Evaluation of Antimicrobial Resistance Patterns of Bacteria Isolates From Chronic Wounds of Patients Attending Murang’a Level 5 Hospital, Kenya

Abstract

Background: Chronic wounds pose a serious public health risk. Therapy of chronic wound infections is significantly hampered by the unchecked and rapid spread of bacterial pathogens. In Kenya there is a scarcity of the statistics on antimicrobial sensitivity and resistance of bacteria isolated from chronic wound infections. This study has determined the colonizing bacteria of chronic wounds and their antibacterial resistance pattern to most used antibiotics. Risk factors associated with chronic wounds was also evaluated. This analysis was carried out in Murang’a Level 5 Hospital which is located in rural area of Central region in Kenya.

Methods: It was a hospital-based cross-sectional study. Swabs were aseptically picked from chronic wounds and transported in Amies transport media in a cooler box to Microbiology laboratory. Inoculation was done on SBA and MAC and incubated at 37⁰c for 24 to 48 hours. Gram stain followed for the provisional isolate’s identification. The isolated microorganisms were evaluated for drug sensitivity and resistance using Kirby Bauer disk diffusion method on Mueller Hinton Agar.

Results: The positivity rate was 81.3%. Staphylococcus aureus lead at 29.7%, Pseudomonas aeruginosa 16.3% and E. coli 15.2%. Levofloxacin was the most sensitive antibiotic to S. aureus, doxycycline and gentamicin followed closely. All Gram-negative bacteria in this study demonstrated high susceptibility to meropenem, piperacillin/tazobactam, gentamicin, imipenem, cefepime and ciprofloxacin in that order. They all showed resistance to ceftriaxone, Augmentin, co-trimoxazole and ampicillin. 22.6% of all Staphylococcus aureus isolated were methicillin resistance (MRSA) strains. 5.95% were induced clindamycin resistance (ICR) strains. 2.38% had both MRSA and ICR strains. In all Enterobacteriaceae isolated, 19 (16.23%) are Extended spectrum beta-lactamase (ESBL) producing strains. E. coli accounted for 10 ESBL strains while the rest 9 ESBLs were from Klebsiella pneumoniae.

Conclusion: Frequent monitoring of antimicrobial susceptibility pattern is necessary to curb the spread of antibacterial resistance.