Research Article
Aerobic Bacteria Isolates and Antibiotic Susceptibility Patterns in Suspected Wound Infection Patients at Dil-Chora Referral Hospital, Dire Dawa, Eastern Ethiopia
1Dil-Chora Referral Hospital, Department of Medical Laboratory, Dire Dawa, Ethiopia.
2Haramaya University, College of Health and Medical Sciences, School of Medical Laboratory Sciences, Tropical and Infectious Disease and medical Parasitology programs, Ethiopia.
3Oda Bultum University, College of Health Sciences, Department of Medical Laboratory Sciences, P.O. Box, 226 Chiro, Ethiopia.
4Haramaya University, College of Health and Medical Sciences, School of Medical Laboratory Sciences, Medical Microbiology and Immunology programs, P.O. Box, 235 Harar, Ethiopia.
*Corresponding Author: Wondimagegn W. Eba., Oda Bultum University, College of Health Sciences, Department of Medical Laboratory Sciences, P.O. Box, 226 Chiro, Ethiopia.
Citation: Ibrahim. A, Egata G, Wondimagegn W. Eba, Teklemariam Z, Tadesse S. Awaju. (2024). Aerobic Bacteria Isolates and Antibiotic Susceptibility Patterns in Suspected Wound Infection Patients at Dil-Chora Referral Hospital, Dire Dawa, Eastern Ethiopia. Scientific Research and Reports. BioRes Scientia Publishers. 1(5):1-9. DOI: 10.59657/2996-8550.brs.24.027
Copyright: © 2024 Wondimagegn W. Eba, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: July 30, 2024 | Accepted: August 29, 2024 | Published: November 04, 2024
Abstract
Background: Bacterial wound infections are a common and serious health problem that can disrupt wound healing, resulting in morbidity and death in patients, particularly due to drug-resistant pathogens. Limited research exists on this topic in eastern Ethiopia.
Objective:This study aims to assess aerobic bacteria isolate, their drug susceptibility patterns and associated factors among suspected patients admitted for wound infection at Dil-Chora Referral Hospital, Dire Dawa, eastern Ethiopia.
Methods: A hospital-based cross-sectional study was conducted among 188 patients with wounds from March to June 2020. Data were collected using a pretested, structured questionnaire. Wound swabs and pus discharges from 188 patients were collected using convenient sampling techniques. Gram staining, biochemical testing, and culture were used to isolate and identify etiologic agents. Antibacterial susceptibility test was performed on Muller Hinton agar using the Kirby-Bauer disc diffusion method.
Results: In this study, 89.4% of wound infections yielded bacteria, predominantly Gram-negative (54%) and Gram-positive (46%). S. aureus (32.9%) and Proteus species (28.6%) were predominant. Gender [AOR=7.5; 95% CI (5.6–13.2)], type of specimen [AOR=16.8; 95% CI (12.7–18.3)], and type of ward [AOR=12.3; 95% CI (8.3–16.5)] were significantly associated with bacterial wound infection. All isolated Gram-positive bacteria resisted Beta-lactams but responded to amikacin and vancomycin. Gram-negative bacteria showed high resistance to ampicillin, chloramphenicol, cotrimoxazole, ceftriaxone, and doxycycline, but they were susceptible to amikacin. Overall, multi-drug resistance was high at 85%.
Conclusions: Our study detected a high prevalence of bacterial wound infections with notable drug resistance. Gender (female), types of specimens (pus discharge), and types of wards (orthopedic ward) had a significant effect on the outcome variable (P< 0.05). Amikacin, gentamicin, and vancomycin emerged as preferred antibiotics at Dil-Chora hospital. Clinical diagnosis of wound infection should consider microbiological culture and susceptibility patterns for effective treatment.
Keywords: aerobic bacteria; bacterial isolates; drug susceptibility pattern; wound infection
Introduction
Wound infection continues to be challenging for people with a wound, their families and health professionals [1]. Bacterial wound infections are a common and significant health concern that can affect the healing process of wounds, leading to morbidity and mortality in patients. This comes at significant economic cost and negatively influences quality of life outcomes for the person with a wound and their family [1, 2]. An estimated 2 million instances of wound infections occur globally each year [3, 4]. Variety of finding reported that wound infections in Africa ranged from 2.5% to 30.9% [5, 6, 7]. Furthermore, several studies from other globe have found varying rates of wound infection prevalence such as 78.9%, 44.8%, and 64.8% in India [8], Nepal [9], and Nigeria (10%), respectively.
In Ethiopia, bacteria isolate from wound infections varies from 70.2% to 96.3% [11, 12]. The common bacterial pathogens associated with wound infection include S. aureus, Klebsiella species, E. coli, Proteus species, Pseudomonas species, and Coagulase Negative Staphylococci, particularly the infection caused by drug resistant pathogens are a global crisis [11–13]. In recent years, drug-resistant bacterial infections have become increasingly serious, as top ten threats to global health [14, 15]. Widespread bacterial resistance to presently available medicines has made wound infection management more difficult [11–13, 16–17, 18–19]. Antimicrobial-resistant bacterial wound infections significantly raise medical care costs and increase patient morbidity and death [20]. In this regard, this study has not been explored previously in the study area. Therefore, it was aimed to assess aerobic bacteria isolates, drug susceptibility pattern and associated factors among clinically suspected patients admitted for wound infection at Dil-Chora Referral Hospital, Dire Dawa, Eastern Ethiopia.
Materials and methods
Study area, design and period
Dire Dawa administration council is located in the Eastern part of Ethiopia which is 550 Km away from Addis Ababa. Hospital based cross sectional study design was conducted on patients with wound infection who were admitted at Dil-Chora Referral Hospital, from March 15, 2020 to June 14 2020.
Sample size determination and sampling technique
Sample size was determined by using a single population proportion formula by considering a 95% confidence interval, an expected margin of error (d) of 0.05, a 10% non-response rate, and the 87.4% prevalence of bacteria isolates from wound infection in a study conducted at Jimma University Specialized Hospital, Southwest Ethiopia (12). The final sample size was 188 patients with infected wounds were chosen using a practical sampling approach.
Data collection method
The data was collected via a face-to-face interview using pre-tested structured questionnaires that were adopted from different kinds of literature [11, 12, 22]. The questionnaire contains two parts: on the first part socio-demographic variables like age, gender, residence, educational status, marital status, monthly income, family size while the second part contains, clinical information such as history of wound infection, type of laboratory test, and personal habit.
Two trained B.Sc. Nurses were collected the data. One B.Sc. Laboratory technologist has supervised the activities of data collectors. The training was provided to both data collectors and supervisors by the principal investigator and senior Medical Microbiologist for two days (one day theoretical and one day practical) on the sample collection procedure and the data collection tools before the actual data and sample collection had started.
Wound Swab Specimen collection
Open wound swabs were aseptically collected by spinning it under enough pressure onto a sterile cotton swab after the dressing was removed, and the surface exudates and contaminants were cleansed off with moistened sterile gauze dipped in sterile normal saline solution. To lower the possibility of contamination, duplicated wound swabs were obtained from each site. After being collected, nasal swabs were inoculated in a properly labeled sterile Amies transport media (Oxoid Ltd. England) and transported by using an ice-box to keep the cold chain until it reaches the Haramaya University’s Microbiology Laboratory.
Culture, isolation and identification of bacteria
The wound swab was inoculated on Blood agar (OXOID, England) and MacConkey agar (OXOID, England) by sterile inoculation loop using the streak plate method [23]. The inoculated plates were incubated aerobically at 37oC for 24-48 hours. Preliminary identification of bacterial isolates was made based on colony morphology and gram stain. Using many distinct biochemical assays, bacterial isolates were identified [23].
Antimicrobial susceptibility testing
The antimicrobial susceptibility test of the isolated bacteria was done according to the Clinical Laboratory Standards Institute guidelines (CLSI) [24] using Kirby-Bauer disk diffusion method on Muller Hinton agar (OXOID, Basingstoke, United Kingdom). Suspension of confirmed isolates was done using normal saline and adjusted to match that of 0.5 McFarland standards to obtain approximately a colony count of 107 or 108 colony forming units (CFU) per ml. A sterile swab was dipped into the suspension, applied to the Muller Hinton agar plat and evenly spread, and left at room temperature to dry for 3 to 5 min. Antibiotic discs like ampicillin (10 μg), ciprofloxacin (5 μg), gentamicin (10 μg), cotrimoxazole (25 μg), chloramphenicol (30 μg), doxycycline (30 μg), amikacin (10 μg), and ceftriaxone (30 μg). Penicillin G (10 IU), erythromycin (15 μg), and vancomycin (30 μg) were placed at a distance of 15mm from each other on to the Muller Hinton agar and incubated at 37 oC for 16–18 hours. (23). Diameters of the zone of inhibition around the discs were measured using automated calipers and classified as sensitive, intermediate, and resistant according to Clinical and Laboratory Standards Institute guidelines (24).
Variables
Dependent variables
Prevalence of aerobic Bacteria isolates in suspected wound infection
Antibiotic susceptibility patterns of the isolates
Independent variables
Age, gender, residence, educational status, marital status, monthly income, family size, history of wound infection, Type of specimens, Type of ward and personal habits.
Operational definition
Aerobic bacteria are bacteria that can grow and live when oxygen is present [1].
Wound infection is defined as the presence of replicating microorganisms within a wound leading to host/tissue injury [2].
Quality control
Training was given to the data collector. The collected data were checked for completeness at the end of each day of data collection. Double data entry was done using Epi-Data to minimize errors during data entry.
For culturing and biochemical tests, standard operating procedures and the manufacturer’s instruction manual were strictly followed andSterility was checked by incubating 5% of the prepared culture media at 37 °C overnight and checked for growth of contaminants. The American Type Culture Collection (ATCC) S. aureus (ATCC-25923), E. coli (ATCC-25922), and P. aeruginosa (ATCC-27853), which were obtained from the Ethiopian Public Health Institute (EPHI), and used as quality control for the Gram Stain, culture, biochemical, antibiotic susceptibility testing.
Data processing and analysis
Data were entered and cleaned using Epi Data (Version 3.02) then exported to the Statistical Package for Social Science (SPSS Version 16) for analysis. Descriptive statistics such as frequency, percentage, and cross-tabulation were used to summarize the characteristics of the study population. Bivariate and multivariate analyses were performed to identify factors associated with bacterial wound infection. Variables with p less than 0.3 at a 95% confidence interval in bivariate analysis were considered for multivariate analysis. Variables with p less than 0.05 at 95 percentage CI in the multivariate analysis were considered significantly associated factors with bacteria wound infection.
Results
Socio-demographic characteristics
A total of 188 patients with clinical evidence of wound infection who were admitted to Dil-Chora Referral Hospital at the time study period were enrolled. Among enrolled patients, the majority 58.5% of them were between 21–40 age categories. The mean age of study participants was 35±16 years with ranged from 3 to 95 years. Majority (59.6%) of the study participants were female. Moreover, more than half (52.7%) of participants were from urban area and majority (68.6%) were married (Table 1).
Table 1: Socio-demographic characteristics of patients admitted for wound infection at Dil-Chora Referral Hospital, Dire Dawa, Ethiopia, 2020
| Variables | Category | Frequency | Percentage |
| Age | 1-20 | 24 | (12.8%) |
| 21-40 | 110 | (58.5%) | |
| >40 | 54 | (28.7%) | |
| Gender | Female | 112 | (59.6%) |
| Male | 76 | (40.4%) | |
| Residence | Urban | 99 | (52.7%) |
| Rural | 89 | (47.3%) | |
| Educational status | Can’t read and write | 70 | (37.2%) |
| Write and read only | 20 | (10.6%) | |
| Primary (Grade 1-8) | 51 | (27.1%) | |
| Secondary (Grade 9-12) | 28 | (14.9%) | |
| College and above | 19 | (10.1%) | |
| Marital status | Single | 31 | (16.5%) |
| Married | 129 | (68.6%) | |
| Widowed | 25 | (13.3%) | |
| Divorce | 3 | (1.6%) | |
| Monthly income | <1000> | 125 | (66.5%) |
| 1000-2000 | 44 | (23.4%) | |
| >2000 | 19 | (10.1%) | |
| Family size | 1-4 | 80 | (42.6%) |
| >8 | 108 | (57.4%) |
Magnitude of Bacteria isolates
From a total of 89.4% (168/188) [95% CI: 84.1%–93.0%] of the collected wound sample, 213 had bacterial isolates. Among the isolates, more than half (54%, 115/213) were Gram-negative bacterial isolates. Were more prevalent than Gram-positive, as Proteus species (28.6%) were the most Prevalent. In addition, from the isolated gram-positive bacteria, S. aureus (32.9%) was the predominant bacteria isolate followed by CoNS (13.1%) (Table 2).
Table 2: Bacteria isolates among patients admitted for wound infection at Dil-Chora Referral Hospital, Dire Dawa, Eastern Ethiopia, 2020
| Bacteria Isolates from wound | Frequency | Percentage (%) |
| Staphylococcus aureus | 70 | 32.9 |
| Proteus species | 61 | 28.6 |
| Coagulase negative Staphylococcus species | 28 | 13.1 |
| Pseudomonas aeruginosa | 18 | 8.5 |
| Klebsiella species | 13 | 6.1 |
| Escherichia coli | 9 | 4.2 |
| Citrobacter species | 8 | 3.8 |
| Providencia species | 6 | 2.8 |
| Total | 213 | 100 |
Factors associated with Bacterial wound infection
In the bivariate analysis, the prevalence of bacterial isolates was higher in age groups 20–40, female, previous history of wound infection, pus discharge type of specimens, and types of wards (Orthopedic, Gynecology, Obstetrics, and Surgical type of ward). However, in multivariate analysis, females were found to be 7.5 times more prone to develop bacterial wound infection than males (AOR: 7.5; 95% CI: 5.6–13.2). In addition, study participants with pus discharge samples were 16.8 times more vulnerable to develop bacterial wound infection than other wound swabs samples (AOR: 16.8; 95% CI: 12.7–18.3). Those study participants who were admitted to the orthopedic ward were 12.3 times more likely to develop a bacterial wound infection than those admitted to another ward (AOR: 12.3; 95% CI: 8.3–16.5) (Table 3).
Table 3: Bivariate and Multivariate analysis of socio-demographic, Clinical and other factors related with of bacteria isolated among patients admitted for wound infection at Dil-Chora Referral Hospital, Dire Dawa, Eastern Ethiopia, 2020.
| Variables | Culture | Bivariate analysis | Multivariate analysis | |
| Positive (%) | Negative (%) | COR (95% CI) | AOR (95% CI) | |
| Age | ||||
| 1-20 | 19(79.17%) | 5 (20.83%) | 4 (2.46-14.9) | 0.14 (0.004-5.78) |
| 21-40 | 103(93.64%) | 7(6.36%) | 1.5(0.1785.632) | 0.94 (0.28-31.6) |
| >60 | 46 (85.19%) | 8(14.81%) | 1 | 1 |
| Gender | ||||
| Female | 107(95.54%) | 5 (4.46%) | 5.3 (1.823-15.2) | 7.5 (5.6-13.2) * |
| Male | 61 (80.26%) | 15(19.74%) | 1 | 1 |
| Previous history of wound infection | ||||
| Yes | 7 (53.85%) | 6 (46.15%) | 8.78 (3.53-12) | 5.3 (3.53-12) |
| No | 161 (92%) | 14 (8%) | 1 | 1 |
| Type of specimens | ||||
| Pus discharge | 120(97.56%) | 3 (2.44%) | 14.2(3.9716.03) | 16.8 (12.7-18.3) *** |
| Wound swab | 48 (73.85%) | 17(26.15%) | 1 | 1 |
| Type of ward | ||||
| Gyn & Obs | 73 (93.59%) | 5 (6.41%) | 0.02 (0.02-0.19) | 2.4 (0.16-3.6) |
| Orthopedic | 51 (91.08%) | 5 (8.92%) | 0.05 (0.01-0.35) | 12.3 (8.3-16.5) ** |
| Surgical | 26 (86.67%) | 4 (13.33%) | 0.15(0.027-0.87) | 3.49 (0.4-3.5) |
| Medical | 14 (73.68%) | 5 (26.32%) | 0.5 (0.09-2.62) | 3.78 (0.46-3.8) |
| Pediatrics | 4 (80%) | 1 (20%) | 1 | 1 |
*Statically significance (p<0 p=0.004), p=0.001), xss=removed AOR=Adjusted CI=95%>
Antibiotics susceptibility pattern of bacteria isolates
Gram-positive bacteria: Amikacin (100%), vancomycin (100%), chloramphenicol (87.5%), and gentamycin (80%) were found to be most active antimicrobials in sensitivity test against S. aureus and CoNS isolates from wound infection. However, S. aureus was found resistant to ampicillin (100%), penicillin (100%), erythromycin (91.4%), and doxycycline (74.3%) (Table 4).
Table 4: Drug susceptibility pattern of gram-positive bacteria isolates among patients admitted for wound infection at Dil-Chora Referral Hospital, Dire Dawa, Eastern Ethiopia, 2020
| Isolates | Results | Antimicrobial agents /No. of bacterial isolates (%) | ||||||||||
| C | CRO | CN | AN | TS | CIP | E | AM | P | VA | D | ||
| S.aureus | S | 60(85.7) | 35(50) | 56(80) | 70(100) | 45(64.3) | 35(50) | - | - | - | 70(100) | 18(25.7) |
| (n=70) | I | 3(4.3) | 15(21.4) | - | - | - | 5(7.1) | 6(8.6) | - | - | - | - |
| R | 7(10) | 20(28.6) | 14(20) | - | 25(35.7) | 30(42.9) | 64(91.4) | 70(100) | 70(100) | - | 52(74.3) | |
| CONS | S | 18(64.3) | 23(82.1) | 24(85.7) | 15(53.6) | 12(42.9) | 15(53.6) | 9(32.1) | 6(21.4) | 5(17.9) | 28(100) | 13(46.4) |
| (n=28) | I | 3(10.8) | 2(7.1) | - | 6(21.4) | 3(10.7) | 4(14.3) | 5(17.9) | 2(7.1) | 3(10.7) | - | 6(21.4) |
| R | 7(25) | 3(10.8) | 4(14.3) | 7(25) | 13(46.4) | 9(32.1) | 14(50) | 20(71.4) | 20(71.4) | - | 9(32.1) | |
KEY: S = Sensitive I = Intermediate R = Resistant; −: zero; CN: Gentamicin; C: Chloramphenicol; TS: Cotrimoxazole; CRO: Ceftriaxone; CIP: Ciprofloxacin; AM: Ampicillin; P: Penicillin; D: Doxycycline; AN: Amikacin; E: Erythromycin; VA: Vancomycin.
Gram-negative bacteria: Amikacin (100%) and Gentamycin (75.4%), showed most activity against Proteus species. but they were highly resistant to ampicillin (100%), chloramphenicol (88.5%), and cotrimoxazole (78.7%). Pseudomonas aeruginosa isolates had a 100% resistance rate to cotrimoxazole, doxycycline, and ampicillin. Klebsiella spp. had a 92.3% resistance rate to ampicillin. Citrobacter isolates were highly resistant to ampicillin (100%) and doxycycline (87.5%), whereas they were 100% sensitive to gentamycin and amikacin. Providencia showed 83.3% resistance to ampicillin and cotrimoxazole, but they were 100% sensitive to amikacin. In addition, E. coli showed 100% sensitivity to amikacin and 77.8% to ceftriaxone (Table 5).
Table 5: Drug susceptibility pattern of gram-negative bacteria isolates among patients admitted for wound infection at Dil-Chora Referral Hospital, Dire Dawa, Eastern Ethiopia, 2020
| Isolates | Results | Antimicrobial agents /No. of bacterial isolates (%) | |||||||
| C | CRO | CN | AN | TS | AM | D | CIP | ||
| Proteus spp | S | 7(11.) | 19(31) | 46(75.) | 61(100) | 10(16.) | - | 34(55.) | 11(18) |
| (n=61) | I | - | 5(8.2) | 5(8.2) | - | 3(4.9) | - | 7(11.5) | 6(10) |
| R | 54(88) | 37(60) | 10(16.) | - | 48(78.) | 61(100) | 20(32.) | 44(72) | |
| P. aeuruginosa | S | 10(55) | 6(33.3) | 4(22.2) | 14(77.8) | - | - | - | 8(44.4) |
| (n=18) | I | 2(11.1) | - | 2(11.1) | - | - | - | - | 3(16.7) |
| R | 6(33.3) | 12(66.) | 12(66.) | 4(22.2) | 18(100) | 18(100) | 18(100) | 7(38.9) | |
| Klebseilla spp | S | 4(30.8) | 5(38.5) | 11(84.6) | 10(76.9) | 7(53.8) | - | 6(46.2) | 8(61.5) |
| (n=13) | I | - | 1(7.7) | - | 3(23.1) | - | 1(7.7) | 2(15.4) | 1(7.7) |
| R | 9(69.2) | 7(53.8) | 2(15.4) | - | 6(46.2) | 12(92.3) | 5(38.4) | 4(30.8) | |
| E. coli | S | 4(44.5) | 7(77.8) | 5(55.6) | 9(100) | 5(55.6) | 5(55.6) | 3(33.3) | 4(44.5) |
| (n=9) | I | 3(33.3) | - | 1(11.1) | - | 3(33.3) | 2(22.2) | - | 2(22.2) |
| R | 2(22.2) | 2(22.2) | 3(33.3) | - | 1(11.1) | 2(22.2) | 6(66.7) | 3(33.3) | |
| Citrobacter spp | S | 3(37.5) | 2(25) | 8(100) | 8(100) | 4(50) | - | 1(12.5) | 4(50) |
| (n=8) | I | 2(25) | 2(25) | - | - | 1(12.5) | - | - | - |
| R | 3(37.5) | 4(50) | - | - | 3(37.5) | 8(100) | 7(87.5) | 4(50) | |
| Providencia spp | S | 4(66.7) | 3(50) | 4(66.7) | 6(100) | - | 1(16.7) | 3(50) | 4(66.6) |
| (n=6) | I | - | - | 2(33.3) | - | 1(16.7) | - | 1(16.7) | 1(16.7) |
| R | 2(33.3) | 3(50) | - | 5(83.3) | 5(83.3) | 2(33.3) | 1(16.7) | ||
KEY: S = Sensitive I = Intermediate R = Resistant; CN Gentamicin; C: Chloramphenicol; TS: Cotrimoxazole; CRO: ceftriaxone; CIP: Ciprofloxacin; AM: Ampicillin; D: Doxycycline; AN: Amikacin.
Multidrug-resistance pattern: Of the total 231 bacterial isolates, 181 (85%) were identified as multidrug resistance (MDR) (resistance to more than or equal to two different classes of antimicrobial agents). Of them, 83.7% of Gram-positive were MDR. Among the isolated gram-positive bacteria, S. aureus (100%) followed by Coagulase Negative Staphylococcus spp. (CONS) (42.9%) showed the highest percentage of MDR while 86.1% of Gram-negative bacteria were MDR. A higher rate of MDR was seen among P. aeruginosa (100%) and Proteus spp. (88.5%) (Table 6).
Table 6: Multidrug resistance of gram-positive and gram-negative bacteria isolates among patients admitted for wound infection at Dil-Chora Referral Hospital, Dire Dawa, Ethiopia, 2020
| Bacteria isolates | Antimicrobial classes resisted to No (%) | Total MDR | |||||||
| R0 | R1 | R2 | R3 | R4 | R5 | R6 | R7 | (%) | |
| S. aureus (n=70) | 0 | 0 | 6(8.6) | 18(25.7) | 30(42.9) | 9(12.9) | 5(7) | 2(2.9) | 70(100) |
| CONS (n=28) | 4(14.3) | 12(42.9) | 6(21.4) | 2(7.1) | 1(3.6) | 2(7.1) | 0 | 1(3.6) | 12(42.9) |
| Total (n=98) | 4(4.1) | 12(12.2) | 12(12.2) | 20(20.4) | 31(31.6) | 11(11.2) | 5(5.1) | 3(3.1) | 82(83.7) |
| Proteus spp. (n=61) | 0 | 7(11.5) | 13(21.3) | 17(27.9) | 10(16.4) | 6(9.8) | 7(11.5) | 1(1.6) | 54(88.5) |
| P. aeruginosa(n=18) | 0 | 0 | 0 | 6(33.3) | 5(27.8) | 4(22.2) | 2(11.1) | 1(5.6) | 18(100) |
| Klebseilla spp. (n=13) | 0 | 3(23) | 4(30.8) | 2(15.4) | 3(23) | 1(7.7) | 0 | 0 | 10(76.9) |
| E. coli (n=9) | 2(22.2) | 2(22.2) | 1(11.1) | 3(33.4) | 1(11.1) | 0 | 0 | 0 | 5(55.6) |
| Citrobacter spp. (n=8) | 0 | 1(12.5) | 2(25) | 3(37.5) | 2(25) | 0 | 0 | 0 | 7(87.5) |
| Providencia spp. (n=6) | 0 | 1(16.7) | 2(33.3) | 2(33.3) | 0 | 1(16.7) | 0 | 0 | 5(83.3) |
| Total (n=115) | 2(1.7) | 14(12.2) | 22(19.2) | 33(28.7) | 21(18.3) | 12(10.4) | 9(7.8) | 2(1.7) | 99(86.1) |
Key: R0= Sensitive to all antimicrobials tested; R1, R2, R3, R4, R5, R6, R7 -Resistant to one, two, three, four, five, six, seven antimicrobials, respectively.
Discussion
In this study, the overall prevalence was 89.4%. This is comparable with studies conducted in Jimma, Nigeria, Pakistan, and India, respectively [12, 25, 26, 27], but it was lower than studies conducted in Jimma, Nigeria, and India [13, 28, 29]. However, it was higher than the reports from Gondar, Mekelle, Cameroon, and Nepal [11, 30-32]. The possible reasons for such a difference could be the study period, study design, sample size, types of wound samples collected, and organisms isolated. According to our study on microbial species isolated from infected wounds, higher proportion of gram-positive bacteria than Gram-negative bacteria were detected, S. aureus (32.9%) and CoNS (13%) followed by Proteus spp. (28.6%) appeared to be the most frequent isolates. A similar finding was reported from other parts of Ethiopia, Gondar and India [11, 33]. However, it was higher than the studies conducted in Jimma, Nigeria, Bangladesh, and Iran [13, 28, 34, 35]. A higher proportion of Gram-positive bacteria in the early stages of wound infections may be due to their ability to colonize the wound initially from the skin. In this study, being female was found to be 7.5 times more likely to develop a bacterial wound infection than male, which is supported by study, conducted previously [11]. However, this study disagrees with studies conducted previously in Debre Markos [22], Mekelle [30], Jimma [39], Cameroon [31], Nigeria [41], Pakistan [42] and Nepal [9]. This variation could be the majority of study participants were females. Patients who had pus discharge specimens were found to be 17 times more prone to develop wound infection. A similar study reported in Gonder, Ethiopia [11]. The possible reason for high bacterial isolation from pus discharge might be the presence of pus in the wound indicates bacterial infection. Patients who were admitted to the orthopedics ward were 12 times more vulnerable to develop a bacterial wound infection than patients who were admitted to pediatrics. This study is consistent with the study conducted in Mekelle, Ethiopia [30], but it is inconsistent with the study done in Jimma, Ethiopia [39] and Brazil [43]. The possible reason for the high prevalence of bacterial isolation in patients admitted to orthopedic wards might be that operative soft-tissue damage is a major risk factor for developing infections and longer hospitalization leads to acquiring an infection.
Regarding antimicrobial susceptibility test for gram-positive bacteria, S. aureus isolates showed high resistance to Beta-lactam antibiotics. This was consistent with studies conducted in Jimma, Ethiopia, Nepal, and Bangladesh [13, 32, 34, 9]. This might be due to the production of beta-lactamases and the expression of penicillin-binding protein 2a. Among the Gram-negative bacteria, Proteus spp. is highly resistant to ampicillin, chloramphenicol, cotrimoxazole, and ciprofloxacin. A similar finding was reported from Jimma, Ethiopia, and India [13, 16]. In addition, P. aeruginosa was highly resistant to ampicillin, cotrimoxazole, doxycycline, ceftriaxone, and gentamycin. This is in agreement with studies conducted before [12, 35, 38, 39, 40]. The above findings indicate most of the bacteria were resistant to commonly prescribed antimicrobials. This finding could be explained by practice of empirical prescription, the nosocomial infections contribute to the emergence of resistant strains of organisms due to antibiotic selection pressure and circulation of resistance gene among the strains. Furthermore, in this study, the overall MDR rate was 85%, with a greater MDR among Gram-positive isolates (83.7%], as a serious global public health threat that has increased both mortality and morbidity. This finding was supported by previous study done in Jimma, Ethiopia [12].
Conclusion and Recommendations
High magnitude of bacteria isolates and their drug resistance were detected. Gender, types of discharge (pus discharge), and types of wards (orthopedic ward) were significantly associated with outcome variable (P less than 0.05). Amikacin, gentamicin, and vancomycin (for gram-positive bacteria only) were the most effective antibiotics against isolated organisms. The diagnosis of wound infection should be based on a combination of clinical judgment and microbiological culture with susceptibility pattern.
Declarations
Ethical approval and consent
Ethical clearance was obtained from the Institutional Health Research Ethics Review Committee of Haramaya University, College of Health and Medical Sciences. Signed written consent was obtained from the Administrative of the hospital and patients after the objective of the study was explained. Information obtained during this study was kept confidential. Confidentiality was maintained by numeric coding of specimens and questionnaires. All the laboratory examinations of the swabs were done free from charge and confirmed positives were given appropriate information and treated following drug susceptibility findings.
Availability of data and materials
This paper is based on the thesis of Adil Ibrahim. It has been published on the Haramaya University institutional repository.
Conflict of interest
The author announced that they have no conflict of interests.
Acknowledgments
The authors would like to acknowledge Haramaya University for financial support, Dil-Chora Hospital for helping with the data collection, and study participants for providing information.
Authors' contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Consent for publication
Not applicable
Funding statement
Not applicable
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