The Prevalence and Antimicrobial Susceptibility Patterns of Bacteria That Cause Chronic Wound Infections Among Patients at Kenyatta National Hospital

Abstract

Background: Wound infection is a common complication of chronic wounds and a public health issue with significant morbidity and mortality. There is a paucity of data on the prevalence, bacterial causes of wound infections and antimicrobial susceptibility patterns in Kenya. This study was carried out at Kenyatta National Hospital (KNH) to bridge this gap. Study objectives: To determine the prevalence of chronic wound infection; identify the causative bacteria and their antimicrobial susceptibility patterns in chronic wound infections among patients in medical wards and clinics. Study design and setting: A descriptive cross-sectional study was conducted for two months in 2020 at KNH medical wards, Surgical Outpatient and Diabetes clinics. Socio-demographic characteristics, clinical data and a wound punch biopsy for microscopy culture and sensitivity were obtained from 106 participants. Data derived was coded into IBM SPSS version 21.0 for descriptive analysis. Results: The study population was predominantly male (60.4%) with a mean age of 47 years. The most common comorbidities were diabetes mellitus and hypertension. The prevalence of wound infections was 85.8%, with gram-negative bacilli/ rods being the most common (73.6%). The most common organisms were Proteus mirabilis, Proteus aeruginosa and S. aureus at 17.6%, 13.9% and 12.0% respectively. Conclusion: There were high rates of antimicrobial resistance among gram-negative and gram-positive organisms. Meropenem, Amikacin and Piperacillin/Tazobactam had the best sensitivity rate against the gram-negative organisms. Tigecycline, Teicoplanin and Linezolid had the best xi activity against gram-positive organisms and to avoid resistance, antibiotics should only be used when specified. Recommendations: Tissue culture should be incorporated in the management of infected wounds as per standard practice. Antibiotic use in the management of infected wounds should be guided by sensitivity results after adequate source control/debridement has been achieved. This study supports the current KNH Antibiotic guidelines recommendations on empiric antimicrobial therapy in wound infections