PriMera Scientific Medicine and Public Health (ISSN: 2833-5627)

Case Study

Volume 3 Issue 1

Incidence, Antibiotic Susceptibility Pattern and Plasmid Profile of Bacterial Pathogens from Surgical site Infections in a Tertiary Hospital in Lagos, Nigeria

Dauphin Dighitoghi Moro*, Hakeem Olanrewaju Bello, Taiwo Oluwabukola Bello, Ukhureigbe Miriam Oluchi, Hammed Kolawole Shittu, Zenas Chisom Agubata, Chinyere Theresa Nzomiwu, Collins Chidiebere Nwaji and Jude Chidozie Nwaji

June 28, 2023

DOI : 10.56831/PSMPH-03-074

View PDF

Abstract

Surgical site infections [SSIs] remain a common postoperative complication despite the use of prophylactic antibiotics and other preventive measures, mainly due to increasing antimicrobial resistance. SSIs increase postoperative morbidity and mortality and may require hospital admission, intravenous antibiotics and even surgical re-intervention. A hospital based descriptive study was conducted on 100 consented postoperative patients with clinical SSIs. Data on patients was obtained using structured data collection form. Swab samples were collected aseptically from each patients. Bacteriological culture examination and identification was done following standard microbiological techniques. Antibiotics sensitivity test was done by Kirby-Bauer disc diffusion method. Ninety (90%) bacterial isolates were recovered from surgical site infection. Gram negative bacteria (GNB) were predominant (83.3%) with the dominant being Escherichia coli (27.78%) and Staphylococus aureus (16.67%). All the isolates were highly resistant to amoxicillin/clavunalate, ceftazidime, cefuroxime, levofloxacin and all the isolates were resistant to metronidazole but susceptible to imipenem, polymycin B and amikacin. The plasmid analysis in this study revealed that out of the 40 (44.4%) multi-drug resistance isolates, 35 (87.5%) of which were Gram-negative bacteria had 9 (22.5%) detectable plasmid pattern with the molecular weight of between 2027kbp to 23120kbp while the remaining 26 (74.6%) had no plasmid bands. The remaining 5 (12.3%) which was Staphylococcus aureus isolates had 2 (40%) detectable plasmid pattern with the molecular weight of between 23130kbp and 6557 while the remaining 3 (60%) had no plasmid bands. Imipenem is the drug of choice in the treatment of surgical site infections in this study area These findings necessitates judicious antibiotic use and calls for surveillance of SSIs periodically as well as strict adherence to good sanitation practice to reduce spread of drug-resistant pathogens.

Keywords: Surgical Site Infections; Antimicrobial susceptibility; Gram negative; Bacteria; Gram positive; Plasmid Profile; Clinicians; Operating Room

References

  1. Soresen LT, Karlsmark T and Gottrup F. “Abstinence from smoking reduces incisional wound infection: a randomized controlled trial”. Annals of surgery 238.1 (2003):1-5.
  2. Farhan S, Zeeshan S, Moshin Z and Shahzad A. “Frequency of Post-operative Surgical Site Infections in a Tertiary Care Hospital”. Journal of Dental and Medical Sciences 7.11 (2019): 42-43.
  3. Shrestha A and Sharma VK. “Bacteriological study of wound infection and antibiotic susceptibility pattern of the isolates”. Nepal Journal of Science and Technological 14.2 (2013): 143-150.
  4. Church D. “Burn Wound Infections”. Clinical Microbiology Review 19.2 (2006): 403-434.
  5. Manikandan C and Amsath A. “Antibiotic susceptible of bacterial strains isolated from wound infection patients in Pattukkottai, Tamilnadu, India”. International Journal Current Microbiology Applied Science 2 (2013): 195-203.
  6. Anguzu JR and Olila D. “Drug Sensitivity Patterns of Bacterial Isolates from Septic Post-operative Wounds in a Regional Referral Hospital in Uganda”. Africa Health Sciences 7 (2007): 148-154.
  7. CDC Guideline for the Prevention of Surgical Site Infection 152.8 (2017): 784-791.
  8. Owens CD and Stoessel K. Surgical site infections: epidemiology, microbiology and prevention”. J Hosp Infect 2 (2008): 3-10.
  9. Horan TC, Gaynes RP, Martone WJ, Jarvis WR and Emori TG. “CDC definitions of nosocomial surgical site Infections: A modification of CDC Definitions of nosocomial Surgical Site Infections: A modification of CDC definitions of Surgical Wound Infections”. Infection Control Hospital Epidermiology 13.10 (1992): 606-608.
  10. Altemeier WA. “Sepsis in Surgery. Presidential address”. Arch Surg 117.2 (1982): 107-112.
  11. Garner JS, Javis WR, Emori TG, Horan TC and Hughes JM. “CDC definitions for nosocomial infection”. American Journal of Infection Control 16 (1988): 128-40.
  12. Cantlon CA, Stemper ME and Schwan WR. “Significant Pathogens isolated from surgical site infections at a community hospital in the Midwest”. America Journal of Infection Control 34.25 (2006): 526-529.
  13. Barie PS and Wilson SE. “Impact of evolving epidemiology on treatments for complicated skin and skin structure infections: The surgical perspective”. Journal of America College Surgery 220.1 (2015): 105-106.
  14. Anderson DJ. “Surgical site infections”. Infectious diseases and Clinic of North America 25.1 (2011): 135-153.
  15. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL and Wade JC. “Practice guidelines for the diagnosis and management of skin and soft tissue infections: Update by the infectious Diseases Society of America”. Clinical Infectious Disease 2 (2014): 10-52.
  16. Lawson EH, Hall BL and Ko CY. “Risk factors for superficial vs deep/organ-space surgical site infections: implications for quality improvement initiatives”. Jamaica Surgery 148.9 (2013): 849-858.
  17. Malik A, Mohammad Z and Ahmad J. “The diabetic foot infections: biofilms and antimicrobial resistance. Diabetes and Metabolic Syndrome”. Clinical Research and Reviews 7.2 (2013): 101-107.
  18. Cheesbrough M. “Medical Laboratory Manual for Tropical Countries”. Microbiology. Butterworth and Co. Ltd 3 (2007): 258-270.
  19. Clinical Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. Twenty second informational supplement. Wayne, PA, USA: CLSI (2012): M100-S22.
  20. Kirby QMM. and Bauer AW. “Antibiotic susceptibility testing by a standardized single disc method”. Am. J. Clin. Path 45 (1966): 493-6.
  21. PY Liu, YJ Lau, BS Hu, JM Shyr, ZY Shi, WS Tsai, YH Lin and CY Tseng. “Analysis of clonal relationships among isolates of Shigella sonnei by different molecular typing methods”. Journal of Clinical Microbiology 33 (1995): 1779-1783.
  22. Olufunmilola BM, Olugbenga AO and Folasoge AA. “Bacterial Agents of Surgical Site Infections in South-Western Nigeria”. American. Journal of Biomedical Sciences 5 (2010): 217-225.
  23. Bibi SGA, Channa TR, Siddiqui and Ahmed W. “Pattern of bacteria pathogens in postoperative wounds and their sensitivity patterns in Karachi, Pakistan”. Journal of Surgery Pakistan 17.4 (2012): 164-167.
  24. Bisi-Johnson MA and Olowe OA. “Studies on bacteria agents of surgical site infection in Osogbo, South Western Nigeria”. International Journal of Infectious Diseases 1.21 (2014): 346.
  25. Giacometti A, Cirioni O, Schimizzi AM, Del Prete MS, Barchiesi F and D’errico MM. “Epidemiology and microbiology of surgical wound infections”. Journal of Clinical Microbiology 38.2 (2000): 918-922.
  26. Kemebradikumo P, Fente BG and Oladapo O. “Current microbial isolates from wound swabs. Their culture and sensitivity pattern at the Niger Delta University Teaching Hospital, Okolobiri, Nigeria”. Tropical Medical Health. 41.2 (2013): 49-53.
  27. Pradeep M and Rao KVV. “A study on surgical site infections, their bacteriological profile and antimicrobial susceptibility pattern”. International Journal of Medical Microbiology Tropical Disease 5.1 (2019): 9-13.