BACTERIAL ASSOCIATED WITH SURGICAL WOUND INFECTIONS IN UNIVERSITY OF BENIN TEACHING HOSPITAL, BENIN CITY, EDO STATE NIGERIA

Transcription

1 International Journal of Medical Sciences & Pharmaceutical Research, Volume2, Issue1, Jan-Jun-2018, pp 01-06, BACTERIAL ASSOCIATED WITH SURGICAL WOUND INFECTIONS IN UNIVERSITY OF BENIN TEACHING HOSPITAL, BENIN CITY, EDO STATE NIGERIA 1 Uhunmwangho, E.J., Nwadike, Ifeanyi & 2 Iyamu, A.O., 1&2 Department Of Medical Laboratory Science, College of Medicine, Ambrose Alli University, Ekpoma ABSTRACT A total of 89 specimens from surgical wounds were screened for the presence of aerobic bacteria using standard bacteriological methods. Samples were incubated on blood agar, chocolate agar, Machonkey agar. These were incubated aerobically at 37oc for 48 hours,77 yielded aerobic bacteria with the following decreasing order of prevalence, staphylococcus aureus (22.1%), Acinobacter (18.3%), Klebsiella proteus (14.2%), Pseudomonas aeruginosa (12.2%), Alkaligenes (8.1%), Citrobacter (6.1%), Staphylococcus albus (6.4%), Escherichia coli (2.5%), Proteus (10.2%), Providencia (3.8%) and Enterobacter (3.89%). The highest incidence is in the age group of 41 and above while the age group (11-20) years gave the lowest incidence. Key words: Bacterial, Surgical Wound, Edo State Nigeria, Infections INTRODUCTION Infection can be defined as the successful invasion, establishment and growth of microorganisms in the tissue of the host. Some factors such as immunological status of the individual, genetic constitution and certain components of the individual (Asonye and Ezelum, 2003). A wound is a break in the normal tissue resulting in a variety of cellular and molecular sequele (Bailey and Love, 2000). The infection of the wound can be defined as the invasion of body tissues by microorganisms following a breakdown of local and systematic host defenses. Microorganisms may be defined as living creatures that are microscopic in size and relatively simple, often unicellular in structure (Bailey and Love, 2000). Surgical wound infections are wound infection acquired after surgical operation. It results from operation with a break in aseptic technique (Westaby, 1989). Despite the advances in surgical techniques, theatre sepsis, antibiotic patency, nutritional support systems, sepsis after surgery continues to be a major cause of morbidity or mortality (Kaontz, 2001). The surgical wound patient is a prime target for infection, the wound, the presence of surgical prosthesis, intravenous lines and drains are well potential sites of infections. The number of organisms that will produce infection of most pathogens is a concentration of greater than 10 5 submit paper : editor@arseam.com download full paper : 1

2 Uhunmwangho & Iyamu / Bacterial Associated With Surgical Wound Infections in University of Benin Teaching Hospital, Benin City, Edo State Nigeria per gram of body tissue. These may enter the wound, multiply and exceed the ability of local tissue defence to handle them (Rains et al, 1984). The microorganism incriminated in wound cut across several genera (Bucknell and Ellis, 1994). Therefore, strict adherence to aseptic techniques for surgical procedure as well as maintenance of high level of hygienic standard in the patient environment are measures employed to reduce or restrict infection of surgical incision. Surveillance for wound infection is a useful tool to demonstrate the magnitude of the problem and the judicious use of antibiotic prophylaxis, and reporting are the most effective means to reduce the wound infection rate to an attainable minimum (Koontz, 2001). An infection control team can make a valuable contribution ot he prevention of wound infection which can be in the form of advice, monitoring of patients and staff education (Westaby, 1989). Many bacteria develop resistance to antibiotic due to indiscriminate usage. Broad spectrum antibiotics can be given empirically to treat such infection or more specific narrow range antibiotics are given based on culture and sensitive tests (Bailey and Love, 2000). In Nigeria, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and klebsoilla species has been implicated in surgical wound infection (Ieibur et al., 2000). MATERIALS AND METHODS The sample was collected form the wound of the patient with sterile swab sticks and it was inoculated within one hour of collection onto appropriate culture media so as to demonstrate the presence of bacteria which may be causing disease. Each sample was inoculated aseptically onto 2 blood agar plates, 2 chocolate plates and 2 MacConkey agar plate, and streaked to obtain discrete colonies. The use of double culture plate was carried out to obtain a more accurate reslty by way of comparison. The inoculated plates were then incubated aerobically at 37 o C for 24 hours after which they were examined macroscopically for any significant growth of bacteria as well as the examiniation of their cultural characteristic. However, anaerobic incubation was not carried out due to lack of material for anaerobic bacteriology. The organisms were imeediately categorized after culturing into Gram-positive and Gram-negative bacilli by Gram staining techniques. The morphology and staining reaction of individual organism were observed with the X100 objective of the light microscope, as a preliminary criterion for placing an unknown species in its appropriate bacteriological group. ISOLATION AND IDENTIFICATION All isolate were identified by standard techniques as described by Cowan and Steel (1970) in the manual for the identification of medical bacteria. These standard techniques includes colonial appearance of the organism on the media, morphological characteristics such as size, form, elevation, pigment production, lactose and non-lactose fermentation, opacity, colour etc. submit paper : editor@arseam.com download full paper : 2

3 International Journal of Medical Sciences & Pharmaceutical Research, Volume2, Issue1, Jan-Jun-2018, pp 01-06, Specific biochemical test were performed on appropriate colonies for the identification of the organism using lactose, indole, mannitol, glucose, sucrose, urease, citrate, catalase etc. observation was carried out on the biochemical reaction as confirmatory test for identification. TEST FOR ANTIMICROBIAL SUSCEPTIBILITY PATTERN The isolate were subjected to commercially prepared systemic antibiotic disc, so as to determine their sensitivity pattern by the use of the disc diffusion method. The cultures were inoculated confluently over the surface of nutrient agar plates aseptically by first emulsifying in peptone water. Excess peptone water were decanted an the plate was allowed to dry. The disc were placed on the nutrient agar plate, and after ten minutes incubated overnight at 37 o C. Their susceptibility patterns were then observed and zones of inhibition measured. A control was similarly carried out by the use of the control organism J, 6, 2K 12 Escherichia coli. About 1 hour before use, the working stock of the disc were allowed to warm at room temperature and protected from direct sunlight. RESULT A total of 77 bacteria were isolated from 89 wound swabs (Table 1). The highest incidence is in the age group of 41 and above while the age group years gave the lowest incidence (Table 2). Staphylococcus aureus was the commonest organism isolated, accounting for 22.07%, others were Acinobacter (14.28%), Proteus spp (11.68%), Pseudomonas (12.98%), Klebsiella spp (14.28%), coagulase negative staphylococci (6.49%), Escherichia coli (2.59%), Citrobacter (3.89%), Enterobacter (2.59%), Alkaligenes (5.19%) and Providencia spp (3.89%) (Table 3). It was observed that the new generation antibiotics were effective against the isolate encountered (Table 4). DISCUSSION Surgical wound infections are serious problems for patients and have been known to complicate the recovery from normal surgical procedure in the hospital (Emweani et al., 2003). Surgical wound infection is as a result of break in aseptic techniques and poor hygiene standard in patient environment (Westaby, 1989). A number of report exist indicating microorganism associated with surgical wound infection. However, Emweani et al., (2003) has reported a changing pattern in the prevalence of microorganism causing wound infection. It is therefore likely that this changing pattern will result in changing susceptibility pattern. Hence, this study focuses on identifying etiological agent of surgical wound infection as well as their susceptibility pattern. A total of 77 (86.51%) out of 89 sample processed were infected with aerobic bacteria. This is in agreement with Emeweani et al., (2003) who recorded a prevalence of 81%. The prevalence of surgical wound differs significantly by 81%. The prevalence of surgical wound submit paper : editor@arseam.com download full paper : 3

4 Uhunmwangho & Iyamu / Bacterial Associated With Surgical Wound Infections in University of Benin Teaching Hospital, Benin City, Edo State Nigeria differs significantly (p>0.05) among gender of the study population (Male vs. Female, 85.69% vs 87.50%). All age group were affected with higher prevalence, with the age group and having the highest prevalence (Table 1). This does not agree with the findings of Emweani et al., (2003). It is difficult to surmise the reason for these differences because the condition that made the patient to come to the hospital was not documented. A total of 79 isolate were discovered and Staphylococcus aureus was the most predominant isolate as well as in both genders (Table 2). The high prevalence of Staphylococcus aureus observed in this study agrees with the work of Isibor et al., (2000) and Emweani et al., (2003). It is most probable therefore that Staphylococcus aureus came from patient themselves or from medical personnel s or environment in the event of break in aseptic technique during and after operation. The Gram negative organism incriminated had lower prevalence than Staphylococcus aureus and they include in descending order of prevalence, Acinobacter species, Klebsiella species, Pseudomonas aeruginosa, Alkaligenes species, Citrobacter species, Providencia species, Enterobacter species and Escherichia coli. Generally, the prevalence confirms the changing pattern observed by Emweani et al., (2003) with Staphylococcus aureus now predominating. The antibacterial susceptibility pattern observed in this study reveals high level resistance among some of the isolate (Table 4). Generally Amoxycilin Clavulanic acid was the most active antibacterial agent used. The clavulanic acid content of these antibacterial agent is a potent inhibitor of B-lactamse, an enzyme that render B-lactamase drug ineffective (Barry and Fushs, 2005). It is possible that most of the B-lactamase drug were ineffective due to the presence of this enzyme. Rational use of antibacterial agent is advocated as the conventional antibiotic coverage giving during surgery may require re-evaluation. CONCLUSION In conclusion, a prevalence of 85.51% of surgical wound infection was observed. Gender did not influence the prevalence of infection and Staphylococcus aureus was the most predominant isolate causing surgical wound infection. Rational use of antimicrobial agent is advocated to stem the tide of bacterial resistance. RECOMMENDATION We therefore recommend that further work should be done to find the likely source of wound infection and all hospital should ensure that adequate sterilization is carried out on dressing carts so as to reduce the occurrence of surgical wound infection. submit paper : editor@arseam.com download full paper : 4

5 International Journal of Medical Sciences & Pharmaceutical Research, Volume2, Issue1, Jan-Jun-2018, pp 01-06, REFERENCES Asonye, C.C. and Ezelum, C.C. (2003). Bacteria etiology of eye infection. Journal of the National Academy 2: Attermier, W.A. (1982). Hospital acquired infection, a prospective study (1 st edition). W.B. Saunders, (edtior). Pp Bailey, R. and Love, T. (2000). Wound infection. In short practice of Surgery. (23 rd edition). Oxford University Press (Publishers). Pp Baker, F.J., Silverton, R.E. and Palister, C.J. (2001). Staphylococcus. In: Introduction to Medical Laboratory Tech. (7 th edition). Bounty Press Limited, London (Publisher). Pp Barry, A.L. and Fuchs, P.C. (2005). Susceptibility of bacteria respiratory pathogens to Amoxycillin and Amoxycillin-clavulanic acid. European Journal of Clinical Microbiology and Infectious. Diseases 13(15): Bidle, M. (2000). Staphylococcus pyogenes. In: Principles and Practise of Surgery (3 rd edition). Pp Bucknell, T.E. and Ellis, H. (1994). Wound Infection. In: Wound healing. Saunders (Publisher). Pp Cheesbrough, M. (2000). Morphology of Staphylococci. In: Medical Laboratory Manual for Tropical Countries (2 nd edition). University Press, Cambridge (Publisher). Part 2 Pp Churchill, L. (1999). Pocket Medical Dictionary (14 th edition). Longman Singapore (Publisher). Pp Cowan, S.T. and Stell, K.J. (1970). Bacteria Identification. In: Manual for the Identification of Medical Bacteria. Cambridge University Press, London (Publisher). Pp Cruse, P.J.E and Foord, R.C. (1980). A 5 years prospective study of surgical wound. Archives of Surgery 109:206. Enweani, I.B., Esumeh, F.I., Akpe, R.A., Tatfeng, M.Y. and Isibor, J.O. (2003). Bacteria associated with post operative wounds in two Nigerian hospitals. Journal of Contemporary issues 1 (1&2): Isibor, C.N., Ahonkhai, I. and Akrele, J. (2000). Etiological spectrum of post operative wound infection in Delta State, Nigeria. Nigeria Journal of Microbiology 14: Jawertz, E., Melnick, J.L., Adelberg, E.A., Butel, J.S. and Ornston, L.N. (1989). Staphylococcus aureus. In: Medical Microbiology (18 th edition) Lange Medical Publication. Pp Knootz, F.P. (2001). Antimicrobial agent. American Journal of Antimicrobial Agent 16(1): Laufman, P. (2002). Wound Infection. In: The pathology of trauma (92 nd edition). Little Brown and Company (Publishers). Pp Leigh, D.A., Emmanuel, F.X., Sedwick, J. and Dean, R. (1990). Post operative urinary tract and woundinfections in women undergoing caesarean sections. A comparism of two study periods in 1985 and Journal of Hospital Infection 15: submit paper : editor@arseam.com download full paper : 5

6 Uhunmwangho & Iyamu / Bacterial Associated With Surgical Wound Infections in University of Benin Teaching Hospital, Benin City, Edo State Nigeria Meers, P.D. (1981). Infection of hospital. British Medical Journal 282: Oguachuba, H.N. (1985). Hospital infection in orthopaedic traumatological department of the Jos University Teaching Hospital. Nigerian Medical Journal 9: Prescott, L.M., Harley, J.P. and Klein, D.A. (2002). Microbiology (5 th edition). McGraw Hill (Publisher). Pp Sharon, G. and Mark, T. (1987). A prospective study of wound infection (1 st edition). London Oxford University Press (Publisher). Pp Smith, J. and Walkins, J. (2000). Care of wound. In: Care of Post Operative Surgical Patient (3 rd edition). Butterworth and Company Limited (Publisher). Pp Udeh, S. (1991). Incidence of aerobic Gram-positive bacteria in post operative wound infection in the University of Benin Teaching Hospital. A project wound on the Institute of Medical Laboratory Science of Nigeria. Pp Wemambu, S.N.C. (1986). Wound infection and nasal colonization with Staphylococcus aureus in Benin city. Nigeria Journal of Hospital Infection 2: Westaby, S. (1989). Wound care. 1 st edition. Heinemann Medical Book (Publisher). Po submit paper : editor@arseam.com download full paper : 6