Abstract
Pyogenic wound infections are one of the most common clinical entities caused and aggravated by the invasion of pathogenic organisms. Prompt and aggressive antimicrobial therapy is needed to reduce the burden and complications associated with these infections. In this study, we intended to investigate the common pathogens and their antimicrobial susceptibility patterns from the pyogenic wound infections at a tertiary care hospital in Kathmandu, Nepal. A laboratory based cross-sectional study was carried out among the pyogenic clinical specimens of the patients visiting Manmohan Memorial Teaching Hospital, Kathmandu, Nepal. Processing of clinical specimens and isolation and identification of bacterial pathogens were carried out using standard microbiological methods. Antimicrobial susceptibilities and resistant profiles were determined by following the standard guidelines of Clinical and Laboratory Standards Institute (CLSI). About 65% of the clinical specimens were positive for the bacterial growth and Gram positive bacteria (57.4%) were the leading pathogens among pyogenic wound infections. Staphylococcus aureus (412, 49.28%), Escherichia coli (136, 16.27%), Klebsiella spp. (88, 10.53%), and Pseudomonas spp. (44, 5.26%) were the common pathogens isolated. High level of drug resistance was observed among both Gram positive bacteria (51.9%) and Gram negative bacteria (48.7%). Gram positive isolates were resistant to ampicillin, ciprofloxacin, cotrimoxazole, erythromycin, and cloxacillin. Gram negative isolates were resistant to cephalosporins but were well susceptible to amikacin and imipenem. Pyogenic wound infections are common in our hospital and majority of them were associated with multidrug resistant bacteria. The detailed workup of the prevalent pathogens present in infected wounds and their resistance pattern is clearly pertinent to choosing the adequate treatment.
Highlights
Infections of the skin and soft tissue due to either trauma, surgery, or burns may result in the generation of exudates composed of dead leucocytes, cellular debris, and necrotic tissues [1]
The specimens not fulfilling the criteria of American Society for Microbiology (ASM) [11] and duplicate specimens from same patients were excluded from this study
1,198 specimens were processed at the clinical microbiology laboratory; 778 (64.9%) of them showed the significant bacterial growth confirming the infection
Summary
Infections of the skin and soft tissue due to either trauma, surgery, or burns may result in the generation of exudates composed of dead leucocytes, cellular debris, and necrotic tissues [1]. Pyogenic or pus forming wound infections are characterized by severe local inflammation subsequent to tissue injury leading to generalized clinical disease through the various toxic mechanisms associated with invasion of pyogenic bacteria. Some of the common etiological agents responsible for causing pyogenic infections are bacteria such as Staphylococcus aureus, Streptococcus pyogenes, Escherichia coli, Klebsiella spp., Proteus spp., Pseudomonas spp., and Acinetobacter spp. Pyogenic wound infections are significant subgroup of infections encountered by infectious disease physicians in the hospitals worldwide. These infections are associated with higher morbidity and antimicrobial regimens are generally recommended to reduce the burden as well as to prevent associated long term complications [5]. The crisis of antibiotic resistance among pyogenic bacterial infections has been attributed to the inappropriate use of antimicrobial agents in developing country [8]
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