Antimicrobial susceptibility of bacteria that cause wound sepsis in the paediatric surgical patients at Kenyatta national hospital
Abstract
Background: Wound infections contribute significantly to morbidity and mortality in
surgical patients. A number of factors contribute to wound infection; however
microorganisms are the major causes with bacteria being the most prevalent. Determination
of local bacterial sensitivity patterns to antibiotics is important in providing a guide for
antibiotic selection and appropriate management.
Objectives: The main objective of this study was to identify the bacteria that cause wound
infections and their antimicrobial sensitivity patterns in the paediatric surgical wards at
Kenyatta National Hospital.
Methodology: A cross- sectional design was used and the target population was children
below the age of 13 years admitted in the surgical wards. The study was carried out for a
period of two months, from mid April 2014 to mid June 2014. Data was collected using a
questionnaire, specimens from the infected wounds were collected using sterile swabs and
analyzed in the microbiology laboratory. Data was analyzed using the statistical software,
SPSS version 20.
Results: The prevalence of wound infection was 82%. Staphylococcus aureus was the most
prevalent followed by Pseudomonas aeruginosa, Proteus spp, coagulase negative
staphylococcus, Beta hemolytic streptococcus, Klebsiella spp, Non lactose fermenters, and
Enterococcus faecalis. Patients who had mixed infections were 8.67% of the total
participants. Staphylococcus aureus was highly sensitive to ceftriaxone but resistant to
ceftazidime. MRSA formed 50.6% of the Staphylococcus aureus isolates. BHS was highly
sensitive to amoxicillin clavulanate and resistant to cefuroxime. Escherichia coli was
sensitive to ciprofloxacin but resistant to amoxicillin clavulanate, cefuroxime, ceftriaxone,
imipenem and ceftazidime. Klebsiella spp was sensitive to all the antibiotics that were tested.
Proteus mirabilis was sensitive to all the antibiotics except ceftazidime. The NLF were only
sensitive to imipenem, ciprofloxacin and cefoxitim. Pseudomonas aeruginosa was highly
sensitive to ciprofloxacin and imipenem but less sensitive to ceftazidime and resistant to
ceftriaxone. Enterococcus faecalis was sensitive to amoxicillin clavulanate, cefuroxime,
ceftriaxone and ciprofloxacin but resistant to cefoxitim, imipenem and ceftazidime.
Ceftriaxone, cefuroxime, flucloxacillin and amoxicillin clavulanate were widely used beside
other antibiotics for either prophylaxis or treatment of the wound infections.
Conclusion: The prevalence of wound infection remains high despite wide use of antibiotics
in the paediatric surgical wards. Resistance to new antibiotics like imipenem was observed.
Recommendations: Due to high resistance of the organisms to antibiotics, sensitivity tests
should be regularly carried out to enhance rational use of antibiotics and antibiotic choice
should be made based on the sensitivity patterns, ability to penetrate tissue, low toxicity and
no allergic reactions. The prescribed antibiotics should have the dose and duration clearly
indicated and upon administration, it should be clearly marked on the patient’s treatment
sheet.
Treatment guidelines for use of antibiotics should be formulated based on the hospital
formulary and the sensitivity patterns. This should be reviewed occasionally to ensure
rational use of antibiotics.
Publisher
University of Nairobi