Pattern of Orofacial Infective Bacterial Microorganisms and Their Antibiogram Profiles at Kenyatta National Hospital

Abstract

Background: Antibiotic resistance is becoming a global threat to health. In Kenya it is an already acknowledged public health problem. The cost of treating deep neck space infections of odontogenic origin is high. This is compounded by the requirement of highly skilled manpower. Furthermore, complications arising from these infections can be very severe and include facial nerve palsy or even death. Aim of the study: To determine the range of bacterial pathogens and antibiotic sensitivity patterns among patients presenting with bacterial orofacial infections. Study site: The Kenyatta National Hospital (KNH), which is a national teaching and referral hospital. Research Design: This was a cross-sectional study involving 39 patients with orofacial infections who presented to the outpatient dental clinic and the emergency and accident departments. Material and Methods: A convenient sample of 39 participants was selected. Swabs or pus aspirate specimens from the patients were taken to the University of Nairobi and KNH microbiology laboratories for culture and sensitivity test. For each case two samples were taken; one for anaerobic culture in a medium and the other for aerobic culture without a medium. Molecular identification of microorganisms and antibiotic sensitivity was carried out at the KNH laboratory using the”Vitek 2” machine. The latter is used not only to identify microorganisms but also test for the sensitivity of these microorganisms to antimicrobials. Results: Thirty nine consenting participants were recruited for the study with an age range of 4-71 years and a mean of 34.33(+/- 17.56). Males accounted for 61.5% of the participants among whom 56.4% were in the 21—40-year age group. Thirty six percent of the respondents sought treatment for periapical abscesses. All the patients who were diagnosed with Ludwig’s angina were males. Seventy two percent had used an antimicrobial agent before the samples were taken. The Chi-square test showed a non-stastically significant association between bacterial growth and prior use of antibiotics before samples were taken. Among the antimicrobials used, metronidazole accounted for 32%. Among the samples taken 47.4% showed aerobic microbial growth while among the participants who reported having taken antimicrobials for the infection xiii before being recruited in the study only 29% had aerobic growth. The sensitivity of the aerobes towards meropenem, amikacin, levofloxacin and ciprofloxacin was found to have been statistically significant using the ordinal regression test. Conclusions: Most of the bacteria in orofacial infections were found to have been aerobes at 47.4%. There was also a significant percentage of anaerobes at 31.6% while 21% of the infections were found to have been of mixed bacterial origin. Recommendations: Having found that meropenem and metronidazole were very effective in the management of orofacial bacterial infections, it is recommended that these drugs be used judiciously in the management of infections to avoid resistance in future.