Abstract
Globally, the burden of chronic wound infections is likely to increase due to the rising levels of bacterial resistance to antibiotics. In the United States of America alone, more than 6.5 million chronic wounds with evidence of bacterial infection are diagnosed every year. In addition, the polymicrobial environment in chronic wound infections has been observed from several studies as a risk factor for development of resistance to many antibiotics including the third generation cephalosporins currently used in Mbarara Regional Referral Hospital for treatment of chronic wound infections. Therefore the main objective of this study was to determine the prevalence of chronic wound isolates and their minimum inhibitory concentrations (MIC) against third generation cephalosporins. This study was a cross-sectional descriptive and analytical survey of bacterial isolates from chronic wound infection among 75 study participants admitted in the surgical ward of Mbarara Regional Referral Hospital (MRRH), a tertiary Hospital in Western Uganda. Standard laboratory bacterial culture and identification techniques as well as broth microdilution method were used to isolate, identify pathogens and test for MIC respectively. We found that 69/75 study participants had samples with bacterial growth and the most prevalent pathogens isolated were staphylococcus aureus (40.6%) and Klebsiella spp. (29%). Generally, most isolates were susceptible to cefoperazone + sulbactum 2 g (Sulcef) and ceftriaxone 1 g (Epicephin). The overall prevalence of isolates in chronic wound infection among patients admitted in the surgical ward of MRRH was 92% and the most prevalent isolates were Staphylococcus aureus, Klebsiella species and proteus species respectively. The observed MIC values were higher than the CLSI clinical breakpoint, implying a decreasing trend in susceptibility of chronic wound isolates to third generation cephalosporins.
Highlights
The burden of chronic wound infections is likely to increase due to the rising levels of bacterial resistance to antibiotics[1]
Higher prevalence of chronic wound isolates in surgical ward of Mbarara Regional Referral Hospital could be as result of high incidence of wound contamination during dressing and inadequate infection prevention and control practices and high rate of emergency surgical operations that are likely to compromise the standard of operating procedures as reported from one study conducted in the same setting[20]
The findings further revealed that enterobacter agglomerans (0.72 μg/ml), Klebsiella species (1.6 μg/ml) and staphylococcus aureus (2.96 μg/ml) respectively exhibited lower minimum inhibitory concentrations (MIC) than proteus species (6.34 μg/ml) against cefotaxime 1 g (Omnatax) (Table 4)
Summary
The burden of chronic wound infections is likely to increase due to the rising levels of bacterial resistance to antibiotics[1]. Third generation cephalosporins have been recommended as the drug of choice in the management of severe bacterial infections including chronic wound infections in Uganda’s clinical guidelines, 81% of the prescriptions reviewed indicates inappropriate use of ceftriaxone ( wrong diagnosis), increasing the risk of bacterial resistance to ceftriaxone and other third generation cephalosporins[4]. Patients with chronic wound infections are likely to experience long hospital stays, high treatment costs, further delay of wound healing, development of severe invasive bacterial infections and increased emergency of antibiotics resistance if ineffective third generation cephalosprins are used. This study was conducted to determine the prevalence of pathogens in chronic wound infections and their minimum inhibitory concentrations (MIC) against third generation cephalosporins, so as to guide Clinicians to make evidence-based prescription of third generation cephalosporins required for timely and effective management of chronic wound infections as well as dose optimization and individualization
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
