The growing threat of antibiotic resistance in wound infections: evidence from tertiary care in Pakistan
DOI:
https://doi.org/10.2298/ABS230313021IKeywords:
Wound infection, Antibacterial susceptibility, Multi-antibiotic resistance (MAR) index, Resistance patterns, Diversity IndicesAbstract
Paper description:
- The overall prevalence of wound infection was 53.5%.
- Staphylococcus aureus was the most prominent bacteria, followed by Escherichia coli.
- Linezolid, vancomycin and teicoplanin were the most effective antibiotics. Diversity matrices were used to quantify the uncertainty of the effectiveness of antibiotics; 129 resistance types were detected.
- The presence of diverse resistance types points to the need to characterize the microbial pathogens in infected wounds and analyze antibiotic susceptibility profiles prior to application of antibiotic therapy aimed at reducing the emergence and dissemination of antibiotic resistance.
Abstract: The present study analyzed 361 non-duplicated wound swab samples from 187 males and 174 females, ranging in age from 0 to 100 years with a mean age of 37.1±1.9 years, and to determine the prevalence of bacterial wound infections and the diversity of antibacterial susceptibility patterns of the isolated bacteria to detect the presence of unique/rare resistance types. Of these, 53.46% (193) were found to have wound infections. Most of the infected patients fell in the age group II (21-40 years). A total of 14 bacterial species were identified, with Staphylococcus aureus and Escherichia coli being the most common Gram-positive and Gram-negative bacteria, respectively. Linezolid and vancomycin were the most effective antibiotics against the isolated Gram-positive bacteria, while most Gram-negative bacteria were sensitive against colistin and polymyxin-B. Based on antibiotic resistance, 129 types of resistance were detected. Multi-resistance was detected in 157 (81.3%) bacterial strains, while 162 strains had a multi-antibiotic resistance index (MAR) of 0.2. Simpson and Shannon diversity indices indicated high bacterial diversity in the wound samples. The study provides valuable insight into the prevalence of bacterial infections in wounds and that antibiotic resistance patterns can be useful in guiding the development of effective treatment strategies.
Downloads
References
Kujath P, Michelsen A. Wounds-from physiology to wound dressing. Dtsch Arztebl Int. 2008;105(13):239. https://doi.org/10.3238/arztebl.2008.0239
Bessa LJ, Fazii P, Di Giulio M, Cellini L. Bacterial isolates from infected wounds and their antibiotic susceptibility pattern: some remarks about wound infection. Int Wound J. 2015;12(1):47-52. https://doi.org/10.1111/iwj.12049
Wadekar M, Sathish J, Jayashree PC. Bacteriological profile of pus samples and their antibiotic susceptibility pattern. Indian J Microbiol Res. 2020;7:43-7. https://doi.org/10.18231/j.ijmr.2020.010
Batra S, Balothia V, Agarwal S, Sharma R. Bacteriological Profile and Antimicrobial Susceptibility Pattern of Pus Culture Isolates from a Tertiary Care Hospital, SMS Medical College Jaipur. Eur J Mol Clin Med. 2020;7(11):7502-8.
Rai S, Yadav UN, Pant ND, Yakha JK, Tripathi PP, Poudel A, Lekhak B. Bacteriological profile and antimicrobial susceptibility patterns of bacteria isolated from pus/wound swab samples from children attending a tertiary care hospital in Kathmandu, Nepal. Int J Microbiol. 2017;2017(1):2529085. https://doi.org/10.1155/2017/2529085
Misha G, Chelkeba L, Melaku T. Bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Ethiopia: a prospective cohort study. Ann Clin Microbiol Antimicrob. 2021;20(1):33. https://doi.org/10.1186/s12941-021-00440-z
Tameez-ud-Din A, Sadiq A, Chaudhary NA, Bhatti AA, Lehrasab RS, Khan MT. Bacteriological Profile and Antibiotic Sensitivity Pattern of Pus Samples in a Tertiary Care Hospital. J Rawalpindi Med Coll. 2020;24(1):18-22. https://doi.org/10.37939/jrmc.v24i1.1535
Trojan R, Razdan L, Singh N. Antibiotic susceptibility patterns of bacterial isolates from pus samples in a tertiary care hospital of Punjab, India. Int J Microbiol. 2016;2016(1):9302692. https://doi.org/10.1155/2016/9302692
Ayandele AA, Oladipo EK, Oyebisi O, Kaka MO. Prevalence of multi-antibiotic resistant Escherichia coli and Klebsiella species obtained from a tertiary medical institution in Oyo State, Nigeria. Qatar Med J. 2020; 2020(1):1-6. https://doi.org/10.5339/qmj.2020.9
Tobin EA, Samuel SO, Inyang NJ, Adewuyi GM, Nmema EE. Bacteriological Profile and Antibiotic Sensitivity Patterns in Clinical Isolates from the Out-Patient Departments of a Tertiary Hospital in Nigeria. Niger J Clin Pract. 2021;24(8):1225-33.
Olowo S, Adewuyi G, Inyang N, Nmema EE. Bacteriological Profile and Antibiotic Sensitivity Patterns in Clinical Isolates from the Out-Patient Departments of a Tertiary Hospital in Nigeria. Ann Med Health Sci. 2021:11(1):1453-60.
Sudhaharan S, Kanne P, Chavali P, Vemu L. Aerobic bacteriological profile and antimicrobial susceptibility pattern of pus isolates from tertiary care hospital in India. J Infect Dev Ctries. 2018;12(10):842-8. https://doi.org/10.3855/jidc.10473
Mahat P, Manandhar S, Baidya R. Bacteriological profile of wound infection and antibiotic susceptibility pattern of the isolates. J Microbiol Exp. 2017;4(5):126-33. https://doi.org/10.15406/jmen.2017.04.00126
Nigussie D, Makonnen E, Legesse BA, Fekadu A, Davey G. Antimicrobial susceptibility of bacteria isolated from the infected wounds of patients with lymphoedema in East Wollega, Ethiopia. Trans R Soc Trop Med Hyg. 2020;114(12):962-73. https://doi.org/10.1093/trstmh/traa143
Levine NS, Lindberg RB, Mason Jr AD, Pruitt Jr BA. The quantitative swab culture and smear: A quick, simple method for determining the number of viable aerobic bacteria on open wounds. J Trauma. 1976;16(2):89-94. https://doi.org/10.1097/00005373-197602000-00002
Soo Yean CY, Selva Raju K, Xavier R, Subramaniam S, Gopinath SC, Chinni SV. Molecular detection of methicillin-resistant Staphylococcus aureus by non-protein coding RNA-mediated monoplex polymerase chain reaction. PLoS One. 2016;11(7):0158736. https://doi.org/10.1371/journal.pone.0158736
Yar A, Choudary MA, Rehman A, Hussain A, Elahi A, Waqar AB, Alshammari A, Alharbi M, Nisar MA, Khurshid M, Khan Z.Genetic Diversity and Virulence Profiling of Multi-Drug Resistant Escherichia coli of Human, Animal, and Environmental Origins. Antibiotics. 2022;11(8):1061. https://doi.org/10.3390/antibiotics11081061
Mengesha RE, Kasa BG-S, Saravanan M, Berhe DF, Wasihun AGJBrn. Aerobic bacteria in post-surgical wound infections and pattern of their antimicrobial susceptibility in Ayder Teaching and Referral Hospital, Mekelle, Ethiopia. BMC Res Notes. 2014;7(1):575. https://doi.org/10.1186/1756-0500-7-575
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas M, Giske C, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infec. 2012;18(3):268-81. https://doi.org/10.1111/j.1469-0691.2011.03570.x
Mir R, Salari S, Najimi M, Rashki A. Determination of frequency, multiple antibiotic resistance index and resistotype of Salmonella spp. in chicken meat collected from southeast of Iran. Vet Med Sci. 2022;8(1):229-36. https://doi.org/10.1002/vms3.647
de Amorim JD, da Silva Junior CJ, de Medeiros AD, do Nascimento HA, Sarubbo M, de Medeiros TP, Costa AFS, Sarubbo LA. Bacterial Cellulose as a Versatile Biomaterial for Wound Dressing Application. Molecules. 30;27(17):5580. https://doi.org/10.3390/molecules27175580
Alharbi AS. Bacteriological profile of wound swab and their antibiogram pattern in a tertiary care hospital, Saudi Arabia. Saudi Med J. 2022;43(12):1373-82.
Mukherjee S, Mishra S, Tiwary S. Microbial Profile and Antibiogram of Pus Isolate in a Tertiary Care Hospital of Western Odisha. J Evol Med Dent Sci. 2020;9(16):1325-31. https://doi.org/10.14260/jemds/2020/289
Hope D, Ampaire L, Oyet C, Muwanguzi E, Twizerimana H, Apecu RO. Antimicrobial resistance in pathogenic aerobic bacteria causing surgical site infections in Mbarara regional referral hospital, Southwestern Uganda. Sci Rep. 2019;9(1):17299. https://doi.org/10.1038/s41598-019-53712-2
Ohalete C, Obi R, EmeaKoroha M. Bacteriology of different wound infection and their antimicrobial susceptibility patterns in Imo state Nigeria. World J Pharm Pharm Sci. 2012;1(3):1155-72.
Roy S, Ahmed MU, Uddin BMM, Ratan ZA, Rajawat M, Mehta V, Zaman SB. Evaluation of antibiotic susceptibility in wound infections: A pilot study from Bangladesh. F1000Res. 2017;6:2103. https://doi.org/10.12688/f1000research.12887.1
de Abreu PM, Farias PG, Paiva GS, Almeida AM, Morais PV. Persistence of microbial communities including Pseudomonas aeruginosa in a hospital environment: a potential health hazard. BMC Microbiol. 2014;14(1):118. https://doi.org/10.1186/1471-2180-14-118
Wadekar MD, Sathish J, Pooja C. Bacteriological profile of pus samples and their antibiotic susceptibility pattern. Indian J Microbiol Res. 2020;7(1):43-7. https://doi.org/10.18231/j.ijmr.2020.010
Guan H, Dong W, Lu Y, Jiang M, Zhang D, Aobuliaximu Y, et al. Distribution and antibiotic resistance patterns of pathogenic bacteria in patients with chronic cutaneous wounds in China. Front Med. 2021;8:609584. https://doi.org/10.3389/fmed.2021.609584
Mohammed A, Adeshina GO, Ibrahim YK. Incidence and antibiotic susceptibility pattern of bacterial isolates from wound infections in a tertiary hospital in Nigeria. Trop J Pharm Res. 2013;12(4):617-21. https://doi.org/10.4314/tjpr.v12i4.26
Ayandele A, Oladipo E, Oyebisi O, Kaka M. Prevalence of multi-antibiotic resistant Escherichia coli and Klebsiella species obtained from a tertiary medical institution in Oyo State, Nigeria. Qatar Med J. 2020;2020(1):9. https://doi.org/10.5339/qmj.2020.9
Puca V, Marulli RZ, Grande R, Vitale I, Niro A, Molinaro G, Prezioso S, Muraro R, Di Giovanni P. Microbial species isolated from infected wounds and antimicrobial resistance analysis: Data emerging from a three-years retrospective study. Antibiotics. 2021;10(10):1162. https://doi.org/10.3390/antibiotics10101162
Alam MM, Islam MN, Hawlader MD, Ahmed S, Wahab A, Islam M, Uddin KR, Hossain A. Prevalence of multidrug resistance bacterial isolates from infected wound patients in Dhaka, Bangladesh: a cross-sectional study. Int J Surg Open. 2021;28(1):56-62. https://doi.org/10.1016/j.ijso.2020.12.010
Ennab R, Al-Momani W, Al-Titi R, Elayan A. Antibiotic profile of pathogenic bacteria isolated from postsurgical site infections in public hospitals in Northern Jordan. Infect Drug Resist. 2022;15:359. https://doi.org/10.2147/IDR.S350406
Abay S, Kayman T, Otlu B, Hizlisoy H, Aydin F, Ertas N. Genetic diversity and antibiotic resistance profiles of Campylobacter jejuni isolates from poultry and humans in Turkey. Int J Food Microbiol. 2014;178:29-38. https://doi.org/10.1016/j.ijfoodmicro.2014.03.003
Haegeman B, Hamelin J, Moriarty J, Neal P, Dushoff J, Weitz JS. Robust estimation of microbial diversity in theory and in practice. ISME J. 2013;7(6):1092-101. https://doi.org/10.1038/ismej.2013.10
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Hassan Imran, Zaman Khan, Fiza Saleem, Sidra Gull, Ali Tahir
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License that allows others to share the work with an acknowledgment of the work’s authorship and initial publication in this journal.
