ISOLATION, IDENTIFICATION AND ANTIMICROBIAL SUSCEPTIBILITY OF BACTERIA ASSOCIATED WITH WOUND

CHAPTER ONE
INTRODUCTION

1.0 BACKGROUND OF THE STUDY

Wounds infection has been recognized as the most critical problem especially in the presence of foreign materials that increases the risk of serious infection even with relatively small bacterial infection (Rubin, 2006). Wound infection is a major concern among healthcare practitioners, not only in terms of increased morbidity to the patient but also in view of its burden on financial resources and the increasing requirement for cost effective management within the healthcare system. The control and management of infection is a complex and important aspect of wound care. Although, antibiotics have been of great value in treatment and in prophylaxis to prevent infections, the timing of administration, choice of antimicrobial agent, durations of administration have clearly defined the value of antibiotics in reducing wound infections (Gautama et al., 2013).
The most common bacterial genera infecting wounds are Enterococci, Escherichia, Pseudomonas, Klebsiella, Enterobacter, Proteus and Acinetobacter (Tayfour et al., 2005).
Wound infection patients are subjected to several factors that may be associated with multidrug resistant microorganism carriage such as inappropriate antibiotic treatment, chronic course of the wound and frequent hospital admission The most common underlying event for all wounds is trauma (Giaccometti et al.,2000). Trauma may be accidental or intentionally induced. The category of intentionally induced trauma includes hospital-acquired wounds, which can be grouped according to how they are acquired, such as surgically and by using intravenous medical devices. The none intentionally induced hospital-acquired wounds can be the pressure sores. the development of wound infection depends on the integrity and protective function of the skin, the number and types of organism and their synergy, the pathogenicity and virulence of the bacterial species, nature of surgery, use of antibiotics and the immuno-competency of the host (Sule et al.,2002).
Infected wounds are characterized by bacterial burden, chronic inflammation and an unbalanced cellular defense mechanism (Zhao et al.,2010). Every year, millions of people experience burns, suffer from non healing wounds, or have acute wounds that become complicated by infections, dehiscence, or problematic scarring. Effective wound treatment requires carefully considered interventions often requiring multiple clinic or hospital visits and the resulting costs of wound care are staggering (Zafar et al.,2007). In developing countries, like Ethiopia, wound infections are major health problems (Biadglene et al.,2009).Large number of people die daily of preventable and curable wound infections (Mulu et al.,2006).These are serious problems in hospitals specially in surgical practices where clean operations can become contaminated with virulent organisms and subsequent infection (Taiwo et al.,2002). It is also a common practice that antibiotics can be purchased without prescription, this leads to misuse of antibiotics by the public, thus, contributing the emergence and spread of antimicrobial resistance (Amare et al.,2011).
Advances in infection control have not completely eradicated these problems, because of high prevalence of drug resistance pathogens (Ohalete et al.,2012).The widespread and prolonged use of antibiotics leads to the emergence of resistant bacteria pathogens in infections contributing to high morbidity and mortality rates(Nwachukwu et al.,2009). The antibiotics resistant pathogens are acquired from either health care setting environment, health care personnel or inpatients(Amare et al.,2012). Hospital-acquired infections are further complicated by increasing prevalence of multi drug resistant bacteria pathogens like methicillin-resistant S.aureus (MRSA), methicillin-resistant coagulase negative Staphylococcus (CoNS),Vancomycin-resistant Enterococcus (VRE) and Polymicrobial flora and fungi (Sani, et al.,2012).
Wound infection is a major concern among healthcare practitioners, not only in terms of increased trauma to the patient but also in view of its burden on financial resources and the increasing requirements for cost-effective management within the healthcare system (Bereket et al.,2012).knowledge of the causative agents of wound infection has proved to be helpful in the selection of Empirical therapy, on infection control measures in health institution, and in formulating rationales of antibiotic policy (Shittu et al.,2002).it is therefore important to identify antimicrobial resistant pathogens, thus, the aim of this research work was to identify the bacterial etiologies and antimicrobial susceptibility patterns.

1.1 AIMS AND OBJECTIVES
The main aim of this work is to determine the antibiotic susceptibility of bacteria associated with wound.
Specific objectives include:

1. To isolate and identify bacteria associated with wound using standard methods.
2. To determine the antibiogram of wound isolates using agar diffusion method.

1.2 STATEMENT OF RESEARCH PROBLEM
Wounds have really posed a serious threat to both surgical and non-surgical wounds. There has been prevalence in wound following some disease state, and may have failed to heal after administration of common antibiotics resulting to foul smelling and petrifying wounds owing to their discriminate use of drugs especially in Nigeria. This problems really propelled me to know whether it is because of indiscriminate use of drugs that contributed to sensitive organisms to become resistance to the drugs or could it be because of nosocomial infection which comes by staying very long in the hospital. And why Staphylococcus has been the predominant organisms threatening wounds.

1.3 SIGNIFICANCE OF THE STUDY
Wound infection is a major concern among healthcare practitioners, not only in terms of increased trauma to the patient but also in view of its burden on financial resources and the increasing requirement for cost-effective management within the healthcare system. Knowledge of the causative agents of wound infection has proved to be helpful in the selection of empirical therapy, on infection control measures in health institution, and in formulating rationales of antibiotic policy. It is therefore important to identify antimicrobial resistant pathogens from both inpatient and outpatient isolates. Information on bacterial pathogens from inpatient and outpatient is limited. Thus, the aim of this research was to determine the bacterial etiologies and antimicrobial susceptibility patterns and to compare the antimicrobial susceptibility patterns of in- and outpatients of wound swab culture attending Demak Clinic and Maternity.