Bacterial Aetiology and Antibiotic Susceptibility Profile of Post-Operative Sepsis among Surgical Patients in a Tertiary Hospital in Rural Eastern Uganda

Abstract

Background:Post-operative wound sepsis remains a surgical challenge of public health concern constituting approximately 20% of the health care-associated nosocomial infections. This study aimed at determining the prevalence and antimicrobial resistance patterns of bacterial pathogens isolated from post-operative wound infections at Mbale Regional Referral Hospital.Materials and Methods:This was a descriptive cross-sectional study conducted from June to October 2015. Study participant samples were sub-cultured upon reception in the Microbiology laboratory and the isolated bacterial pathogens were analysed. Phenotypic antimicrobial susceptibility profiles were determined using the Kirby-Bauer method. Interpretation of the zone diameters was done following the Clinical and Laboratory Standards Institute guidelines. Phenotypic screening for Methicillin-resistant Staphylococcus aureus (MRSA) was performed using oxacillin (1 μg). D-test was also performed for phenotypic screening of inducible clindamycin resistant Staphylococcus aureus, Data were entered into Microsoft Excel and analysed using IBM SPSS statistics (version 16).Results:Overall post-operative sepsis was 69/80 (86.2%) with Staphylococcus aureus as the most predominant organism 41/104 (39.4%) followed by Escherichia coli 22/104 (21.2%) and Klebsiella species 15/104 (14.4%). Of the 41/104 isolated Staphylococcus aureus, 27/41(65.9%) were MRSA strains and 5/41 (12.2%) were inducible clindamycin resistant Staphylococcus aureus strains. The isolated Staphylococcus aureus was resistant to multiple drugs though susceptible to vancomycin and clindamycin. In addition, none of the isolated Enterococci species was vancomycin resistant. Although most of the isolated Gram-negative organisms were sensitive to imipenem, resistance was observed for tetracycline, trimethoprim/sulphamethoxazole, and ceftriaxone.Conclusion:Staphylococcus aureus was the most common causative agent associated with postoperative sepsis with most of the strains being MRSA. Multi-drug resistance was observed in 63/104 (60.6%) of the isolated organisms in our study. Hence the need to better develop and strengthen antimicrobial stewardship programs as well as to understand the carriage of antimicrobial resistance genes among these organisms.

Antibiotic susceptibility patterns of bacteria isolates in post-operative wound infections among patients attending Mama Lucy Kibaki Hospital, Kenya

“…Findings on the resistance rates of gram negative rods were comparable to the results obtained from a study in Ethiopia [27]. Additionally, MRSA rate of 65.4% observed in the present setting was in harmony with results from a study conducted in Uganda that reported a MRSA rate of 65.9% [28]. These current occurrences were attributed to lack of effective surveillance programs for SSI etiologies and their antibiograms.…”

Methicillin Resistant Staphylococcus aureus nasal carriage and associated factors in a rural tertiary hospital in Eastern Uganda: A prospective cross-sectional study

“…The patient's carried endogenous micro ora may all play a vital role in the cause of nosocomial infections (19) (20). In a study conducted on surgical wound infections in the hospital indicated that 65.9% of the cases were caused by MRSA strains (21).…”

Effectiveness of preoperative bath using Chloroxylenol antiseptic soap on the incidence of post emergency Cesarean section surgical site infection at Mbarara Regional Referral hospital, Uganda: a Randomized Controlled trial

“…Second, we did not culture the micro-organisms to identify the cause of the SSI. However, other studies in the region have been done and the common organisms that cause SSI and the drug sensitivity pattern have been studied and are now known (Hope et al, 2019) (George et al, 2018).…”