Bacteria associated with wound Sepsis and their Antimicrobial susceptibility patterns among patients attending Mulago Hospital Outpatient department
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Background: Wound sepsis is one of the most common infection in which bacterial flora proliferates and delay the wound healing process. It is a major complication of wounds with significant increase in costs, morbidity and potential mortality. The present study was conducted at Mulago National Referral and teaching Hospital outpatient department and the primary aim of the study was to determine the bacterial pathogens associated with wound sepsis and their drugs susceptibility patterns. Methods: This was field and laboratory based cross sectional study that involved both Qualitative and Quantitative data collection methods. The study involved 140 patients with septic wounds caused by abscesses, trauma or burns as well as post-operative cases. It was carried out for the period of four (4) months between the months of February up-to May 2019. Wound swabs were obtained by using Levine’s techniques and identification of bacterial isolates was determined by standard microbiological techniques. Antibiotic sensitivity testing was determined by using Kirby Bauer diffusion method. Additional data was collected using questionnaires and entered in Microsoft excel (spread sheets) and then uploaded to and analyzed using statistical package for social sciences (SPSS) version 20.0. All levels of statistical significance were established at p<0.05. Results: The most prevalent wound type was trauma 92(69.3%), followed by post-operative wounds 16(11.4%), burn wounds 15(10.7%) and lastly abscesses 12(8.6%). The prevalence of wound sepsis during the study period was 75.0%. A total of one hundred fifty (150) bacterial isolates were recovered from wound swabs. In 62(44.3%) cases, cultures were mono-microbial, 43(30.7%) cultures were poly-microbial and no bacterial isolates were obtained in 35(25.0%) cases. Staphylococcus aureus was the most prevalent isolate 53(35.3%) while Streptococcus species 2(1.3%) constituted the least. Among the eight (8) antibiotics used, Linezolid was found to be the most effective drug against all Gram-positive isolates whereas Ciprofloxacin and Piperacillin were the most effective drugs against all Gram-negative isolates. The study reported female gender as the risk factor to wound sepsis as there was a statistical association between the incidence of wound sepsis and gender (P= 0.040). Other risk factors such as; age, type of wound and comorbidities (i.e. Diabetes and HIV status) did not associate with wound sepsis as their p values were greater than 0.05. Conclusions and recommendations: The main bacterial pathogens causing wound sepsis were Staphylococcus aureus and Pseudomonas aeruginosa. The susceptibility patterns of locally available and used antibiotics (i.e. Amoxicillin and Gentamycin) at Mulago hospital outpatient department were low. It is recommended that Infection control and drug dispensing policies at Mulago Hospital be strengthened through greater collaboration between microbiologists and medical practitioners to stem the spread of resistant bacteria. In addition to conducting further research on etiological agents from septic wounds and their susceptibility profile so as to assist in prescribing the right drugs and discourage emerging resistance. The study further recommends that Linezolid, Ciprofloxacin and Piperacillin to be used in preference to Amoxicillin and Gentamycin for treatment of septic wounds at Mulago hospital outpatient department.