PREVALENCE AND ANTIBIOGRAM OF STAPHYLOCOCCUS AUREUS FROM WOUND SPECIMEN IN FEDERAL MEDICAL CENTRE (FMC) UMUAHIA, ABIA STATE, NIGERIA.

ABSTRACT

The importance of Staphylococcus aureus, a persistent nosocomial and community acquired pathogen has become a global health concern. It has a remarkable capability of evolving different mechanisms of resistance to most antimicrobial agents. The present study was carried out to determine the prevalence of Staphylococcus aureus in clinical samples and their susceptibility pattern to antibiotics. Standardized microbiological and biochemical methods where used to screen 60 wound swabs for Staphylococcus aureus. 27(45%) isolates was obtained from the samples. Antibiotic susceptibility result revealed high percentage sensitivity to Rifampicin (88.9%), levofloxacin (85.2%), ciprofloxacin (77.8%), erythromycin (77.8%), streptomycin (77.8%), gentamicin (74%), ceftriaxone (70.4%). Norfloxacin showed moderate sensitivity of 59.3%. Resistance was recorded for ampiclox (55.5%), amoxicillin (51.8%), cefuroxime (51.8%) and chloramphenicol (51.8%). The result showed that the macrolides, aminoglycosides, and quinolones are effective for management of Staphylococcal infections. It is recommended that antibiotic sensitivity testing is carried out on all isolates from wounds before chemotherapy to avoid selection of drug resistance strains.

TABLE OF CONTENTS

Title page                                                                                                                                i

Dedication                                                                                                                              ii

Acknowledgements                                                                                                                iii

Table of contents                                                                                                                    iv

List of tables                                                                                                                           v

Abstract                                                                                                                                   vi

CHAPTER ONE

1.0           INTRODUCTION

1.1       Aims                                                                                                                            3

1.2       Objectives                                                                                                                   3

CHAPTER TWO

2.0       LITERATURE REVIEW

2.1       The Test Organism Staphylococcus aureus                                                                     4

2.2       Identification of  Staphylococci in The Clinical Laboratory                                              5

2.3       Epidemiology of Staphylococcu saureus Infections                                                         6

2.3.1     Clinical Manifestations of S. aureus                                                                               7

2.4       Pathogenesis of  S. aureus Infections                                                                              8

2.5       Role of Adherence  Infections  Associated With Medical Devices                                    9

2.6       Resistance Of Staphylococci To Antimicrobial Drugs                                                      11

2.7       Wound Sepsis                                                                                                               12

2.8       Epidemiology Of Wound Infections                                                                               13

2.9       Classification Of Wound                                                                                               15

2.10      Microbiological Impact                                                                                                 17

2.11      Future Prospects                                                                                                           18

CHAPTER THREE                           

3.0       MATERIALS AND METHODS

3.1       Study Area                                                                                                                  19

3.2       Population study                                                                                                         19

3.3       Sample Collection                                                                                                 19

3.4       Media Preparation And Innoculation Of Wound Samples                                         19

3.4.1    Innoculation Of Samples And Isolation Of Staphylococcus Aureus                         20

3.5       Identification Of Isolates.                                                                                              20

3.6           Gram Stain Technique                                                                                                20

3.7           Biochemical Tests                                                                                                      20

3.7.1      Catalase test                                                                                                                20

3.7.2      Coagulase test                                                                                                             21

3.8           Antibiotic Sensitivity Testing                                                                                                                                                                 21

CHAPTER FOUR

4.0       RESULTS                                                                                                                   22

CHAPTER FIVE

5.0       DISCUSSION AND CONCLUSION 

5.1       Discussion                                                                                                                   27

5.2        Conclusion                                                                                                                   28

5.3        Recommendation                                                                                                          29

References                                                                                                                                30

LIST OF TABLES

Tables       Title of tables                                                    Page

1          .                     Biochemical  characterization and identification of S. aureus                     23

2                      Isolation rate of Staphylococcus aureus from samples.                                            24

 3                     Susceptibility and resistance of Staphylococcus aureus  to various antibiotics.      25

 4                     Percentage of the susceptibility and resistance of S.aureus to various antibiotics.   26

CHAPTER ONE

1.0           INTRODUCTION

Bacterial contamination of wounds is an important cause of mortality. Rapidly emerging nosocomial pathogens and the problem of multi-drug resistance necessitate periodic review of antibiogram pattern of organisms isolated in wounds (Mehta et al., 2007).The development of wound infection depends on the integrity and protective function of the skin (Anupurba et al., 2010). The widespread use of antibiotics, together with the length of time over which they have been available have led to major problems of resistant pathogens in wound infections contributing to morbidity, and mortality (Nwachukwu et al., 2009).It has been shown that wound infection is universal and the bacterial type varies with geographical location, resident flora of the skin, clothing at the site of wound, time between wound and examination(Anupurba et al., 2010).

In general, a wound can be considered infected if purulent materials drain from it, even without confirmation of positive cultures. Also, many wounds are colonized by bacteria, whether infected or not. Infected wounds may not yield pathogens by culture owing to the fastidious nature of some pathogens, or   if the patient has received an antimicrobial therapy (Nwachukwu et al., 2009). Many bacterial agents are known to cause wound infections. Initial injury to the skin triggers coagulation and an acute inflammatory response followed by exposure of subcutaneous tissue following loss of skin integrity which provides a moist, warm, and nutritive environment that is conducive to microbial colonization and proliferation (Yah et al., 2010).

Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is the most common specie of Staphylococcus to cause Staphylococcal infection. Staphylococcus aureus has emerged as one of the mainly important human pathogens, and has over the past numerous decades, been a leading foundation of hospital and community-acquired infections (Johnssons et al., 2004; Loffler et al., 2005, Shittu and Johnson, 2006).

The major reservoir of Staphylococcus aureus in hospitals are colonized and infected in-patients and colonized hospital workers. Carriers of S. aureus are at risk of developing endogenous infections or transmitting infections to health care workers and patients. S. aureus causes folliculitis, boil, furnculosis, scalded skin syndrome, conjunctivitis, paronychia, mastitis, and toxic shock syndrome for menstruating women who use tampons. Staphylococcal pneumonia can occur if Staphylococcal infection spreads to the lungs (Klodkowska-Farner et al., 1995). Hospital acquired Staphylococcal infections are common in newborn babies, surgical patients and hospital staff. Patients develop sepsis in operation wounds, which take place in the theatre during operation, and others post-operations in the ward (Tuo et al., 1995). Staphylococcal food poisoning can also occur in which a toxin produced by the bacteria is ingested with food. Food with a high salt or sugar content favours the growth of S. aureus (Tuo et al., 1995). Many outbreaks of staphylococcal food poisoning result from hand contacts (Bryant et al., 1998).

Drug resistance in microorganisms is a predictable and perhaps inescapable response to the use of antimicrobial agent. It can arise from the selection of resistant strains among naturally susceptible species or from the ingress of new strains of naturally resistant species. The extent of use of particular agents in a given environment dictates the rate at which resistance arises among microbial populations (Kunin et al. 1990). Staphylococcus aureus is naturally susceptible to virtually every antibiotic that has ever been developed. Resistance is often acquired by horizontal transfer to genes from outside sources, although chromosomal mutation and antibiotic selection are also important (Henry and Frank 2010).

Since the emergence of S. aureus strains with resistance to methicillin shortly after its introduction into clinical medicine (Jevons, 1961), it has established itself as a leading agent for a wide range of infections. Methicillin resistant Staphylococcus aureus(MRSA) has become a common problem in hospitals, community and livestock causing a wide range of acquired infections (Kopp et al.,2004; Lodise and McKinnon, 2005; Nixon et al., 2006). This study will be carried out to determine the prevalence and antibiogram of wound patient with staphylococcal infection in Federal Medical Centre (FMC) Umuahia, Abia State, Nigeria.

1.1       Aim

1.              To determine the prevalence and antibiogram of wound patient with Staphylococcal infection in Federal Medical Centre (FMC) Umuahia, Abia State, Nigeria.

1.2       Objectives1Objectives

1. To isolate, characterize and identify Staphylococcus aureus from wound specimens

2.  To determine the prevalence of Staphylococcal infection in wound specimens

3.   To determine antibiogram of Staphylococcus aureus isolated from wound specimens

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