ABSTRACT
The Isolation, Identification and antibacterial susceptibility pattern of pathogens from wound infections were carried out. A total of 50 wounds swabs were analyzed for isolation of pathogens. Patients with wounds included accidents, burns ad other skin wounds were investigated in this study. The most common pathogen isolated was Staphylococcus aureus representing 51.2% of the total isolates followed by Escherichia coli with 29.2% occurrence. Pseudomonas aeruginosa accounted for 5 (12.1%) of the overall isolates while Klebsiella species accounts for 7.31%. A greater percentage of the isolates were recorded in the skin infection patients with 23(56.0%) occurrences followed by the accidents and bums wound each accounting for 21.9%. Majority of the isolates were sensitive to Ofloxacin, gentamicin and Nitrofurantion while showing high level of resistance to other commonly used antibiotics like amoxicillin and Cloxacilin. It is imperative therefore to determine the clinically significant isolates, perform antimicrobial sensitivity testing and subsequently provide guidance on the most appropriate treatment. This assistance will not only facilitate successful wound management but also assist in the control of antibiotic usage and hence reduce the spread of antibiotic resistance among bacteria.
Table of Contents
Title Page i
Certification ii
Dedication iii
Acknowledgements iv
Table of Contents v
List of Tables vii
List of Plates viii Abstract ix
CHAPTER ONE: INTRODUCTION
1.0 Introduction 1
1.1 Aims and Objectives 3
CHAPTER TWO: LITERATURE REVIEW
2.0 Literature Review 5
2.1 Categories of Wound 8
2.1.1 Abrasion 8
2.1.2 Incision 8
2.1.3 Laceration 8
2.1.4 Puncture 9
2.2 Wound Infection 9
2.3 Recognition of Wound Infection 11
2.4 Wound Healing 13
2.4.1 Addressing Bacterial Burden as an Obstacle to Wound Healing 15
2.5 Management and Treatment of Wound Infections 16
2.5.1 Antibiotic Therapy 16
2.5.2 Disinfectants 17
CHAPTER THREE: MATERIALS AND METHODS
3.0 Sample Collection 19
3.1 Media Preparation 19
3.2 Inoculation of Samples 20
3.3 Sub-Culture and Purification 20
3.4 Characterization and Identification of Isolates 20
3.5 Biochemical Characterization 21
3.5.1 Gram Staining Method 21
3.5.2 Catalase Test 21
3.5.3 Indole Production Test 22
3.5.4 Coagulase Test 22
3.5.5 Citrate Utilization Test 22
3.5.6 Carbohydrate Fermentation Test 23
3.5.7 Methyl Red Test 23
3.5.8 Voges-Proskauer Test 24
3.5.9 Oxidase Test 24
3.6 Antimicrobial Sensitivity Test 24
CHAPTER FOUR: RESULTS
4.0 Results 26
CHAPTER FIVE: DISCUSSION AND CONCLUSION
5.1 Discussion 33
5.2 Conclusion 35
References 36
LIST OF TABLES
Table Title Page
1 Occurrence of Wound Pathogens among Children and Adults 27
2 Prevalence of Bacterial Isolates in Wound Infection 28
3 Frequency of Isolation of Gram Positive and Negative Bacteria 29
4 Isolation of Bacteria from Different Wound Types 30
5 Antibiotic Sensitivity Pattern of the Isolates 31
CHAPTER ONE
1.0 INTRODUCTION
A wound is a breach in the skin and the exposure of subcutaneous tissues. Following this disruption and loss of skin integrity and loss of protective function, wound provides a moist, warm and nutritive environment that is conducive to microbial colonization and proliferation (Bowler et al., 2001). Colonization of a wound by microorganisms lead to wound infections which delays wound healing and may cause wound breakdown, herniation of the wound and complete wound dehiscence (Shittu et al., 2002).
Wounds are inescapable events of life, which arise due to physical injury, chemical injury and microbial infections. Wounds are commonly encountered in chemical practice. They may arise post operatively, following trauma or could be of infective origin (Sule et al., 2002). Wounds facilitate a favourable lodgement for the existence and multiplication of bacteria (Agnihotri et al., 2004). Individuals with diminished immunity are highly susceptible and at increased risk of developing a wound infection. All wound are contaminated by both pathogens and body commensals ranging from Gram-positive and Gram-negative bacteria to yeasts, which are derived from the host’s normal flora (Barret and Herndon, 2003).
The development of infection at wound sites depends on complex interplay of many factors such as microbial virulence, patient risk factors like diabetes, cigarette smoking, obesity and coincident remote site infections or colonization (Reichman and Greenberg, 2009), tissue trauma and foreign materials in the wound. The presence of foreign materials increases the risks of serious infection even with relatively small bacterial inoculums (Rubin, 2006).
The severity of wound infection depends largely on the infecting pathogen and on the site of infection. Generally, a wound can be considered infected if purulent material is observed without the confirmation of a positive culture.
Wound infection could be seen as the presence of pus in a lesion, as well as other general or local features of sepsis including pyrexia and pain. Wound infections are one of the most common hospital acquired infections and are an important cause of morbidity and mortality. The development of such infections represent delayed healing, cause anxiety and discomfort for patients, longer stay at hospitals and add to costs of healthcare services (Williams et al., 2004). Thus the importance of wound infection in both economic and human terms should not be underestimated. Following colonization, these organisms start penetrating the viable tissue depending on their invasive capacity, local wound factors and the degree of the patient’s immune suppression (Mehedi et al., 2013). Bacterial infections in wound patients are common and are difficult to control. Sepsis consequently is common and sepsis is often fatal (Armour et al., 2007).
The most commonly incriminating bacterial agents in wound infections include Staphylococcus aureus; Pseudomonas spp, Proteus spp, Klebsiella spp, Eschericlia coli, coagulase-negative Staphylococcus (CONs), Enterococci, other Streptococci and Candida. These organisms produce a number of virulence factors that are important in the pathogenesis of invasive infection (Sinai, 2007).
The control of wound infections has become more challenging due to widespread bacterial resistance to antibiotics and to a greater incidence of infections caused by Methicillin Resistant Staphylococcus aureus (MRSA), polymicrobic flora and by fungi. However, some species of microorganism are sensitive to aminoglycosides and vancomycin (Raza et al., 2013). The unrestrained and rapidly spreading anti-microbial resistance among wound bacterial population has made the management and treatment of wound infections a serious challenge in chemical and surgical practice.
Inspite of technological advances that have been made in surgery and wound management, wound infection remains an on-going health problem which cannot be completely eradicated. However, by taking prompt control measures against the most commonly isolated organisms and proper care of wound may lead to the minimization of wound infection. Having knowledge of the spectrum of organisms causing wound infections and their resistance patterns is important when considering strategies for controlling the development and spread of resistance. Prompt identification and management of chronic wounds.
1.1 Aims and Objectives
This study was carried out to determine the occurrence of the commonest bacterial pathogens associated with wound infections and their sensitivity pattern. Because the antimicrobial resistance patterns of the bacterial isolates keep changing and evolving with time and geographical location, this study was conducted to access the current status of bacterial pathogens involved in wound infections and their antimicrobial resistance pattern in a medical centre in Abia State, Nigeria.
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