ANTIMICROBIAL RESISTANCE PATTERN OF MICROBIAL FLORA OF SKIN AND NOSE OF HEALTH CARE WORKERS AND NON HEALTH CARE WORKERS

ABSTRACT

The normal flora of healthcare workers may serve as reservoirs for causing healthcare associated infections (nosocomial infections). Nosocomial(hospital- acquired) infections are those infections arising from hospital environment or patients own microflora, or inadequately sterilized  equipments.  Swabs were obtained from the skin and nose of healthcare workers and non healthcare workers respectively. Samples were analyzed using Blood agar and Macconkey agar. After identification of bacteria, the disc diffusion techniques of antimicrobial susceptibility testing was performed on all the isolates. Among microbial isolates recovered from our participants, the commonest isolates among healthcare workers were staphylococcus aureus with prevalence of 83.3% while Staphylococcus aureus prevalence in non healthcare workers was 75%. whereas the least isolates recovered from healthcare workers was Streptococcus species with prevalence of 12.5% and Pseudomonas aeruginona was not isolated from non healthcare workers. The result of antimicrobial susceptibility test shows a multi-drug resistant to the antimicrobial agents among healthcare workers compared to non-healthcare workers.

TABLE OF CONTENTS

COVER PAGE

TITLE PAGE

CERTIFICATION      -           -           -           --         -           -           -            -           -           i

DEDICATION           --         -           -           -           -           -           -            -           -           ii

ACKNOWLEDGEMENT      -           -           -           -           -           -            -           -           iii

TABLE OF CONTENTS       -           -           -           -           -           -            -           -           iv

LIST OF TABLES     -           ---        -           -           -           -           -            -           -           vi

LIST OF FIGURES    -           -           -           -           -           -           -            -           -           vii

ABSTRACT  -           -           -           -           -           -           -           -            -           -           viii

CHAPTER ONE

1.0           INTRODUCTION      --         -           -           -           -           -            -           -           1

1.1       AIM AND OBJECTIVES      -           -           -           -           -            -           -           2

CHAPTER TWO

2.0           LITERATURE REVIEW       -           -           -           -           -            -           -           3

2.1       NOSOCOMIAL PATHOGENS AND SITES OF INFECTION                  -           -           4

2.1.1    Emergence and Risk group of Nosocomial Infection -           -            -           -           6

2.2       CHARACTERISTICS OF STAPHYLOCOCCUS AUREUS -            -           -           7

2.2.1    Mode of reproduction             -           -           -           ---        -            -           -           8

2.2.2    Roles in causing diseases        -           -           -           -           -            -           -           8

2.2.3    Skin infections            -           -           -           -           -           -            -           -           9

2.3       SPECIES OF PSEUDOMONAS       -           -           --         -            -           -           9

2.4       SPECIES OF STREPTOCOCCI         -           -           -           -            -           -           10

2.5       ANTIBIOTIC RESISTANCE AND MECHANISM             -            -           -           11

2.6       CAUSES OF ANTIMICROBIAL RESISTANCE    -           -            -           -           11

2.6.1    Biological causes        -           -           -           -           -           -            -           -           12

2.6.2    Societal Causes           -           -           -           -           -           -            -           -           12

2.6.3    Antibiotics resistance of Staphylococcus aureus       -           -            -           -           13

2.6.4      Methicillin resistant Staphylococcus aureus (MRSA)          -           -           -           13

2.6.5      Mode of transmission            -           -           -           -           -           -           -           13

2.7     PREVENTION AND CONTROL         -           -           -           -   -           -           14

CHAPTER THREE

3.0           MATERIALS AND METHODS       -           -           -           -            -           -           16

3.1       SOURCE OF SAMPLES       --         -           -           -           -            -           -           16

3.2       SAMPLE COLLECTION      -           -           -           -           -            -           -           16

3.3       MEDIA PREPARATION      -           -           -           -           -            -           -           17

3.4       ISOLATION OF BACTERIA            -           -           -           -            -           -           17

3.4.1    Characterization and identification    --         -           -           -            -           -           17

3.5       ANTIBIOTIC SUSCEPTIBILITY TEST      -           -           -            -           -           17

3.6       GRAM–STAIN REACTION -           -           --         -           -            -           18

3.7       BIOCHEMICAL TEST FOR FURTHER IDENTIFICATION             -           -           19

3.7.1    Catalase test    -           -           -           -           -           -           -            -           -           19

3.7.2    Coagulase test                         -           -           -           -           -            -           -           19

3.7.3    Oxidase test    -           -           -           -           -           -           -            -           -           20

3.7.4    Motility test    -           -           -           --         -           -           -            -           -           20

3.7.5    Citrate utilization test -           -           -           -           -           -            -           -           20

CHAPTER FOUR

4.0       RESULTS       -           -           -           -           -           -           -            --         -           21

CHAPTER FIVE

5.0       DISCUSSION -           -           -           -           -           -           -            -           -           29

5.1       CONCLUSION          -           -           -           ---        --         -            -           -           30

5.2       RECOMMENDATION          -           -           -           -           -            -           -           31

REFERENCES

                                              LIST OF TABLES

Table             Title                                                                 Page

1                      Antibiotics used and their concentration        -           -            -           -           18

2                      Morphorlogical identification and biochemical                                             23                                characterization  of isolates

3                      Frequency of occurrence of bacteria isolates from skin             -           -           24

                        and nose of healthcare workers

4                      Frequency of occurrence of bacteria isolates from skin                   -           25

                        and nose of non healthcare workers

5                      Antimicrobial resistant pattern of isolates from skin and                 --         27

                        nose of healthcare workers    

6                      Antimicrobial resistant pattern of isolates from skin and                 -           28

                        nose of non healthcare workers.

LIST OF FIGURE

Fig 1:  Frequency of occurrence of different types of isolates           -            -           -           25

             recovered from skin and nose of both HCW and NHCW

CHAPTER ONE

1.0        INTRODUCTION

Antimicrobial resistance of bacteria is a worldwide and ever growing problem, directly linked to the use of antimicrobial drugs. Resistant bacteria emerge under the selective pressure of antibiotics. In hospital, where large-scale usage of antibiotics is common, bacteria resistant to several antibiotics frequently occur and generate serious problems for the treatment of patients with infections by these microorganisms. Well known multi-resistant bacteria causing problems in many countries all over the world are Methicillin –resistant Staphylococcus aureus , Vancomycin-resistant enterococci, extented-spectrum betalactamase Acinetobacter baumannii, and multi resistant Mycobacterium tuberculosis. (Comaglia et al, 2004).

To reduce the problem of antimicrobiaj resistance, action should be taken along two tracks: promotion of the prudent use of antibiotics and prevention of the spread of resistant bacteria . With this, the prevention of antimicrobial resistance becomes the reponsibility of every healthcare workers.

The resident skin flora is the physiological skin flora, also known as colonising flora. It comprises bacteria such as S.epidermidis, Propioni and Corynebacteria, which do not have a pathigenic effect on the skin. The microoganisms have important functions: there metabolism inhibits the growth of non-resident bacteria and fungi, and maintain the balance between the colonizing  microorganism. Around 80% of the resident skin flora is on the surface 0f the stratum corneum, the outermost layer of the epidermis. Particularly high concentrations of microorganism are found in body regions rich in sebaceous glands, e.g scalp, forehead, axillae, front of the chest, and the area between the shoulder blades.

Nosocomial infections (NIs) are regarded as the main global concern and their prevalence rates are variable based on some factors, however, about one-third of Nosocomial infections are preventable (Kampf, and Kramer, 2004) Staphylococcus aureus has been recognized as an epidemiologically important pathogen. They are responsible for most infections: the genus has at least 30 species. The main three important species are the S. aureus, S. epidermis and S. saprophyticus. Of all these species, S. aureus is the major pathogen for humans. Its pathogenic effect is characterized by its ability to haemolyze blood, coagulate plasma and produce a variety of extracellular enzyme and toxins. S. aureus is present in the nasal passage and throat, on hair and skin of healthy individual (Makoni, 2002).

The most important method for Nosocomial infection control is hand hygiene because hand washing helps reduce the transmission of skin micro flora originating from hand and nose of health care workers (HCWS) particularly the nurses (Polin and Saiman, 2003). These microorganisms include resident, transient and infections flora (Eksi et al, 2010). Moreover, the flora of the hands of health care work vary by work setting and differ from non health care workers (NHCWS) (Cimotti et al, 2004). Factors such as temperature, moisture and work environment can affect the number and types of flora found on Health care workers hand.

Despite antibiotics therapy, Staphylococcus infections occur and has severe consequences methicillin resistant to most antibiotics. Methicillin was introduced in 1959 to treat this infection but in 1961, shortly after the f methicillin, Staphylococcus aureus isolate which had acquired resistance to methicillin was reported.

1.1       AIM AND OBJECTIVES

1.         To isolate and characterize the most common aerobic bacteria flora recovered from the      skins and noses of a health care workers and non health care workers.

2.         To determine the antimicrobial resistant pattern of both healthcare workers and non healthcare workers.

3.         To compare the antimicrobial resistant pattern between healthcare workers and non healthcare workers.

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