Isolation and Identification of Bacteria Associated With Wound Sepsis
CHAPTER ONE
AIM & OBJECTIVES OF STUDY
- The aim of this work is to isolate and identified bacteria associated with wound sepsis
- And the objectives are to assess whether any correlation exists between age, sex and different types of wounds.
- To assess the antibiogram of different bacteria associated with wound sepsis to offer advice on therapy.
CHAPTER TWO
LITERATURE REVIEW
GENERAL INCIDENCE TO WOUND SEPSIS
The incidence of wound sepsis have posed a serious threat to both surgical and non-surgical wounds and quite a number of cases have been reported, some of them are as follows:
- In a survey carried out in England on 520 and 2974 patients that passed through thoracic surgery, the sepsis rate was 5.8% and 2.57 respectively accounting for about 28 and 13 cases respectively, (Stokes, 1980). In another study in surden on 9,8, 51 and 3, 3.8 patients having clean and non clean wounds respectively sepsis rate was 1.9% and 8.3% respectively which amounted to 187 and 275 cases respectively (Ljungist 1964).
- In the lenyeta National Hospital Navobi on study of 48 patients 7 was infected amounting to 14.6%, out of 63 clean contaminated wounds 18 was infected amounting to 28.6% and of about 111 caparatomies 25 was infated amounting 22.5% infection rate, (Bassak 792).
- In a survey came out. In port Harcourt on leaguers, in the developing in the developing countries it was found that sickle cell diseases was complicated by chronic ulceration of the legs. The ulcers which are usually located over the mallgeli are as a result of localized skin and sub coetaneous infection following occlusion of the vessels by sickle cells. Salmonella osteomyelis was common in these patients and may progress as to skin (Ulceration, Watobo-Brown 1987) Another study on secondary bacterial infection of 6g in a sickle cell patients in parts of eastern Nigeria in Enugu (medical centre) inclusive and the sickle cell ulcer is capable of affecting any sex. Onyenebukwue (1995)
AETIOLOGICAL AGENTS OF WOUND SEPSIS
Quite a lot of work have been done to assertion the incidence and aetological agents most frequently and commonly found in wound sepsis indifferent populations and such works include; the work done in India on the Bacteriology of wound infection a total of 171 cases of wounds of various aetiological gents were examined and screened bacteriological for evidence of infection by surface swab culture and quantitative full thickness wound biopsycuhuse technique. Wound infection rates according to clinical wound types were clean 9.5% clean contaminated 24.3% dirty wound amounted to 52.9% and the commonest causative organism were Staphococcus aureus 23.7%, E.coli 16.9%, staphylococcus epidermis 13.0% and pseutomonas aeruginosa 13.0% when isolated intra operatively, Enterobacter species, proteus species, Klebsiella species and Pseudomonas aeruginose appeared to have a high probability of causing post operating wound infection twin (1992) infection from anaerobic bacteria usually follow the rejection of organisms an endogenous microflora. Usual cause of infection following selective organ resictron are staphylococcus species, streptococcus species, E.coli, Enterococcus species, streptococcus spp which are endogenony aerobic organisms while en0dogenous are bactericides ovals (1988), peptoshep to coccispecies (Weather 1988) in oxford, anaerobic shetococci, gas forming coliforms, or clostridia, candid albicans, staphylococcal spp and pseudomonas aeruginosa from patients having infected diabetic ulcers. Staphylococcal infection was the commonest organism isolated. In poorly controlled diabetics.
CHAPTER THREE
MATERIALS AND CULTURE MEDIA USED
Wound pus, wound exudates, wound swabs, sterile absorbent cotton word (stertin), sterile physiological saline, sterile test tubes, sterile strings or needles, microscopic slide, Bunden burner, swab stick, incubator, innoculating loop, cover slips, peptone water, gram stain reagents, Macconkey agar, chocolate blood agar, blood agar, Kova’s reagent Dextrose citrate Agar, microscope, distilled water; crystal noted blood agar. See appendix for more detail on the media used.
SAMPLE SIZE AND POPULATION SAMPLED
The sample used for this study were 250 patients with wound sepsis clinically at national or thropaedic Hospital Enugu.
From the table I we can see that the patients were categorized into 8 age groups namely: 0-2 years, 3-5 years, 6-8 years, 9-11 years, 12-14 years, 15-17 years, 18-20 years and 21 years and above (adult) of the 28 case of wound sepsis studied 155 were males and 96 are females patients were also grouped in patients and out patients. 57 (22.8%) males and 33(10.7%) females as the in-patients, and 77 (38.8%) males and 63 (25.2%) females as the out patients. Subject were also sampled according to the sample types of wound, age and sex contribution for surgical wounds 73 (29.2%) were males and 37 (14.8%) females, sickle cell ulcer patients showed 22 (8.8%) males and 15(6%) females, Diabetics ulcer patients 26 (10-4%) males and 19 (7.6%) were females, Gun shot wounds 4(16%) were all males and no females had gun shots wound and 33 (13.2%) males and 21 (8.4%) were females of other various wounds.
CHAPTER FOUR
PATTERNS OF ORGANISMS. ISOLATED IN WOUND SEPSIS IN ENUGU
In cultures done on 250 samples, 199 were positive for pathogens and 51 were negative out of which 97 (48.8%) were staphoco (susacioreus, 28 (141%) were pseudo monas aeruginosa, 23 (11.6%) were protens mirabilis and 11 (5.5%) were protens nilyaris.
Others are streptococcus facatis 9 (4.5%), Escherichia coli 7(3.5%) feast cells 6.60%), streptococcus progenies 6 (3.0%), Klebsiella pneumonia 5 (2.5%). Staphylococcus aureus has the highest prevalence 97 (8.8%) while salmonella spp has the lowest prevalence 3(1.5%) in the study.
Table 4: shows the age and sex distribution of isolates in wound sepsis. Within the various age groups the total isolates for both male and female patients were 0,0-2 age range 21 males and 9 females, 3-5 age group, 12 males and 13 females; 6-8 age group 8 males and 5 females; 9-11 age group is males and 8 females; 12-14 age group, 12 males and 10 females; 15 + 17 age group 4 males and 6 females. 18 – 20 age group 7 males and 5 females and for 21 years and above, 35 males and 23 females making a total of 199 positive isolate.
CHAPTER FIVE
DISUSSION, SUGGESTION, CONCLUSION AND RECOMMENDATION
DISCUSSION
Out of 250 cases of wound sepsis studied the pattern of bacterial pathogens causing sepsis in Enugu showed that staphicoccus aureus was the most prevalent accounting for 48.8 of the total isolates followed by pseudomona aeuruginosa 28 (14.1%), protens mirabilis 23 (11.6%), protens vulgens 11(5.5%), streptococcus faeidis 9(4.5%), Eschew chia 7 (3.5%). Yeast cells 6(3.6%), stophtococcus preumous 5 (2.5%), Klesiella preumonae 4(2.0%) and Salmonella species 3(1.5%). Staphylococcus aureus has the highest prevalence while Samorella species has the least.
The study is in compliance with the works done by various researcher all over the world which include that done is sandi Arabia by Twun et al (1992). In which case staphylococcus aureus was the predominant organism about 23. The of total isolated from 1770 septic wards.
The present study also confirm that done by the following Kanyahow 1991, watub o-Brown 1987, Twin 1992. Heather 1988, man 1992, heather etal 1988, onyemelukwe 1995. The test of synificance of the various isolates from this study shows that there is significant sex difference .
In wound sepsis caused by staphylococcus aureus (2.005>0.025) and preteus inhabits (P<0.005>0.01) and no significant sex difference in the case of all other isolates. The research also shows that more males were significantly affected than the females for the 6-8 years age group (p<0.05>0.025) from the analysis of the refalts of impatience and out-patients there is significant sex differences between the males and females showing that more males had wound sepsis in both cases than the females counter parts which agrees with the report by willing 1996. Males. With age group is more affected probably because they are in their active stage of life and involved in adventures rather than pre-cautionary activities for the impatient the males accounted for 57(22.8%) of the total subjects and females 33(13.2%) of total subjects while in the case of out patients males 97 (38%) and females 63 (25.2%). For inpatients (P>0.05) and in the case of out patients (P>0.05)
On the age distribution, there is significant age difference between the various age groups amonst the isolases generally. In all cases (P<0.05). This was probably due to the manner in which parents and children careless about any wound sustained in the course of htier daily activities as some people even wound sustained in the course of their daily activities as some people even use sand to stop harmorriage on surfaces of accident injuries through which they introduce a lot of bacterial pathogens on the wounds including anaerabic organising.
During this study, 37 (148%) patients with sickle cell led ulcer wound sepsis was examined and out of this number 30 (12%) were positive (15%) of total isolated while 7 (28%) was negative, about 1.5(15%) (3.5%) of total isolates. The pediment staphylococcus aureus 13 (43.3%) about 6.5% of total isolates and the least were escherichia coli. And salmonella species 2 (6.7% ) and 1% of the total isolates. This finding complies with that of onyeprelustive, (1995) on secondary bacterial injection of leg ulcers in sickle cell patients in parts of eastern.
Digenioc with Enugu inclusive. The sickle cell ulcer can afford to affect any sex because the disease is hereditary and capable of affecting any sex and producing its attendant effects staphylococcus aureus is more preponderant because of possibility of contamination due to chronic wound duration. There was agreement with review by Datubo. Brown 91987), weather (1998) on wound sepsis of various types indifferent parts of the world.
This prevalence of staphylococcus might be due to nosconial infection and poor hygiene under which the patients are managed. Inclusively, it could be because staphylococcus aureus is more prevalence in nature both as normal flora and pathogen organism. This could be also be due atop ubiquitrong nature of stephlococcus aureus and their ability to adept to any environment with assotance of the coagulate contamination of solution used in the dressing of wound, makes them more resistance to patients immunestate as well as the poor sanitary conditions under which the patients lives enhanced the virulence of this organism 21 samples were negative from the surgical wounds. Four cases of gun shot wounds was studied and in all cases males were the subject examined probably because they are frequently in contact with firearms.
The most prevalent organism isolated was staphylococcus aureus 2 (50%) about 1% of total isolates and the rest organisms were protens vulgarize 1(2.5%) 0.5% of total isolates and Streptococcus pneumonia 1(25%) about .5% of total isolates, Bacterial isolates from diabetic ulcers showed that of the 45 subjects examined, 31 was positive and 14 was negative of this number staphylococcus aureus was the most preponderant 16 (51.6%) about (5.6%) of total isolates and the least isolated were klebsiella pneumniae 1(3.2%) about 0.5% of total isolates and galmonella species 1(3.2%) and 0.5% of total isolates. The high sugar content in their tissue enhances bacterial growth and delays healing leaching to chronic ulcers diabetics. Yeast cells was isolated 2(6.5%) 1% of total isolates. This finding agrees with that of weathered (1988) P (0.05<0.25) from this study its amount was not significant and hence the number was infinitesimal but worthy of note because it almost occurs in diabetic with chronic ulcers. Excess sugar in the tissue lowers host resistance to fungal infections. In ward sepsis were high in sanitary conditions, poor medical attention and self Medication without prescription which enhances wound sepsis and chronically of infected wounds as Observed by Datarown (1984). Into sensitivity showed that most strians of S.aureus were sensitive to clora cillin, Erythromycin, Gentamycin, chloramphenicol with reduced susitivity to other drugs producers (penicillinase Isa-beta lactamased pseudomonas aerugimosa was sensitive to oxfloracillin, Gentamycin, cipro floxacillin and collistin sulphate. Indecreasing importance P.Minabillis was totally sensitive to cipro floracilin and most sensitive to oxflorallin and Amplicillin. P. Vulgaris sensitive to oxfloxacillin, and ciprofloracillin. K. Preumonia sensitive to Oxfloracillin, ciproflora cillin and chloramphenicol steptoccus premonia. Sensitive to Erythromycin, contrimazola and penicillin. S. pyosgenes sensitive to Erythromycin, Ampicillin and contrimarole, collision sulphate. Inspite of the fact that staphylococcus aureus can be isolated from the perfectly normal individual, there is strong feeling that their findings in septic wounds should be reported especilally as it has been showed to be predominated in our environemnt due to our poor senitaty conditions. The current practice were increased self medication of antibiotics, with little or no notice of the finding of fungi inseptic wounds does not take cognizance of the fact of indebilidated or compromised patients. Yeast organism can give rise to serious and sometimes fatal wound sepsis especially as presence of antibiotics enhances the proliteration of fungi.
SUGGESTIONS
As a result of this study, the following suggestions are made, further research in wound sepsis such as mid, genial and parasitical should be included for wider range of research. Health education should be instituted to enhance good environmental sanitation and high asepsis to be maintained in the hospital in general and in operating them in particular so as to reduce the high incidence of wound sepsis in Enugu. The nurses and medical doctors with lessons and wound should be isolated and while dressing patients they should observe hygiene and cnitation to niod contamination. The medical laboratory should be equipped so as to meet contemporary challenges on medical microbiology as regards to sterilizing the equipments in dressings, pads and coffon wool for dressing wounds.
CONCLUSION
This study was designed to isolate and identify bacteria associated with wound sepsis, noting their distribution pottern, age and sex relationships, predisposing factor and any other factor affecting it and also their antibiotic sensitivity especially in Nigeria where drugs are taken indiscriminately without prescription. It was discovered that the wound sepsis is predominantly associate with staphylococcus aureus and there is correlation between age, sex and different types of wound sepsis.
Therefore, there should be neatness and standard management of the wound to avoid deterioration.
RECOMMENDATION
The predominant rate of staphylococcus aureus as revealed by the study is apparently high. Sit istherefore recommended athat antibiotic therapy be instituted so enough after any wound to check the coloinization of such wounds by opprtunities patrogens. The cultures and sensitive results of such wound sepsis is recommended to use toguide the final antibacterial therapy which gives the highest efficiency. Short stay in the hospital is recommended to avoid mosconial infection. And also that the environmental conditions where patients with wound stay to be clean to avoid spraying of ionfection organism of anoter type of wound to areas wound. The dressing materials pads must be new and clean with sterile solution. And also every wound should be dressed often and steady of last daily to avoid getting infection, degeneration and putrefying of the ck. From the sensitivity pattern of the isolated organisms. Most organisms isolated were sensitive to cipsroflozacilin. Amplicilin; colmoxatole, ery-throughcin, oxyfloxacilin. This drug is recommended to the patients with wound sepsis.
REFERENCES
- Ako-NalakL1992) Sources of intra-operative bacterial colonization of clean surgical wounds and subbasement post operative wound infection in Nigeria Hospital
- Anderson J.R (1991) M Mr’s Text Book of pallology, 12 edition London Buffer and Tanner pp 17-26.
- Anyanwu, C.H; (1993) Post pneumonic pleural sepsis in Nigeria Children, Tropical Doctor pp 57-60
- Bssak S. (1992) Bacteriology of wound sepsis/infection Journal of India Medical Association pp33-34
- Datubo – Brown D.o.(1987) Leg ulcers in the developing countries Journal of prevention diagnosis and treatment pp9-11
- Eriukhin I.A, (1992) Wound infection. Greek Medical Journal pp 149 – 150, 206 – 215
