Antibiotic Susceptibility Pattern of Staphylococcus aureus Isolated from Pus/Wound Swab from Children Attending International Friendship Children's Hospital

A wound gets infected when the organism gets invaded through the breached skin, proliferated and production of various enzymes, toxins, etc. In order to treat the wound infection, antibiotic susceptibility pattern of organism should be determined before the prescription of the medicine. The present study was conducted from September 2017 to March 2018 with an aim to determine antibiotic susceptibility pattern of Staphylococcus aureus identified from the pus/wound swab among the patients visiting the International Friendship Children's Hospital, Kathmandu, Nepal. Total 270 sample were processed, isolated and identified using standard microbiological procedure and biochemical test. Antibiotic susceptibility test was carried out by using Modified Kirby Bauer's Disc Diffusion Method. Out of total sample, 51.48% (139) showed growth. The growth distribution was found to be high in out-patient department 84.9% (118) than in-patient department 15.1% (21). Among 139 positive growth, 83.5% were gram positive and 16.5% were gram negative. All together 12 different organisms were identified, among which S. aureus was found to be predominant organism 105 (75.5%). S. aureus was found to be sensitive towards Linezolid followed by Doxycycline whereas it was found resistant towards Ciprofloxacin. Among S. aureus identified, 50% were Multidrug resistant (MDR) S. aureus and 55% were Methicillin resistance S. aureus (MRSA). MRSA was found to be sensitive towards Linezolid followed by Doxycycline and resistant towards Ciprofloxacin. The association between MDR and MRSA was found positively significant (i.e. p-value = 0.000). All strains of S. aureus were found to be sensitive towards Vancomycin. 22.86% were double disk diffusion test (D-test) positive. The prevalence of D-test was found to be high in MRSA (75%). The relationship between D-test and MRSA was found to be significantly correlated with each other (r = 0.39). Linezolid, Chloramphenicol, Vancomycin and Doxycycline is a drug of a choice for both S. aureus and MRSA infection.

AmpC β-Lactamase Variable Expression in Common Multidrug-Resistant Nosocomial Bacterial Pathogens from a Tertiary Hospital in Cairo, Egypt

The emergence of AmpC (pAmpC) β-lactamases conferring resistance to the third-generation cephalosporins has become a major clinical concern worldwide. In this study, we aimed to evaluate the expression of AmpC β-lactamase encoding gene among the pathogenic Gram-positive and Gram-negative resistant bacteria screened from clinical samples of Egyptian patients enrolled into El-Qasr El-Ainy Tertiary Hospital in Cairo, Egypt. A total of 153 bacterial isolates of the species Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterococcus faecium were isolated from patients diagnosed with urinary tract infection (UTI), respiratory tract infection (RTI), and wound infections. The total number of E. faecium isolates was 53, comprising 29 urine isolates, 5 sputum isolates, and 19 wound swab isolates, whereas the total number of P. aeruginosa isolates was 49, comprising 27 urine isolates, 7 sputum isolates, and 15 wound swab isolates, and that of the K. pneumoniae isolates was 51, comprising 20 urine isolates, 25 sputum isolates, and 6 wound swab isolates. Our results indicated that there is no significant difference in the expression of AmpC β-lactamase gene among the tested bacterial species with respect to the type of infection and/or clinical specimen. However, the expression patterns of AmpC β-lactamase gene markedly differed according to the antibacterial resistance characteristics of the tested isolates.

Imipenem Resistance Gram-Negative Bacilli Isolated from Patients of a Tertiary Care Hospital in Dhaka, Bangladesh

Introduction: The emergence of antibiotics resistance bacteria is a persistent global problem affecting public health. The occurrence and widespread resistance to Imipenem among hospital bacterial isolates can constitute a significant threat to chemotherapy. Objectives: This cross-sectional study aimed to investigate the imipenem resistant pattern among gram-negative bacilli isolated from different samples in Dhaka medical college hospital. Methods: A total of 300 samples (wound swab, urine, endotracheal aspirate, blood, and sputum) were collected from July 2015 to June 2016. Two hundred four gram-negative bacilli were isolated and tested for resistance to imipenem by the disc diffusion method. Results: Among 204-gram negative bacilli, 39.21% imipenem resistance was detected by the Disc Diffusion method. 14.7% imipenem resistance gram-negative bacilli were from wound swab. 83.33% of Acinetobacter baumannii were Imipenem resistant. Conclusions: Imipenem resistance is widespread among gram-negative bacilli isolated from human infections. Imipenem resistance (39.21%) found in the study is quite worrisome. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 3-5

Identification of Bacteria on Postcesarean Section Patient’s Wound Operation

Objective: To determine the type of bacteria in post-cesarean surgical patient wounds obtained through the patient's surgical wound swab in the Ward Obstetrics and Gynecology RSUD Ulin Banjarmasin in the period August-October 2019.Methods: This study was a descriptive study with a cross-sectional approach. A total of 36 samples were taken using a purposive sampling method, but only 32 bacterial isolates were obtained. Samples in the form of clean operating wound contaminated post-cesarean patients were planted on growth media and identified microscopically to be further classified based on responses to biochemical tests.Results: Descriptive analysis shows that there are three types of bacteria, namely Staphylococcus aureus as much as 59.3%, Staphylococcus epidermidis as much as 25.0%, and Escherichia coli as much as 15.6%.Conclusion: Obtained 3 types of bacteria in the results of surgical wound swab in post-cesarean section patients who were hospitalized in the Ward and Obstetrics Hospital of Ulin Hospital Banjarmasin, namely Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli.Keywords: cesarean section, contaminant bacteria, surgery wound swab. Abstrak Tujuan: Mengetahui gambaran jenis bakteri pada luka operasi pasien pascaseksio sesarea yang didapat melalui swab luka operasi pasien di Bangsal Kandungan dan Kebidanan RSUD Ulin Banjarmasin dalam periode Agustus-Oktober 2019.Metode: Penelitian ini merupakan studi dekskriptif dengan pendekatan potong lintang. Sebanyak 36 sampel diambil menggunakan metode purposive sampling, tetapi hanya didapatkan 32 isolat bakteri. Sampel swab luka operasi bersih terkontaminasi pasien paska seksio sesarea ditanam pada media pertumbuhan dan diidentifikasi secara mikroskopis untuk selanjutnya diklasifikasikan berdasarkan respon terhadap uji biokimia.Hasil : Analisis secara deksriptif menunjukkan bahwa terdapat tiga jenis bakteri, yaitu Staphylococcus aureus sebanyak 59,3%, Staphylococcus epidermidis sebanyak 25,0%, dan Escherichia coli sebanyak 15,6%.Kesimpulan : Didapatkan 3 jenis bakteri pada hasil swab luka operasi pasien pascaseksio sesarea yang dirawat inap di Bangsal Kandungan dan Kebidanan RSUD Ulin Banjarmasin, yaitu Staphylococcus aureus, Staphylococcus epidermidis, dan Escherichia coli.Kata kunci: seksio sesarea, bakteri kontaminan, swab luka operasi.

Prevalence and Antimicrobial Susceptibility Pattern of Klebsiella Pneumoniae Isolated from Various Clinical Specimens in a Tertiary Care Hospital in Bangladesh

Introduction:Klebsiella pneumoniae are common causative agents of various infections and are of great concern for developing resistance against commonly prescribed antibiotics. This study gives an account of isolation of K. pneumoniae from various clinical specimens and their antimicrobial susceptibility, in a tertiary care hospital of Bangladesh. Materials and Methods: Various clinical specimens like urine, wound swab, sputum, blood and endotracheal aspirates were collected and processed for isolation of K. pneumoniae followed by their antimicrobial susceptibility testing. Results: Among the 316 samples that yielded culture positivity, K. pneumoniae were identified as second most common organism. The highest yield of K. pneumoniae (37.33%) were observed from wound swab followed by sputum (26.67%). Most of the isolates were resistant to sulphamethoxazole-trimethoprim (90.67%) and ceftriaxone (90.67%) followed by cefotaxime (89.33%), ceftazidime (89.33%) and cefuroxime (89.33%). The most sensitive antibiotic for the isolates was tigecycline. Conclusion: Isolated K. pneumoniae showed resistance to commonly prescribed antibiotics, which is very alarming and showing the importance on continuous monitoring and strict antimicrobial policy. Medicine Today 2020 Vol.32(2): 95-99

The Microbial Profile and Antibiotic Susceptibility in Burn Wound Infection: A Hospital Based Study

Aim: To determine spectrum of bacteria infecting burn wound and its antibiotic susceptibility at Benue State University Teaching Hospital (BSUTH). Study Design: A one year prospective study of the microbial profile in burn wound infection at BSUTH, Makurdi. Methodology: All patients admitted from August 2018 to July 2019 with burn wound who had wound swab microscopy culture and sensitivity (MCS) after thorough cleaning of the wound were included in the study. Data collected included the Age, Sex, Occupation, Total Body Surface Area (TBSA) of burn, injuring agent, type of burn, bacteria cultured from the wound, antibiotic susceptibility, number of days of admission and outcome of treatment. Results: Out of the 63 patients admitted, flame was the predominant injuring agent seen in 54 (85.7%) patients. The age group 21 – 30 years was the most affected, 27 constituting 42.9%. Burn wound infection occurred in 25(39.7%) patients from whom 33 bacterial isolates were recovered. Gram negative organisms Pseudomonas species and Proteus species were the commonest bacteria isolated constituting 21.21% each. Other isolates were Staphylococcus aurous 36.36%, Escherichia coli 15.15%, Klebsiella species and Staphylococcus saprophyticus (each 3.03%,). There was multiple bacteria colonization of wounds and antibiotics resistance. There was no gender difference in the burn wound infection, P =0.7819. Conclusion: The sensitivity pattern showed many of the bacteria to be resistant to commonly administered antibiotics but sensitivity patterns got are important for empirical antibiotics prescription when patients come with glaring sepsis and are waiting for wound swab microscopy culture and sensitivity. Studying the microbial profile with antibiotic resistance pattern in burn’s wound infection should be a continuous process in all burn units/departments. This will help to formulate and modify at regular intervals, a hospital/departmental antibiotic policy according to the present microbial pattern in the respective burns unit.

Management of Diffuse Necrotic Cutaneous Wound in a Dog

A one-year-old male Terrier dog weighing 22 kg was presented to the Ahmadu Bello University Veterinary Teaching Hospital (ABUVTH), Zaria, Nigeria, with complaints of sloughing of the skin and purulent discharges from an injured (sloughed) shoulder. Clinical examination revealed normal vital parameters, extensive necrotized skin on the dorsum extending from loin to the right shoulder and enlarged superficial lymph nodes. Blood and wound swab samples were evaluated in the clinical haematology and Microbiology Laboratories of the ABUVTH, respectively. The Pathology result showed leucocytosis due to neutrophilia and monocytosis. Staphylococcus aureus was isolated from the wound swab. The wound was managed by wet-to-dry bandaging technique using topical antiseptics (Para-chloroaniline solution, chlorhexidine and povidone iodine), improvised non-adhesive protective membrane (polyethylene) applied at the wound-bandage interface, bandages along with adhesive tape and systemic antibiotics. Healing occurred uneventfully within 6 weeks of the intervention. The paper discusses the detail of the management initiated and how it greatly influenced the skin wound healing in dogs. In conclusion, proper initial assessment of wounds and appropriate treatment through rigorous wound assessment and bandaging are critical to success in the wound healing and restoration of tissue integrity. This management intervention could be further investigated in animals in order to improve the quality of cutaneous wounds management.

THU0339 THE INFLUENCE OF SKIN CALCINOSIS ON THE PROGNOSIS OF DIGITAL ULCERS IN PATIENTS WITH SSC.

Background:Digital ulcers (DUs) are one of the main burdens in patients with systemic sclerosis (SSc) as they have a major impact on quality of life and prognosis. Some DUs are associated with the presence of subcutaneous calcinosis (SC) that may worsen their management, and the prognosis of these DUs is still not well defined.Objectives:To define the characteristics of SSc patients with DUs related to SC and analyze the impact on prognosis and on healing time.Methods:We prospectively collected data from DUs of the hands evaluated in our dedicated wound-care outpatient clinic from October 2018 to August 2019. Fifty-five patients were enrolled (50 females, 18 with limited-SSc and 37 with diffuse-SSc, mean age 62.3±17.2 years). For every DU we collected: presence/absence of calcinosis, pathogenesis (spontaneous, post-traumatic), area of DU, location (fingertip, periungual area, metacarpophalangeal, proximal/distal interphalangeal-PIP/DIP), VAS-pain at the baseline and after two weeks, local signs of infection (edema, redness), deep wound swab results and time to the healing. Additionally, we calculated the wound-bed score (WBS), at the baseline and we correlated the total score with the time of healing. All the ulcers were managed with weekly treatment following a definite protocol: wound cleansing, disinfection, mechanic debridement, application of antiseptic dressing.Results:Out of 98 DUs evaluated, 24 (24.5%) were associated with SC. Patients with SC were older than those without calcinosis (67.1+-16.9 vs 59.4+-16.9 p<0.05) and were more frequently affected by lc-SSc (18 – 75% vs 6 – 25% p<0.001). There were no significant differences between the mean areas of DUs (SC 22mm2vs non-calcinosis 30.8mm2) neither in the localization of the ulcers: fingertip (14-61% vs 34-49.3%), periungual area (4-17.4% vs 16-23.2%), PIP (2-9% vs 13-18.9%), DIP (2-9% vs 9-13%) and MCP (1-4% vs 4-5.8%). The VAS-pain was not statistically different at the baseline (6.0 for SC vs 5.4), neither after 2 weeks (3.8 vs 3.2). Although the presence of local signs of infection was similar (5-20.8% vs 14-18.9%), the positivity for the wound swab was higher in SC compared with those without calcinosis (6-26.1% vs 9-11.5%; p=0.05).All the DUs treated in our outpatient clinic healed but those with SC required more weeks (10.4±7.9 vs. 7.13±5.7; p=0.03). The WBS was similar in the two groups (8.96+-0.46 in SC vs 9.43+-0.33) and was negatively correlated with the time of healing (r=-0.24, p=0.02).Conclusion:Although DUs with calcinosis have a different pathogenesis compared to those without SC, the location, dimensions and DU-related pain are similar in both groups. Despite these aspects, DUs associated with calcinosis are more prone to be infected and require more time to heal; the WBS may represent a simple, easy-calculated score to predict the time for DUs healing. The presence of calcinosis may represent a negative prognostic factor in the management of SSc-DUs.References:[1]Falanga V, Saap LJ, Ozonoff A. Wound bed score and its correlation with healing of chronic wound. Dermatol ther, 2006 Nov-Dec;19(69):383-90Disclosure of Interests:None declared

Bacterial pathogens in wound infection and their antimicrobial susceptibility pattern in a medical college hospital, in Dhaka, Bangladesh

Background: Wound infection is a major health problem that results in prolong hospital stay, increased treatment cost and are responsible for significant mortality and morbidity worldwide. The aim of the present study was to isolate and identify the bacterial pathogens causing wound infection and to determine their antimicrobial susceptibility profile.Methods: This cross sectional study was conducted at the Department of Microbiology, Sir Salimullah Medical College, Dhaka from January 2016 to December 2016. Wound swab samples were collected and inoculated into appropriate media. The bacterial pathogens were identified by using standard microbiological methods. Antimicrobial susceptibility test were performed using disc diffusion technique following Kirby-Bauer method.Results: Out of 239 wound swab samples analyzed 173 (72.4%) were culture positive. Majority (35.3%) of culture positive cases were in age group 16-30 years and 60.1% were male. Staphylococcus aureus (36.9%) was the predominant isolate, followed by Escherichia coli (35.8%), Pseudomonas spp. (17.3%) and Proteus spp. (5.8%). Bacterial isolates were highly resistant Amoxicillin (89-100%), Cephalosporin (60-100%), Ciprofloxacin (53-71%), while they were least resistant to Imipenem (0-14%) and Amikacin (17-30%). Conclusions: In the present study most of the isolates showed high rate of resistance to commonly used antibiotics. Therefore regular monitoring and rational use of antibiotic should be practiced.