Changes in Five Years among Pathogens in Wound Infection and Their Susceptibility to Antimicrobials

Afzalunnessa Binte Lutfor^1, , Ritu Saha¹, Mursheda Akter², Arpita Deb¹, Asif Mujtaba Mahmud² and Sadia Armin Khan¹

¹Department of Microbiology, Ad-din Women’s Medical College Hospital, Dhaka, Bangladesh

²Department of Respiratory Medicine, Asgar Ali Hospital, Dhaka, Bangladesh

Cite this paper:
Afzalunnessa Binte Lutfor, Ritu Saha, Mursheda Akter, Arpita Deb, Asif Mujtaba Mahmud and Sadia Armin Khan. Changes in Five Years among Pathogens in Wound Infection and Their Susceptibility to Antimicrobials. American Journal of Infectious Diseases and Microbiology. 2018; 6(1):1-8. doi: 10.12691/ajidm-6-1-1

Abstract

Background: Proper knowledge about the epidemiology and changing sensitivity pattern of drug in bacterial wound infection is very important in ensuring optimum management of the wound and formulating policies in infection control. Objectives of our study was to disseminate the etiology of bacterial wound infection in two time frames (in 2016 or group A and in 2011 or group B), to provide their susceptibility pattern and to highlight the changes of susceptibility pattern in order to update information regarding antimicrobial resistance and it’s implication in wound management. Method: Bacteria isolated from wound swab, aspirates and pus samples received in year 2016 and 2011 were included in the study. Isolates were identified by conventional tests and antibiotic sensitivity was determined by disc diffusion method according to CLSI guideline. Results: Gram positive cocci are still the predominating organism in wound infection. Both Staph. aureus as well as CoNS (coagulase negative staphylococci) lead the list as pathogens of wound infection. Among Gram negative bacteria, Acinetobacter spp. and Klebsiella spp, were more common than Pseudomonas spp. in our study. Notable raise in ampicillin sensitivity is observed after 5 years among Staphylococci species. Cotrimoxazole is regaining its importance as all the isolates from wound infection have a increasing trend towards susceptibility to it in 5 years. Doxycycline also has raised activity more than 61 % on Gram positive cocci in group A or 2016. Vancomycin, linezolid for Gram positive bacteria and amikacin, meropenem, pipercillin tazobactam, and colistin for Gram negative bacteria are still useful but showing reduced sensitivity after 5 years. Amoxyclav is not very useful as a prophylactic antibiotic as only 40% pathogens were susceptible. Resistance to quinolones, cephalosporins, aminoglycosides are increasing in both Gram positive and negative bacteria with few exceptions.

Keywords:
wound infection microorganisms antibiotic sensitivity changes in five years

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Warren L, Review of Medical Microbiology and Immunology, 12th edn, McGraw-Hill, New York, pg 26.
[2]	World Health Organization. Global action plan on antimicrobial resistance (2015).
[3]	Dow G, Browne A, Sibbald RG. Infection in chronic wounds: controversies in diagnosis and treatment. Ostomy/wound management. 1999 Aug; 45(8): 23-7.
[4]	Demidova-Rice TN, Hamblin MR, Herman IM. Acute and impaired wound healing: pathophysiology and current methods for drug delivery, part 1: normal and chronic wounds: biology, causes, and approaches to care. Advances in skin & wound care. 2012 Jul; 25(7): 304.
[5]	Lutfor AB, Saha R, Deb A, Mahmud AM , Ali AAA, Haque T, Rahman S, Shorno NS, & Arafat A.. Detection of Nocardia from Chronic Skin and Lung Infections in Bangladeshi Patients. American Journal of Infectious Diseases and Microbiology. 2017 May; 5(2), 80-86.
[6]	Emori TG, Gaynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clinical microbiology reviews. 1993 Oct 1; 6(4): 428-42.
[7]	Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T, Tenover FC. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. The Journal of antimicrobial chemotherapy. 1997 Jul 1; 40(1): 135-6.
[8]	Singh NP, Rani M, Gupta K, Sagar T, Kaur IR. Changing trends in antimicrobial susceptibility pattern of bacterial isolates in a burn unit. Burns. 2017 Aug; 43(5): 1083-1087.
[9]	Livermore DM. Bacterial resistance: origins, epidemiology, and impact. Clinical infectious diseases. 2003 Jan 15; 36(Supplement_1): S11-23.
[10]	Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, Nyquist AC, Saiman L, Yokoe DS, Maragakis LL, Kaye KS. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology. 2014 Sep; 35 (S2): S66-88.
[11]	Revelas A. Healthcare–associated infections: A public health problem. Nigerian medical journal: journal of the Nigeria Medical Association. 2012 Apr; 53(2): 59.
[12]	Bowler PG, Duerden BI, Armstrong DG. Wound microbiology and associated approaches to wound management. Clinical microbiology reviews. 2001 Apr 1; 14(2): 244-69.
[13]	World Health Organization. Antimicrobial resistance: global report on surveillance. World Health Organization; 2014.
[14]	Chowdhury F, Sturm-Ramirez K, Abdullah Al Mamun A, Bhuiyan MU, Chisti MJ, Ahmed M, Haider S, Rahman M, Azziz-Baumgartner E. Factors driving customers to seek health care from pharmacies for acute respiratory illness and treatment recommendations from drug sellers in Dhaka city, Bangladesh. Patient preference and adherence. 2017; 11: 479.
[15]	Griffith M, Postelnick M, Scheetz M. Antimicrobial stewardship programs: methods of operation and suggested outcomes. Expert review of anti-infective therapy. 2012 Jan 1; 10(1): 63-73.
[16]	Thanni LO, Osinupebi OA, Deji-Agboola M. Prevalence of bacterial pathogens in infected wounds in a tertiary hospital, 1995-2001: any change in trend?. Journal of the National Medical Association. 2003 Dec; 95(12): 1189.
[17]	Uddin M, Antibiotic stewardship program; 2012; 6 (02); Bangladesh Journal of medical microbiology,
[18]	Khan HA, Ahmad A, Mehboob R. Nosocomial infections and their control strategies. Asian pacific journal of tropical biomedicine. 2015 Jul 31; 5(7): 509-14.
[19]	Masterton RG. Antibiotic de-escalation. Critical care clinics. 2011 Jan 31; 27(1): 149-62.
[20]	Salkind AR, Rao KC. Antibiotic Prophylaxis to Prevent Surgical Site Infections. American family physician. 2011 Mar 1; 83(5).
[21]	File TM. Duration and cessation of antimicrobial treatment. Journal of hospital medicine. 2012 Jan 1; 7(S1): S22-33.
[22]	Murni IK, Duke T, Kinney S, Daley AJ, Soenarto Y. Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study. Archives of disease in childhood. 2014 Dec 10: archdischild-2014.
[23]	Vandepitte J. Basic laboratory procedures in clinical bacteriology. World Health Organization; 2003 Dec 31.
[24]	Performance standards for antimicrobial susceptibility testing (2002).12th informational supplement. NCCLS document M100-S12, 22No.1.Pennsylvania, USA
[25]	Becker K, Heilmann C, Peters G. Coagulase-negative staphylococci. Clinical microbiology reviews. 2014 Oct 1; 27(4): 870-926.
[26]	Toledo PV, Arend LN, Pilonetto M, Oliveira JC, Luhm KR, Working Group in Healthcare Associated Infections (WGHAI. Surveillance programme for multidrug-resistant bacteria in healthcare-associated infections: an urban perspective in South Brazil. Journal of Hospital Infection. 2012 Apr 30; 80(4): 351-3.
[27]	Bhattacharya S. Is screening patients for antibiotic-resistant bacteria justified in the Indian context?. Indian journal of medical microbiology. 2011 Jul 1; 29(3): 213.
[28]	Lutfor AB, Kikuchi T, Tokue Y, Takahashi H, Shoji S, Fujimura S, Nukiwa T, Watanabe A. Comparative in vitro activity of vancomycin and other antimicrobial agents against methicillin-resistant Staphylococcus aureus and Enterococcus faecium in the Tohoku district of Japan. Chemotherapy. 1998; 44(5): 318-23.
[29]	Chen FJ, Wang CH, Chen CY, Hsu YC, Wang KT. Role of the mecA gene in oxacillin resistance in a Staphylococcus aureus clinical strain with a pvl-positive ST59 genetic background. Antimicrobial agents and chemotherapy. 2014 Feb 1; 58(2): 1047-54.
[30]	Goldberg E, Paul M, Talker O, Samra Z, Raskin M, Hazzan R, Leibovici L, Bishara J. Co-trimoxazole versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus bacteraemia: a retrospective cohort study. Journal of antimicrobial chemotherapy. 2010 May 27; 65(8): 1779-83.
[31]	Jain DK, Arya RK, Ranjan KP , Ranjan N. Emergence Of sensitivity of co-trimoxazole in urinary tract infection; World Journal of Pharmaceutical Research. 2014; 3(6): 2172-2175.
[32]	Bhambri S, Kim G. Use of Oral Doxycycline for Community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infections. The Journal of clinical and aesthetic dermatology. 2009 Apr; 2(4): 45.
[33]	Hammerberg O, Elder D, Richardson H, Landis S. Staphylococcal resistance to aminoglycosides before and after introduction of amikacin in two teaching hospitals. Journal of clinical microbiology. 1986 Oct 1; 24(4):629-32.
[34]	Craven, D. E., C.Reed, N. Kollisch, A. DeMaria, D. Lichtenberg, K. Shen, And W. R. McCabe. 1981 A Large outbreak Of infections caused by a strain of Staphylococcus Aureus resistant to oxacillin and aminoglycosides. Am. J. Med 71: 53-58
[35]	Hauschild T, Sacha P, Wieczorek P, Zalewska M, Kaczyńska K, Tryniszewska E. Aminoglycosides resistance in clinical isolates of Staphylococcus aureus from a University Hospital in Bialystok, Poland. Folia Histochemica et Cytobiologica. 2008; 46(2): 225-8.
[36]	AHFS Drug Information 2006, Bethesda, MD American Society of Health-System Pharmacists.
[37]	Rawat D, Nair D. Extended-spectrum β-lactamases in Gram negative bacteria. Journal of global infectious diseases. 2010 Sep; 2(3): 263.
[38]	Rossolini GM, Luzzaro F, Migliavacca R, Mugnaioli C, Pini B, De Luca F, Perilli M, Pollini S, Spalla M, Amicosante G, Toniolo A. First countrywide survey of acquired metallo-β-lactamases in gram-negative pathogens in Italy. Antimicrobial agents and chemotherapy. 2008 Nov 1; 52(11): 4023-9.
[39]	Cornaglia G, Giamarellou H, Rossolini GM. Metallo-β-lactamases: a last frontier for β-lactams?. The Lancet infectious diseases. 2011 May 31; 11(5): 381-93.
[40]	Bryers JD. Medical biofilms. Biotechnology and bioengineering. 2008 May 1; 100(1): 1-8.ogg.