International Journal of Research in Pharmacology & Pharmacotherapeutics

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1 International Journal of Research in Pharmacology & Pharmacotherapeutics ISSN Print: IJRPP Vol.3 Issue 3 July-Sep-214 ISSN Online: Journal Home page: Research article Open Access Study of antimicrobial sensitivity and resistance of pathogens isolated from postoperative wound infection R.T. Saravanakumar* 1, Dr.V.R. Baskaran 2, Dr.P.K. Manna 1, Dr. G.P. Mohanta 1 1 Department of Pharmacy, Annamalai University, Chidambaram, Tamil Nadu, India. 2 Department of Surgery, Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India..* Corresponding author: R. T. Saravanakumar. id: saro_pharma@yahoo.co.in ABSTRACT Surgical site infection are the third most common type of healthcare acquired infections in hospitals. SSI are the most common nosocomial infection in surgical patients, contributing to perioperative morbidity, prolonged postoperative hospital length of stay, and increased hospital costs. Emergent of pathogens and rapid growth of multidrug resistance demands periodic review of isolation patterns and its sensitivity. Hence, the present study was aimed to study the antimicrobial sensitivity and resistance of some pathogens isolated from postoperative wound infection. The study was carried out in a 14 bedded multi-specialty tertiary care teaching hospital attached to Annamalai University. Clinical specimens were collected from the patient and cultured in the appropriate media. Isolated colonies were subjected to gram staining technique and biochemical tests for identification. Antibiotic sensitivity tests were carried out on isolated and identified colonies using commercially prepared antibiotic sensitivity disc using Kirby-Bauer method. Totally 341 surgeries were carried out during the study period and about 46 surgical site infection were observed. Study results showed the following (a) Of all pathogens, Staphylococcus aureus and Pseudomonas aeruginosa were more prevalent whereas, Klebsiella and Escherichia coli were moderately prevalent and Proteus mirabilis was least prevalent, (c) Of all antibiotics, Amikacin was sensitive to all pathogens in the study with low resistance profile. Keywords: Amikacin, Escherichia coli, Klebsiella, Multi-drug resistance, Infection, Proteus mirabilis, Pseudomonas aeruginosa. INTRODUCTION Surgical site infection (SSI) is the third most common type of healthcare acquired infections (HAI) in hospitals [1]. SSI is defined as an infection at the site of direct operative manipulation that develops within 3 days of operation if no artificial materials (implants) are used or within 1 year if artificial materials are used [2]. SSI are the most common nosocomial infection in surgical patients, contributing to perioperative morbidity, prolonged ~ 231~

2 postoperative hospital length of stay, and increased hospital costs [3-5]. Prophylactic antibiotics plays a significant role in the control of infections, however, there has been considerable concern about the emergence and diffusion of antibiotic resistance resulting from random antibiotic use. Widespread use of broad-spectrum antibiotics is the most important factor, so antibiotic control policy has great importance in drug resistance control. Emergent of pathogens and rapid growth of multi-drug resistance demands periodic review of isolation patterns and its sensitivity. In developed countries constant examination in this field had done for recognizing antibiotic resistance pattern. Recently, the spectrum and resistance of the pathogenic bacteria have constantly changed year after year because of extensive application of antimicrobial drugs. It is necessary to treat infections by empirical use of antimicrobial drugs as soon as possible to reduce the mortality of them [6-11]. Hence, the present study was aimed to study the antimicrobial sensitivity and resistance of some pathogens isolated from postoperative wound infection. MATERIALS AND METHODS The study was carried out between February, 212 to August, 212 in the surgery department of Rajah Muthiah Medical College Hospital, a 14 bedded multi-specialty tertiary care teaching hospital, attached to Annamalai University. Patients and Specimen collection Clinical specimens were collected from the patient with infection and were immediately transferred to the microbiology lab and cultured in the appropriate media. Pathogens in the clinical specimens were exposed to appropriate culture medium and were incubated at 37 C for hrs. Isolated colonies were subjected to gram staining technique and biochemical tests for identification. Antibiotic sensitivity tests were carried out on isolated and identified colonies using commercially prepared antibiotic sensitivity disc using Kirby-Bauer method. RESULTS AND DISCUSSION Totally 341 surgeries were carried out during the study period which includes Gastrointestinal surgeries (52.7%), Diabetic Foot Ulcer (2.5%), Fibroid Uterus (17%), Prostatitis (4.4%), Breast cancer (2.1%), Thyroidectomy (3.2%) and about 46 SSI cases during the study period. The results are summarized in the table 1 and Fig.1. Table 1: Summary of surgeries and SSI S.No. Surgeries Prevalence 1. Gastrointestinal surgeries 18 (52.7%) 2. Diabetic Foot Ulcer 7 (2.5%) 3. Fibroid Utres 58 (17%) 4. Prostatitis 15 (4.4%) 5. Breast cancer 7 (2.1%) 6. Thyroidectomy 11 (3.2%) Number of cured cases 149 (82.8%) 62 (88.6%) 53 (91.4%) 15 (1%) 7 (1%) 9 (82%) Number of infected cases 31 (17.2%) 8 (11.4%) 5 (8.6%) 2 (18%) ~ 232~

3 Prevalence Number of cured cases Number of infected cases Fig. 1. Summary of surgeries and SSI Prevalence of pathogens Pathogens Staphylococcus aureus, Klebsiella, Escherichia coli, Pseudomonas aeruginosa and Proteus mirabilis were isolated from postoperative wound infection. Of all pathogens, Staphylococcus aureus (32.6%) and Pseudomonas aeruginosa (28.3%) were more prevalent whereas, Klebsiella (21.7%) and Escherichia coli (1.8%) were moderately prevalent and Proteus mirabilis (6.5%) was least prevalent. The results are summarized in table 2 and fig. 2 Table 2: Prevalence of pathogens S.No. Isolated pathogens Number of cases 1. Staphylococcus aureus 15 (32.6%) 2. Klebsiella 1 (21.7%) 3. Escherichia coli 13 (1.86%) 4. Pseudomonas aeruginosa 5 (28.3%) 5. Proteus mirabilis 3 (6.5%) ~ 233~

4 Number of cases Staphylococcus aureus Escherichia coli Proteus mirabilis Klebsiella Pseudomonas aeruginosa 11% 28% 6% 33% 22% Fig. 2: Prevalence of pathogens Sensitivity pattern to commonly used antibiotics Isolated pathogens were tested for sensitivity against commonly used antibiotics at the hospital and the sensitivity pattern is summarized in table 3 and Fig.3. Amikacin was sensitive to Staphylococcus aureus, Klebsiella and Escherichia coli with low resistance profile. Though, Amikacin was sensitive to Pseudomonas aeruginosa and Proteus mirabilis its resistance profile was very high when compare to other pathogens. Ciprofloxacin was sensitive to Staphylococcus aureus and Escherichia coli with low resistance profile. However, Ciprofloxacin was sensitive to Klebsiella, Pseudomonas aeruginosa and Proteus mirabilis its resistance profile was very high when compare to other pathogens. Penicillin was sensitive to Staphylococcus aureus, Klebsiella, Escherichia coli and Pseudomonas aeruginosa but its resistance profile was very high than the sensitive. Cefotaxim was sensitive to all tested pathogens but resistance is very less for Staphylococcus aureus, Klebsiella and Escherichia coli and resistance is high for Pseudomonas aeruginosa and Proteus mirabilis. Cefazolin was sensitive to all pathogens in the study but the resistance profile is very high. Vancomycin was sensitive to Staphylococcus aureus with very low resistance profile. Table 3: Sensitivity and resistance pattern of pathogens to commonly used Antibiotics Antibiotics Staphylococcus aureus Klebsiella Escherichia coli Pseudomonas aeruginosa Proteus mirabilis S R S R S R S R S R Amikacin Ciprofloxacin Penicillin NT NT Cefotaxim Cefazolin NT NT Vancomycin 13 2 NT NT NT NT NT NT NT NT S: Sensitive; R: Resistant; NT: Not Tested; Number indicates the number of samples ~ 234~

5 Amikacin Ciprofloxacin Penicillin Cefotaxim Cefazolin Vancomycin S R S R S R S R S R Staphylococcus aureus Klebsiella Escherichia coli Pseudomonas aeruginosa Proteus mirabilis Fig. 3: Sensitivity and resistance pattern of pathogens to commonly used Antibiotics CONCLUSION The present study was aimed to study the antimicrobial sensitivity and resistance of some pathogens isolated from postoperative wound infection. Study results showed the following (a) Of all pathogens, Staphylococcus aureus and Pseudomonas aeruginosa were more prevalent whereas, Klebsiella and Escherichia coli were moderately prevalent and Proteus mirabilis was least prevalent, (c) Of all antibiotics, Amikacin was sensitive to all pathogens in the study with low resistance profile. ACKNOWLEDGEMENTS The authors thank the hospital and other university staff for their support. REFERENCES [1] Nadia Mora Kuplich, Mário Bernardes Wagner, Ricardo de Souza Kuchenbecker, Rodrigo Pires dos Santos. Comparison of surgical site infection rates among surgeons. J Infect Control 212; 1 (2): [2] M. A. Olsen, S. Chu-Ongsakul, K. E. Brandt, J. R. Dietz, J. Mayfield, and V. J. Fraser, Hospital-associated costs due to surgical site infection after breast surgery, Archives of Surgery, vol. 143, no. 1, pp. 53 6, 28 [3] National Nosocomial Infections Surveillance System, National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 24, issued October 24, The American Journal of Infection Control, vol. 32, no. 8, pp , 24. [4] A. J. Mangram, T. C. Horan, M. L. Pearson, L. C. Silver, and W. R. Jarvis, Guideline for prevention of surgical site infection, Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee, The American Journal of Infection Control, vol. 27, no. 2, pp , View at Scopus [5] T. Anthony, J. Long, L. S. Hynan et al., Surgical complications exert a lasting effect on disease-specific health-related quality of life for patients with colorectal cancer, Surgery, vol. 134, no. 2, pp , 23. ~ 235~

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