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.