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PRESENTER: AKOBI OLIVER ADEYEMI DEPARTMENT OF MEDICAL MICROBIOLOGY FEDERAL MEDICAL CENTRE, BIDA,

Bacteriological Profile of Wound Sepsis and Antimicrobial Pattern of Isolates at Federal Medical Centre, Bida, Niger State. Nigeria. PRESENTER: AKOBI OLIVER ADEYEMI DEPARTMENT OF MEDICAL MICROBIOLOGY FEDERAL MEDICAL CENTRE, BIDA, NIGER STATE. NIGERIA.

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PRESENTER: AKOBI OLIVER ADEYEMI DEPARTMENT OF MEDICAL MICROBIOLOGY FEDERAL MEDICAL CENTRE, BIDA,

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  1. Bacteriological Profile of Wound Sepsis and Antimicrobial Pattern of Isolates at Federal Medical Centre, Bida, Niger State. Nigeria. PRESENTER: AKOBI OLIVER ADEYEMI DEPARTMENT OF MEDICAL MICROBIOLOGY FEDERAL MEDICAL CENTRE, BIDA, NIGER STATE. NIGERIA. +2348036545278, +2348095434432 oliverant2006@yahoo.com

  2. INTRODUCTION Wound provides a moist, warm, nutritive environment conducive for microbial colonization, proliferation, and infection (Fauci et al, 2008)1. Several bacterial species live on human skin, in the nasopharynx, gastrointestinal tract, and other parts of the body with little potential for causing diseases (Taiwo et al, 2002)2.

  3. INTRODUCTION (CONTINUE) Breach in the skin surface whether trauma, accident, surgical operation, or burns provide an open door for bacterial infections (Ohalete et al, 2012)3.

  4. LEARNING OBJECTIVES LEARNER SHOULD LEARN 1 PUBLIC HEALTH IMPACT OF HEALTH CARE ASSOCIATED WOUND INFECTION. 2 EPIDEMIOLOGY, PREVENTION AND CONTROL STRATEGIES. 3 NIGER STATE, NIGERIA SITUATION OF THE PROBLEM.

  5. PERFORMANCE OBJECTIVE LEARNER SHOULD BE ABLE TO 1 Estimate the extent of health care associated wound infection in his hospital. 2. Identify the changes in the incidence of health care associated wound infection and the pathogens that cause them. 3. Provide comparative data of health care associated wound infection rates. 4. Develop effective data collection and analysis methods for his hospital. 5. Conduct collaborative research studies on community and hospital acquired infections in his hospital.

  6. TYPE OF INFECTIONS BY ORIGIN 1.Endogenous:Infection cause by the organisms that are present as part of normal flora of the patient body. 2. Exogenous: Infection cause by organisms acquiring by exposure to hospital personnel, medical devices and community.

  7. LITERATURE REVIEW Chronic wound infection occurs in individual with an increased risk of bacteria invasion as a result of poor local factors such as arterial insufficiency, veinous hypertension, trauma and systemic disease like diabetic mellitus and rheumatoid arthritis (Falanga, 1993)4. Wound infection is important in the morbidity and mortality of patients irrespective of its cause; its delay healing and is associated with prolong hospital stay thereby increasing cost of healthcare services (Lateef et al, 2003)5.

  8. LITERATURE REVIEW (CONTINUE) In western world, studies on wound infections are focused on surgical sites infections because other types of wound infections are not problematic (Gaynes et al, 2001).6 Developing countries such as Africa continent, other types of wound infections are major causes of morbidity and mortality among the patients (Melta et al, 2007, and Anguzu, and Ohila, 2007).7,8

  9. LITERATURE REVIEW (CONTINUE) Godebo et al, (2013)9 and Mulu et al, (2006)10 stated that Staphylococcus aureus, Kelbsiella species, Escherichia coli, Proteus species, Streptococcus species, Enterobacter species, Pseudomonas species and Coagulase negative Staphylococci were common pathogens in wound infection.

  10. RESEARCH AIMS The study was aimed to identify etiology of bacteria associated with wound sepsis and antimicrobial susceptibility profile of the isolated organisms in the community.

  11. MATERIALS AND METHODOLOGYS Study population A retrospective study; data were collated from May, 2005 through October 2007 from Medical Microbiology department register. Swab samples of four hundred and eight (408); female 191 and male 217, specimen were collected aseptically from both outpatient and in-patients from various wound site such as burns, ulcer, post operative wound and fracture wound. Subjects were between age groups 0 through 75years old.

  12. Analysis and Identification of Bacteria from swab Samples Samples were received and analyse within 1hr of collection according to Chessbrough, (2002).11 Biochemical characterization were set up according to Oyeleke and Manga (2008).12 Antimicrobial susceptibility test was carried out by Chessbrough (1991).13

  13. Analysis and Identification of Bacteria from swab Samples (Continue) The antimicrobial disc used include Clindamycin (5mcg), Streptomycin(10mcg), Gentamycin (10mcg), Ceftriazone (30mcg), Erythromycin (5mcg), Ofloxacin (5mcg), Augmentin (30mcg), Ciprofloxacin (5mcg), Ampicillin (10mcg), Tetracycline (5mcg),Cotrimoxazole (10mcg), Azythromycin (30mcg) and Pefloxacin (5mcg). Susceptibility to antibiotics was measured by the method of Baker and Breach (1980)14

  14. RESULTS • Figure1, out of four hundred and eight (408) patients enrolled; three hundred and thirty eight 338(82.8%) yielded significant growth of isolates, and 70(17.2%) had sterile culture. Overall highest positive culture was found within age groups 31- 40years with 69(94.5%) growth followed by 21-30years 61(85.9%) and the least growth was found in 51- 60years 27(77.1%). • Figure 2A, showed the frequency of isolates; single isolates was 287(84.9%), and mixed isolates 51(15.1%).

  15. RESULTS (CONTINUE) • Figure 2A: Highest single isolates was Staphylococcus aureus 122(42.5%) followed by Escherichia coli 108(37.6%), Pseudomonas aeruginosa 28(9.8%), Proteus species 15(5.2%) and least isolates were Candida albicans 3(1.0%), Clostridium species 2(0.7%), Coagulase negative Staphylococcus 2(0.7%) and Streptococcus species 2(0.7%). • Figure 2B showed polymicrobial isolates; Escherichia coli and Staphylococcus aureus had highest mixed isolates with 28(54.9%) followed by Escherichia coli and Proteus species 8(15.7%) and least isolates Proteus species and Klebsiella species 1(2%).

  16. RESULTS (CONTINUE) • Figure 3A depict antimicrobial susceptibility pattern of the isolates; Staphylococcus aureus the highest single isolate was susceptible to Ceftriazone (61.5%), Ciprofloxacin (58.2%), Ofloxacin (55.7%) and Clindamycin (68.0%), Gentamycin (59.0%), Erythromycin (39.3%), Azythromycin (52.5%), Pefloxacin (50.8%), Cotrimoxazole (30.3%), Ofloxacin (55.7%), Tetracycline (36.9%), Streptomycin (27.0%) and least susceptible to Ampicillin (0.8%), Augmentin (4.1%), . • Second isolate Escherichia coli was susceptible to Ceftriazone (59.3%), Ciprofloxacin (54.6%) and Ofloxacin (50.9%) and least susceptible to Ampicillin (0.9%). Pseudomonas aeruginosa was susceptible to Ciprofloxacin (60.7%), Ofloxacin(53.6%) and Ceftriazone (53.6%) and least susceptible to Cotrimoxazole (3.6%).

  17. RESULTS(CONTINUE) • Figure 3B depict the antimicrobial activities of mixed isolates; the most prevalence isolate Escherichia coli and Staphylococcus aureus was susceptibility to Ciprofloxacin (57.1%), Ofloxacin (39.3%), Ceftriazone (35.7%), Azythromycin (32.1%), Gentamycin (35.7%), Pefloxacin (25%) and least susceptible to Cotrimoxazole (14.3%), Streptomycin (14.3%), Augmentin (3.6%),Tetracycline (3.6%) and Ampicilin (0%).

  18. Fig 1: Frequency of Subjects in Relation to Age Showing Positive and Negative culture

  19. Fig 2A: Depicts Percentage Frequency of Isolated Organisms

  20. Fig 3A: Percentage Antimicrobial Pattern of Staphylococcus aureus

  21. Antimicrobial susceptibility pattern of Escherichia coli and Staphylococcus aureus

  22. Discussion • Sepsis is a major cause of morbidity and mortality among burn patients and sometimes result to opportunistic infection (Cochran et al, 2002).14 Out of 408 studied population our research showed prevalence of (82.8%) wound infection, and statistically not significant (p-value =0.814, mean age =11.34, mode =12 and S.D±4.361). Our report is higher than Sewunet et al, (2013)15 who reported (42%). • Also, Kyati, et al,(2014)16 reported (67.14%) and (32.85%) isolates in gram positive and gram negative isolates in India. our report is similar to Aynalem et al, (2017)17 who reported incidence of (83.9%) in NorthWestern Ethiopia. However, our report is lower than Lakshmi et al, (2015)18 who reported (93%) among burn infected patients in India.

  23. DISCUSSION (CONTINUE) Nosocomial Infection National Surveillance Service (NINSS), (2002)19 stated that Wound infection complicate illness, and causes anxiety, increases patient discomfort and sometimes lead to death of our patients. Overall highest isolates was within the age groups 31-40years with (94.5%) isolates followed by 21-30years (85.9%). Contrarily, Mama et al, (2014)20 reported highest isolates of (89.5%) among age groups 45-59years in Jimma university specialist hospital, South-West, Ethiopia.

  24. DISCUSSION (CONTINUE) • Our research showed two categories of isolates; Single isolates showed (84.9%) Figure 2A and mixed isolates (15.1%) Figure 2B. • The highest single isolates was Staphylococcus aureus (42.5%) followed by Escherichia coli (37.6%). Our report is similar to Kyati et al, (2014)16 who reported (58.6%), Damien et al, (2015)21 reported (45.2%) in North Central, Nigeria and Aynalem et al, (2017)17 reported (34%) of Staphylococcus aureus has the most prevalent organism. • However, Sewunet et al,15 reported Coagulase negative Staphylococci (42.8%) while Lakshmi et al, (2015),18 Alharbi and Zayed (2014)22 both reported Pseudomonas species (33.6%) and (36.14%) as the highest single isolates.

  25. DISCUSSION (CONTINUE) Also, Escherichia coli and Staphylococcus aureus had highest mixed isolates of (54.9%) followed by Escherichia coli and Proteus species (15.7%). Mengesha et al, (2014)23 reported multiple bacterial isolates in post surgical wound infection (23.95%) with Staphylococcus aureus and Proteus species as most occurrence isolate. The high prevalence rate of enterobacterial isolates in our study suggest faecal contamination due to poor personal hygieneor post procedural contamination. Gould (2009)24 stated that within a community, health care acquired infections (HCAIs), can arise across a wide range of clinical conditions and affect patients of all ages.

  26. DISCUSSION (CONTINUE) However, certain groups of patients are at an increased risk of infections including: elderly, very young, people with cancer, and other malignant diseases, people with impaired immunity, invasive devices, very ill and surgical patients. The predominant single isolate Staphylococcus aureus was susceptible to Ceftriazone (61.5%), Ciprofloxacin (58.2%), Ofloxacin (55.7%), Clindamycin (68%) and least susceptible to Ampicilin (0.8%). Our report contradict Aynalem et al, (2017)17 who reported susceptibility pattern of staphylococcus aureus to Ceftriazone (79.5%), Ciprofloxacin (79.4%) and Penicilin (15.4%), Lakshmi et al, (2015)18 reported Ofloxacin (73.9%), Mama et al, (2014)20 reported susceptibility to Ceftriazone (85.17%) and Ciprofloxacin (96%). However, Mengesha et al, (2014)23reported susceptibility of Staphylococcus aureus to Ceftriazone (10%) and Nazneen et al,(2017)25reported Fluoroquinolones (38.47%).

  27. DISCUSSION (CONTINUE) The highest polymicrobial isolates; Staphylococcus aureus and Escherichia coli were both susceptible to Ciprofloxacin (57.1%), Ofloxacin (39.3%), Ceftriazone (37.5%) and Gentamycin (35.7%), and least susceptible to Cotrimoxazole (14.3%) and Augmentin (3.6%). Our research showed polymicrobial multi-drug resistance isolates. W.H.O (2009),26stated that emergence of resistance in microorganisms are due to indiscriminate use of antibiotics. In addition, the spread of multidrug resistance organisms (MDROs) in health-care settings occurs mostly via health-care workers‘ contaminated hands, contaminated items, equipments and environment, leading to outbreaks and serious infections especially in critically ill patients. Hand hygiene performance is the most important measure among standard precautions.

  28. DISCUSSION (CONTINUE) • Enteric organisms are the predominant isolates in our research, and are ubiquitous organisms found in soil, water and vegetation, and are part of the normal intestinal flora of animals and man. We suggest that hand hygiene advocate should not be limited to health care providers; it should be extended to our patients and their relations. This will help in the control of both community and hospital acquired infections. • Also, Carboneau et al,(2010)27 in U.S.A, advocate increase in hand hygiene from 65% to 82%, there was 51% decrease in hospital acquire MRSA cases during the 12 months period. • Chen et al, (2011)28 advocate increase in hand hygiene in a hospital setting in Taiwan from 43.3% to 95.6% there was 8.9% decrease in hospital acquired infections.

  29. CONCLUSION • overall prevalence rate of (82.8%) wound infection, and monomicrobial isolates of Staphylococcus aureus (42.5%), and polymicrobial of (15.1%) in the studied population is alarming. Policy makers need to advocate importance of hand hygiene in our communities and good sanitary disposal. This can be achieved through media in various indigenous languages, hand bills and periodic education of our patients on admission. Recommendation: There should be in-service training for health care providers such as post graduate training, workshops and conferences. This will expose stake holders to modern facilities and equipments, research methodology and improve method of practice to foster good health care service delivery, invariably reduce medical tourism in African continent.

  30. REFERENCES 1 Fauci A, D. Longo, E. Braunwald, Dennis L Kasper and Stephen L. Hauser,(2008) “Patient management algorithms,” in Harrison’s Principles of Internal Medicine, pp.325–328, TheMcGraw-Hill Companies Inc, 17th edition. 2 Taiwo S, A. Okesina, and B. Onile, (2002)“Invitro antimicrobial susceptibility pattern of bacterial isolates from wound infections in university of Ilorin Teaching Hospital,” African Journal of Clinical and Experimental Microbiology, vol. 3, no. 1. 3 Ohalete C.N, R. K. Obi, and M. C. EmeaKoroha, (2012) “Bacteriology of different wound infection and their antimicrobial susceptibility patterns in Imo state Nigeria,” World Journal of Pharmaceutical Sciences, vol. 13, no. 3, pp. 1155–1172. 4 Falanga V. (1993) Chronic wound: Pathophysiologic and experimental considerations.J. Invest Dermatol 100:721-725. 5 Lateef O.A. Thanni ; Olubunmi A. Osinupebi,; and Mope Deji-Agboola, (2003) Prevalence of bacterial pathogens in infected wounds in a tertiary hospital, Journal of the NationalMedical Association 95(12)1189-1192. 6 Gaynes R, Culver D, Harran T, Edwards J, Richards C, Tolson J.(2001) Surgical site infection Rates in the United States, 1992-1998. The National Nosocomial Infections surveillance systems, Clinical Infect Disease 33 (2): 569-577.

  31. REFERENCE (CONTINUE) 7 Melta M, Duhta P, GuptaV.(2007) Bacterial isolates from burns wound infection and their antibiogram : A eight-year study. Indian J. Plastic sung. 40 (1): 1-28. 8 Anguzu, J.R and Ohila D.(2007) Drug sensitivity patterns of bacterial isolates from septic post-operative wounds in a regional referral hospital in Uganda. Afri. Health Scient. 7(3). 9 Godebo G, Kibru G, Tassew H(2013): Multidrug-resistant bacteria isolates in infected wounds at Jimma, Ethiopia. Ann Clin Microbiol Antimicrob, 12:13. 10 Mulu A, Moges F, Tessema B, Kassu A (2006): Pattern and multiple drug resistance of bacterial pathogens isolated from wound infection at University of Gondar Teaching Hospital, North West Ethiopia. Ethiop Med J, 44(2):125–131. 11 Cheesbrough M (2002). Medical laboratories manual for tropical countries. 2:479. 12 Oyeleke, S. B. and Manga, B. S. (2008). Essentials of Laboratory Practical in Microbiology, 1st Edition. Tobest Publishers, Minna, Nigeria, pp28 – 62. 13 Cheesbrough, M. (1991). Medical laboratory manual for tropical countries.(Vol. II), Microbiology, pp: 146-159. 14 Cochran A, Morris SE, Edelman LS, Saffle JR. (2002) Systemic Candida infection in burn patients. Surg. infection Larch mt. Vol.3(4).pp367-374. 15 Sewunet Tsegaye, Yohanes Demissie, Adane Mihret, Tamrat Abebe (2013) Bacterial Profile and Antimicrobial Susceptibility Pattern of Isolates among Burn Patients at Yekatit 12 Hospital Burn Centre, Addis Ababa, Ethiopia. Ethiop J Health Sci. Vol. 23, No. 3. 16 Kyati Jain, Nilesh Shyam, Chavan and S.M. Jain (2014) Bacteriological profile of post-Surgical wound infection along with special reference to MRSA in central india, indore. International Journal of Integrative Medical Sciences, Vol. 1(1):9-13.

  32. REFERENCES (CONTINUE) 17Aynalem Mohammed, MengistuEndrisSeid,TeklayGebrecherkos, MogesTiruneh, and FelekeMoges (2017) Bacterial Isolates and Their Antimicrobial Susceptibility Patterns of Wound Infections among Inpatients and Outpatients Attending the University of Gondar Referral Hospital, Northwest Ethiopia.Hindawi International Journal ofMicrobiology.Article ID 8953829. 18 Lakshmi N, RamalakshmiKoripella, JayalaxmiManem and PeralaBalamurali Krishna (2014) Bacteriological profile and Antibiogram of Burn wound infections in a tertiary care hospital. Journal of Dental and Medical Sciences (IOSR-JDMS) Vol. 14, Issue 10 Ver. XI, PP 1-4. 19 NINSS (2002). Surveillance of Surgical Site Infection in English Hospitals: a national surveillance and quality improvement programme. Public Health Laboratory Service. • Mama Mohammedaman, AlemsegedAbdissa and TsegayeSewunet (2014) Antimicrobial susceptibility pattern of bacterial isolates from wound infection and their sensitivity to alternative topical agents at Jimma University Specialized Hospital, South-West Ethiopia. Annals of Clinical Microbiology and Antimicrobials 13:14. 21 Damien James Garba, Salami Faruk and Comfort Dancha (2015) Aerobic Bacteria Isolates of Septic Wound Infections and their Antibiogram in North Central Nigeria. American Journal of Biomedical and Life Sciences, 3(3): 36-40. • Alharbi A Sulaiman and Zayed M.E (2014) Antibacterial susceptibility of bacteria isolated from burns and wounds of cancer patients. Journal of Saudi Chemical Society18, 3–11. 23 MengeshaReiyeEsayas, BerheGebre-SlassieKasa, MuthupandianSaravanan, DerbewFikaduBerhe and Araya GebreyesusWasihun (2014) Aerobic bacteria in post surgical wound infections and pattern of their antimicrobial susceptibility in Ayder Teaching and Referral Hospital, Mekelle, Ethiopia. BMC Research,7:575.

  33. REFERENCES (CONTINUE) 24 Gould D (2009) Infection control: hand hygeine. Br J Healthcare Assistants 3(3): 110–13. 25 NazneenSiddiqui, SomnathNandkar, MuktaKhaparkuntikar and ArvindGaikwad (2017) Surveillance of Post-operative Wound Infections Along with their Bacteriological Profile and Antibiotic Sensitivity Pattern at Government Cancer Hospital, Aurangabad, India. Int.J.Curr.Microbiol.App.Sci. 6(3): 595-600. 26 World Health Organization. (2009)WHO guidelines on hand hygiene in health care: first global patient safety challenge : clean care is safer care. Geneva, Switzerland: World Health Organization, Patient Safety. 27 Carboneau C, Benge E, Jaco MT, Robinson M (2010). A lean Six Sigma team increases hand hygiene compliance and reduces hospital-acquired MRSA infections by 51%. J. Healthc Qual.32(4):61-70. 28 Chen YC, Sheng WH, Wang JT, Chang SC, Lin HC, Tien KL,(2011) Effectiveness and limitations of hand hygiene promotion on decreasing healthcare associated infections. PLoS One. 6(11):e27163.

  34. Thank you.

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