with bacteria being the most prevalent (Obuku, 2012). Early recognition of wound infection and appropriate management is important. Antibiotic therapy and surgical management are the cornerstone measures whereby antibiotics offer adjuvant treatment. Wound infection can be caused by single bacteria or multiple microorganisms. Surgical site infections are the second most common cause of nosocomial infections after urinary tract infections (Perencevich,2003) Most surgical site infections occur in ambulatory patients after discharge from the hospital and
therefore beyond the hospital infection control surveillance programs (Cosgrove, 2003). Prolonged preoperative hospital stay and exposure to diagnostic procedures has been associated with increased rate of surgical site infection. In clean surgical procedures, Staphylococcus aureus is the most common pathogen while Pseudomonas aeruginosa is the most common gram negative bacilli.
A number of studies indicate an increase in antibiotic resistant microorganisms in surgical patients. Resistant bacteria causes severe infections that are expensive to diagnose and difficult to treat. The mechanism by which resistance develops is complex and can result in multi-drug resistant bacterial strains due to simultaneous development of resistance to several antibiotics. Determination of local bacterial sensitivity patterns to antibiotics is important in providing a guide for antibiotic selection.
There are factors that increase the risk of wound infection which include patient characteristics such as; age, obesity, malnutrition, endocrine and metabolic disorders, smoking, hypoxia, anaemia, malignancies and immunosuppressants (WHO, 2007). Other factors are the state of the wound which includes nonviable tissue in the wound, foreign bodies, tissue ischaemia, and formation of haematomas, long surgical procedures, and contamination during operation, poor surgical techniques, hypothermia and prolonged pre-operative stay at the hospital.
Wound infections can be prevented by restoring blood circulation as soon as possible relieving pain, maintaining normal body temperature, avoiding tourniquets, performing surgical toilet and debridement of the wound as soon as possible, administration of antibiotic prophylaxis for deep wound and high risk infections (WHO, 2007). High risk wounds include contaminated wounds, penetrating wounds, abdominal trauma, compound fractures, wounds with devitalized tissue; high risk anatomical sites such as hands and feet. Antibiotic prophylaxis should be started two hours before the surgical procedures.
Establishment of the causative microorganism is important and treatment should be initiated based on the bacterial sensitivity patterns. Topical silver dressings have been used to treat infected wounds however; there is no evidence for their efficacy due to multiple microbial aetiologies. (Vermenlen, 2007). To achieve optimum antimicrobial therapy, the biofilm load should be reduced to enhance drug concentration at the wound site (Strup et al, 2013).
Bacterial wound infections are a common finding in open injuries. Severe and poorly managed infections can lead to gas gangrene and tetanus which may cause long-term disabilities (Bjarnsholt, 2013). Chronic infection can cause septicemia or bone infection which can lead to death. Sepsis associated encephalopathy increases morbidity and mortality especially in the ICU patients (Maramattom, 2007).
Infection is an important cause of morbidity and mortality in hospitalized burn patients in patients with burn over more than 40% of the total body surface area, 75% of all deaths following thermal injuries are related to infections (Vindence,2005). The rate of nosocomial infections is higher in burn patients (WHO, 2007)due to various factors like nature of burn injury itself, immunocompromised status of the patient (Preuitt,2008), age of the patient, extent of injury, and depth of burn in combination with microbial factors such as type and number of organisms, enzyme and toxin production, colonization of the burn wound site, systemic dissemination of the colonizing organisms (Preuitt,2004). Moreover the larger area of tissue is exposed for a longer time that renders patients prone to invasive bacterial sepsis. In extensive burns when the organisms proliferate in the eschar, and when the density exceeds 100,000 organisms per gram of tissues, they spread to the blood and cause a lethal bacterenia. Therapy of burn wound infections is therefore aimed at keeping the organisms’ burden below 100,000 per gram of tissues which increases the chances of successful skin grafting.
The denatured protein of the burn eschar provides nutrition for the organisms. A vascularity of the burned tissue places the organisms beyond the reach of host defense mechanisms and systemically administered antibiotics (Canton,2002). In addition, cross-infection results between different burn patients due to overcrowding in burn wards. Also thermal destruction of the skin barrier and concomitant depression of local and systemic host cellular and humeral immune responses are pivotal factors contributing to infectious complication in patients with severe burn (Maramattom,2007). Burn wound infections are largely hospital acquired and the infecting pathogens differ from one hospital to another. The burn wound represents a susceptible site for opportunistic colonization by organisms of endogenous and exogenous origin; thermal injury destroys the skin barrier that normally prevents invasion by microorganisms. This makes the burn wound the most frequent origin of sepsis in these patients (Anguzu, 2005). Burn wound surfaces are sterile immediately following thermal injury, these wounds eventually become colonized with microorganisms, gram-positive bacteria that survive the thermal insult, such as S. aureus located deep within sweat glands and hair follicles, heavily colonize the burn wound surface within first 48h (Oduyebo, 2008). Topical antimicrobials decrease microbial overgrowth but seldom prevent further colonization with other potentially invasive bacteria and fungi. Gastrointestinal and upper respiratory tract and the hospital environment ( Hansbrough,2007). A susceptible site for opportunistic colonization by organisms of endogenous and exogenous origin; Following colonization, these organisms start penetrating the viable tissue depending on their invasive capacity, local wound factors and the degree of the patient s immunosuppression. If sub-eschar tissue is invaded, disseminated infection is likely to occur, and the causative infective microorganisms in any burn facility change with time Individual organisms are brought into the burns ward on the wounds of new patients. These organisms then persist in the resident flora of the burn treatment facility for a variable period of time, only to be replaced by newly arriving microorganisms. Introduction of new topical agents and systemic antibiotics influence the flora of the wound (NCCLS, 2000). The aim of the present study was to obtain information about the type of isolates, identification and antimicrobial sensitivity of bacterial wound infections in burn patients.
Most wound infections can be classified into two major categories; skin and soft tissue infections although they often overlap as a consequence of disease progression. Infections of hospital acquired wounds are among the leading nosocomial causes of morbidity a4nd increasing medical expense .Routine surveillance for hospital acquired wound infection is recommended by both the centers for disease control and prevention and surgical infection society .
The most useful classification of wound from a practical point of view is the rank and wakefield classification (Russell et al., 2004) which classified wounds into tidy and untidy wounds. Tidy wounds are inflected by sharp instrument and contain no devitalized tissue. Examples are surgical incisions, cut from glass, knife and machete. Skin wounds will usually be single and clean cut. Untidy wounds results from crushing, tearing, avulsion, vascular injury or burns and contain devitalized tissue skin wounds will often be multiple and irregular.
Open wounds (Wikipedia, 2007) can be classified into a number of different types according to the object that caused the wound. Types of open wound include: incision or incised wounds, laceration, abrasions (grazes) puncture wounds and gunshot wounds, penetration wounds and gunshot wounds. Closed wounds have fewer categories but are just as dangerous as open wounds. The types of closed wounds include: contusion, hematoma, crushing injuries. Bruise, contusion and Hematoma: a closed blunt injury may result in a bruise or contusion. There is bleeding into the tissue and visible discoloration where the amount of bleeding is sufficient to create localize collection in the tissue, it is described as hematoma.
Puncture wounds and Bites:
Puncture wound is an open injury in which foreign materials and organisms are likely to be carried deeply into the underlying tissues. A major danger is that they may give rise to an abscess. They are caused by an object puncturing the skin such as nail or needle.
Abrasion and Friction Burn:
Is a shearing injury of skin in which the surface is rubbed off. Most are superficial and will heal by epithelization but some may result in full thickness skin loss. It is often caused by sliding fall unto rough surfaces.
Laceration:
Is the result of which a sharp object causing irregular wounds to soft tissues which lie over hard tissue.
Traction and Avulsion: Avulsion injuries are open where there has been a severe degree of tissue damage such injuries occur when hands or limbs are trapped in moving machinery such as rollers.
War wounds and Gunshot Injuries:
Are associated with different severity of tissue damage depending on whether the injury is of low or high velocity.
Crush:
Are further variant of blunt injury and are often accompanied by degloving and compartment syndrome (Wikipedia, 2007).
Ulcer:
Is any breach in an epithelial surface. Chronic ulcers (Example is leg ulcer seen in diabetes mellitus patient) are wounds that fail to heal.
Pressure Sore:
Is also known as decubitus ulcer. These are chronic wounds following tissue necrosis from pressure. They occur over bony prominences. They arise where there is unrelieved pressure in the soft tissue overlying bone such that the external pressure exceeds capillary perfusion and ischemic necrosis occurs.
Burns:
Are tissues from thermal (heat or cold) application or from the absorption of physical energy or chemical contact. Types include scalds, fat burn, flame burns, electrical burns, cold injury, friction burns, cognizing radiation and chemical burns (Russell et al.,2004)
The cell wall of bacteria consists of toxic lip polysaccharides called end toxins. Many of these bacteria endotoxin are bactericidial or bacteriostatic to related species of bacteria, but not themselves. The concept of that substances derived from organisms may kill another (Antibiosis) is almost as old as the science of microbiology (Bud, 2005). More than 3000 years ago ancient people stumbled over the discovery that some India of Central America use mould to treat rashes and infected wounds.
In the 1860s, Louis Pasteur showed that many diseases were caused by bacteria. Later he discovered that he may be able to fight germs with other miocrobes. It was two German doctors who were the first to make an effective medication from microbes; Rudolf Emmerich and Oscar Low conducted their experiment in the 1890s. They proved that the germs that would cause one diseases may be cure for another. A medication called pyocyanase was created from Bacillus pyocyaneus and it was effective in killing the organism that caused cholera, typhoid, diphtheria, and anthrax. It was the first antibiotic to used in hospital.
The antibiotic properties of penicillin spp. were first described in France by Ernest Duchesne in 1897. However, his work went by without much notice from the scientific community until Alexander Fleming’s discovery of penicillin. Modern research on antibiotic therapy began in Germany with the development of the narrow-spectrum antibiotic salvarasan by Paul Ehrlich in 1909 for the first time allowing an efficient treatment of the widespread problem of syphilis. The drug was also an effective against other spirochaetal infected. The invention of the sulfa drug followed that of penicillin. Sulfa drug comes from prontosil. Which is a substance used as a dye. It has been proven that this drug could cure pneumonia, scarlet fever and blood poisoning, (Berkow, 1999). In the 1930s other laboratories started making other drugs in the same family. An American, Doctor Selman Waksman discovered a drug called streptomycin. It originated from microbes found in soil and was a cure for many intestinal diseases. Auremycin a broad spectrum antibiotic was discovered and it was found that it could do the job of both penicillin and streptomycin. Another laboratory discovered chloromycin. In 1949, another laboratory came up with one of most effective antibiotics ever found, Tetracycline. This drug could be used against many bacteria diseases (Skerrft and Stratton, 2006).
Antibiotics can be obtained from microorganisms, plants or could he synthetically produced, an antibiotic is an antimicrobial substance produced by a living micro-organism and active in high dilution (Thomas, 1988). It was defined as a metabolism product of one organism that is detrimental or inhibitory to other organism in very small amount by Daniel in 1992. Antibiotic is a product of the metabolism of a micro organism that is inhibitory to other micro organisms. Antibiotics was originated referred only to substance extracted from fungus or other organisms but it has later come to include many synthetic and semi-synthetic drugs that have antimicrobial or antibacterial effects (Wikipedia, 2007)
The effectiveness of antibacterial agents is influenced by a number of factors. The concentration if it will be bacteriostatic or bactericidal. The d\time of exposure and type of organism; the longer the contact time, the greater would be the number of organisms killed. Organisms which clump together take a longer time to kill than organisms that occur once. Temperature can also influence antimicrobial activity.
Antibiotics may be categorized (Brooks et al., 2003) according to their spectrum of activity or mode of action; Broad (affect both Gram Positive and Gram Negative),Narrow(effect against only one group of organism) or Limited(effective against only one or very few bacteria).They may be classified on the basis of their mode of action(ability to interfere with protein synthesis, structure and function of cytoplasmic membrane, DNA synthesis, or inactive of metabolic pathways). On the basis of their chemical structures they are classified as macrolides (erythromycin), carbohydrate containing antibiotic (aminoglycosides), aromatic antibiotic (chloraphenicol), quinines (tetracycliune), etc.
Resistance to antibiotic is achieved by the pathogens through the following way (CDC, 2004;Prescott et al 2003)
- By pumping the antibiotic out of the cell after it has entered. This pumps is known as multidrug –resistance pumps. Pathogens with this pumps are Escherichia coli, Pseudomonas aeruginosa and Staphylococcaus aureus.
- Some pathogen act by inactivating antibiotics through chemical modes. Examples include penicillin’s enzyme action on beta lactam ring of penicillins, phosphorylation of amino glycosides and acetylating of amino glycoside and chloramphenicol.
- Another way in which resistance to antibiotic is achieved is through the modification of the target sites in the pathogen mutation. This is exhibited in streptomycin resistance by Escherichia coli.
- Some bacteria lack target structures which antibiotics can attack. An example is seen in Mycoplasma which lack bacterial cell wall hence their resistance to penicillin’s.
- By preventing entrance of the antibiotic into the cells. This is seen in penicillin resistant gram negative pathogens.
The gene responsible for antibiotic resistance is located on the plasmid and chromosome in the pathogen (CDC, 2007).
1.2 Problem Statement
Septic wounds are a common cause of morbidity. Despite improvement in the practice of medicine and attempts to provide aseptic conditions in the surgical wards, the incidences of wound infection are increasing. Management of wound infection remains a challenge in the surgical areas with the increasing resistance to antimicrobials Antimicrobial resistance can lead to complications which depend on severity that cause disability or death and increased cost of hospitalization and management. In children, this impacts negatively on the quality of life at a tender age. The antibiotic sensitivity patterns have not been studied fully especially in the surgical pediatric patients at University of Ilorin Teaching Hospital. Inappropriate antimicrobial use is associated with increased resistance. It was therefore important to identify the causative organisms and determine the antimicrobial sensitivity patterns to help reduce infections and ensure appropriate use of antimicrobials.
Purpose of the Study
Wound infection is a common problem in children, proper management with appropriate antibiotics is therefore important to reduce morbidity that may arise. This study aimed to determine the aetiology and antimicrobial sensitivity patterns of bacteria that cause wound infections in the surgical paediatric patients at University of Ilorin Teaching Hospital. Antibiotic misuse and overuse can lead to resistance which necessitated the need for the study.
1.3 Justification
Wound is considered one of the major health problems in the world and infection is one of the most frequent and severe complications in patients who have sustained wounds.
This study is based on understanding that bacteria are responsible for delayed wound healing and the so called normal flora of the skin can become pathogenic. This study will not only identify the bacteria but also perform antibiotics susceptibility test on each them so as to know the drug that will be effective against a particular bacteria present in the wound.
1.4 Aims and Objective
The main objective of this study was to identify the bacteria that cause wound sepsis and their sensitivity patterns in eastern and western part of Ilorin at the University of Ilorin Teaching Hospital.
Specific Objectives
The specific objectives were:
- To determine the prevalence of wound infection in the paediatric surgical wards in University of Ilorin Teaching Hospital.
- To identify the bacteria that cause wound infection.
- To determine the antimicrobial sensitivity patterns of the isolated bacteria
- To find out the antibiotics used in management of wounds in the paediatric surgical wards in University of Ilorin Teaching Hospital.
1.5 Significance
The findings of the study was to help in choosing appropriate antibiotics by considering the sensitivity patterns that were observed, hence appropriate management of the infected wounds.
This would result in a cost effective therapy for the patient and reduced financial burden of hospitalization.
1.6 Limitations
Wound infections are caused by a number of microorganisms which include bacteria, fungi and viruses. This study was only able to address sepsis caused by aerobic bacteria and anaerobic bacteria. The study was not able to address the factors that contribute to resistance patterns that were observed.
Chapter Five
5.0 Discussion, Conclusion and Recommendation
5.1 Discussion
Wound is known to be one of the major health problems in the world, and infection is one of the most frequent and severe complications in patients who have sustained wound (Zogani et al. 2002). Out of 100 cases of wound studied in University of Ilorin Teaching Hospital 72 isolates were positive , while 28 isolates were negative the pattern of bacteria pathogens causing wound infection in University of Ilorin Teaching Hospital showed that Staphylococcus aureus was the most prevalent accounting for 34( 47.2%) of the total 72 isolates followed by Pseudomonas aeruginosa 14(19.5%), Klebsiella pneumoniae accounts for 5(6.85%), E.coli accounts for 11(15.3%), Staphylococcus epidermidis 4(5.65%) and S.pyogenes has the same numerical rate with Streptococcus pyogenes accounting for 4 (5.65%). Staphylococcus aureus has the highest prevalence rate while S. Pyogenes and S.epidermidis has the least prevalence rate.
The study is in compliance with the works done by various researchers all over the world which include that done in Saudi Arabia by Twun et al.,(2002) in which Staphylococcus aureus was the predominant organism. This research work is also relatively related with the reports done in Tanzania. (Vargas et al.,2004).
The result shows that different bacteria are associated with different types of wounds. It also shows the presence of Staphylococcus aureus in almost all the wounds studied. Its prevalence may be due to noscomial infection and poor hygiene under which the patients are managed. It could be because Staphylococcus aureus is more prevalent in nature in both as normal flora and pathogenic organism. This could also be due to the ubiguitousnature of Staphylococcus aureusand the ability to adapt to any environment. It was isolated from the samples taken from patient with diabetic ulcer, surgical wound, burn and pressure sore.
Staphylococcus epidermidis, another member of the Staphyloccal family which is differentiated from Staphylococcus aureus by its white colouration and it being coagulase negative (-ve) as compared to Staphylococcus aureus being yellow and it is coagulase positive. It was also isolated from patients with Diabetic ulcer and surgical wound. It is a bacterium common to infection involving the skin because of it being a normal flora of the skin.
Pseudomonas aeruginosa isolated from sample collected from patient with Diabetic ulcer, surgical wound, Burn and pressure sore. Its pressure in patients with pressure sore can be as a result of contamination with soil because most of the walls of the hospital are not properly plastered. Patients come in contact when they try to move, because they are versalite characterisitics.
E.coli are one of the normal human intestinal micro-flora. It was isolated from samples taken from the Diabetic ulcer, surgical wound, pressure sore seen patient with diabetic mellitus. Its presence may be as a result of contamination of the wound with contaminant from soil, contaminated water or sewage.
Klebsiella is a type of gram-negative bacteria that can cause different types of health care associated infection. It was isolated from sample collected from patient with surgical wound. It presence may be as a result of spread through perosn to person contact because it cannot be transmitted through air.
Streptococcous pyogenes, a member of the family Streptococi was isolated from sample collected from patient with ulcers and burns. It is one of the normal micro-flora of the human flora.
Susceptibility as described in Encyclopaedia microbiology as the interaction of an antimiorobial agent with its target microbe (Daniel 1992) If the microbe succumbs to the activity of the antimicrobial agents, it is considered as susceptible. If it does not, it is considered resistant to determine the susceptibility of the organism to the antimicrobial agent, the zones of inhibition were measured.
The bacterial isolates were varied in their response to the various antibiotics according to observation in Table 1-7.
In this study, Staphyloccoccus aureus was sensitive to Gentamycin, ciprofloxacin and cotrimoxazole. This is in accordance with the work of (Palle et al., 2004). Previous page in which Staphylococcus aureus was sensitive to Gentamycin. This work also reveals that Staphylococcus aureus tends to be resistant to a more antibiotics (Erythromycin and Rocephin). This findings is in agreement with the work of( Sani et al., 2013) and CDC who reported that clinical Staphylococci are resistant to multiple antibiotics multi drug resistance might be linked to high abuse resulting from constant and indiscriminate usage. Advances in control of infection have not completely eradicated the problem because of the development of resistance. In addition, natural products such as honey, sugar etc which have been shown to be broad spectrum topical antimicrobial agents, eradicating antibiotics resistant strains of bacteria from wounds (Denling, 2000) could play a significant role in treatment of wound infection.
Pseudomonas aeruginosa was sensitive to wide spectrum of antibiotics. It was sensitive to Gentamycin, Streptomycin, Ampicillin, Erythomycin and Ciprofloxin. This is in accordance with the result of (Nagowaet al., 2009) in which Gentamycin was the only antibiotics sensitive to the organism. Mean while Cefepime was the only antibiotic resistant to Pseudomonas aeruginosa. In other studies (Raja and Singh, 2007), reduced resistance to Ciprofloxacin was reported.
In this study, Staphylococcus epidermis was sensitive to Ciprofloxacin. This is in agreement with the work of (Manikanda and Amsath, 2013) in which Ciprofloxacin was 100% sensitive to Staphylococcus epidermidis.
Erythromycin, Gentamycin, Ampicillin and Ampiclox were resistance to this organism as stated in this study.
Escherichia coli showed resistant to Ampicillin, Erythromycin and Cotrimoxazole in this study. However, it was sensitive to Ciprofloxacin and Gentamycin. This sensitivity pattern is similar to the work of (Weber et al., 2009) which shows high sensitivity to Ciprofloxacin. Reduced antibiotics susceptibility pattern noted for Escherichia coli suggests its importance for hospital acquired infection, Ampicillin, Penicillin and Erythromycin sensitive to Streptococcus pyogenes as seen in this study, it is in strong agreement with the work of (Gracie et al., 2008) who has 51 (100%) of penicillin and 36 (70.6%) of Ampicillin. However, Choramphenicol which was resistant to the organism in this study is not supported by the work of (Graciaet al., 2008) that has 47 of the 51 strains sensitive to Chloramphenicol.
Klebsiella pneumoniae was sensitive to Ceftazidime. The aminoglycosides Gentamycin and Streptomycin binds to small ribosomal subunits and interfere with protein synthesis in at least (2) different ways (Brooks et al., 2003; Prescott et al., 2003)
- Directly inhibit protein synethesis
- Cause misreading of the genetic message carried by MRNA.
Erythromycin, Tetracycline and Chlormaphenicol which are all bacteriostatic and have a broad spectrum of activity. The Penicillin, Ampicillin are grouped under the B-lactam antibiotic and the work by inhibiting the enzyme leading to the blockage of complete Peptidogly can chains in the plasma membrane of the pathogen thereby causing osmotic lysis.
Ciproflaxin and Streptomycin form zones of inhibition that overlap each other, this suggests that both drugs can be used in Pseudomonas aeruginosa infected wound, in other words, both drugs work in synergy.
5.2 Conclusion
This research project has demonstrated the presence of pathogenic bacteria in wound, noting their distribution pattern, and also the antibiotic sensitivity especially in Ilorin where drugs are taking indiscriminately without prescription. The problem of resistance among previously sensitive strains has led to the development of new antibiotics which has improved resistance to many of the bacterial enzymes.
This study also strongly indicates that Gentamycin is an effective antibiotic as it is sensitive to almost all the isolates. Although it can used to treat bacterial infections particularly those caused by gram negative organisms. It is also effective against some gram positive organisms as revealed from this study.
5.2 Recommendation
The predominant rate of staphylococcus aureus as revealed by this research project is apparently high compared to other pathogens. It is therefore recommended that antibiotic therapy be instituted as a must so as to recommended the antibacterial therapy which gives the highest efficiency.
Short stay in the hospital is recommended to avoid nosocomial infection. Also the environmental conditions were patients with wound stay should be clean to avoid infection spread.
The walls of the patients ward should be properly plastered as this will reduce the contamination of wound (bed ridden patient in particular) with pathogens especially Pseudomonas aeruginosa.
The dressing materials must be new and clean with sterile solution. Also every wound should be dressed often and steady to avoid getting infection degeneration and putrefaction. Most organisms isolated were sensitive to Gentamycin and Streptomycin. This drug is recommended to patients with wound infection


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