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American Journal of Infectious Diseases
Year: 2009  |  Volume: 5  |  Issue: 1  |  Page No.: 1 - 6

Incident of Pseudomonas aeruginosa in Post-Operative Wound Infection

A. Hani Masaadeh and S. Adnan Jaran    

Abstract: Problem statement: The primary aim of this study was to determine the incidents of pseudomonas aeruginosa in post-operative wound infection and its sensitivity pattern to commonly used antibiotics and assessment of Pseudomonas aeruginosa as an agent of nosocomial infections. Approach: During a period of six months between February to December 2005, 115 specimens were collected from King Abdullah University Hospital, Princess Basma Hospital, Princess Badea and Princess Rahma Hospitals. Samples were obtained from the hospitals and processed in our research microbiology lab. Results: Out of the 115 bacterial isolates found in post-operative wound infection, 20 (27.8%) were Pseudomonas aeruginosa, followed by E. coli 18 (15.6%), S. aureus 17 (14.7%), Acinetobacter calcoaceticus 15 (13.0%), K. species 14 (12.1 %), Proteus species 7 (6.0 %), Citrobacter freundii 4 (3.4%), Streptococcus pyogenes 3 (2.6 %), Enterococcus faecalis 3 (2.6%) and no growth 2 (1.7%). The results showed that the occurrence of Pseudomonas aeruginosa was higher in young groups than in the other groups. The lowest causative agents of post operation infections were Streptococcus pyogenes, Enterococcus faecalis and Citrobacter freundii. There was no significant difference in the occurrence of hospital infection between males and females. The sensitivity pattern of P. aeruginosa isolated from patients in post-operative wound infections; the organism was sensitive to amikacin, gentamicin, tobramycin, ciprofloxacin and aztreonam with amikacin showing the highest percentage sensitivity. Conclusion: In conclusion, this study shows that there is an increased rate of incidence of Pseudomonas aeruginosa in post-operative wound infections.

Table 1 shows the occurrence of Pseudomonas aeruginosa in post-operative wound infection in relation to age. The age groups were divided into seven catagories: 10-20, 21-30, 31-40, 41-50, 51-60, 61-70 and 71 and above. The result showed that the occurrence of Pseudomonas aeruginosa was higher in young groups than in the other groups.

Table 2 shows the types and frequency of surgery that have been done for each patient finding that the wound infections and caesarean sections have the most frequency (10 cases for each) and the highest percentage (8.6% for each).

Table 3 shows the most causative agent of post operation infections was P. aeruginosa 32 isolates (27.8%), following E. coli 18 isolates (15.6%). The lowest causative agents of post operation infections


Table 1:

Relationship between post-operative wound infections in relation to age

were Streptococcus pyogenes, Enterococcus faecalis and Citrobacter freundii.

Table 4 shows the relationship between postoperative wound infections and duration of operation, most of the surgeries took 1.0 h 42 (36.9%), which indicates that the majority of the surgical procedures were minor surgeries.

Table 5 shows the relationship between postoperative wound infections and sex. There was no significant difference in the occurrence of hospital infection between males and females.

Table 6 shows Sensitivity pattern of P. aeruginosa isolated from patients in post-operative wound infections, the organism was sensitive to amikacin, gentamicin, tobramycin, ciprofloxacin and aztreonam, with amikacin showing the highest percentage sensitivity.


Table 2:

The types and frequency of surgeries

Table 3:

Frequency and percentage of microorganisms isolated from patients in post-operative wound infection


Table 4:

Relationship between postoperative wound infections and duration of operation


Table 5:

Relationship between postoperative wound infections and sex


Table 6:

Sensitivity pattern of P. aeruginosa isolated from patients in post-operative wound infection (n = 32)

DISCUSSION

The primary aim of this study was to determine the incident of Pseudomonas aeruginosa in post-operative wound infection and its sensitivity pattern to commonly used antibiotics.

During a period of six months between February to December, 2005, 115 specimens were collected from King Abdullah University Hospital, Princess Basma Hospital, Princess Badea Hospital and Princess, Rahma Hospital (local hospitals) (Table 5), suffering from post operation infection, all specimens were directly transferred to the lab and cultured to the appropriate media (as descried in materials and methods).

Hospital acquired infection is a serious problem of most hospitals. Infection may be acquired during the operation or postoperatively in wards[1]. The results obtained showed a high incidence of Pseudomonas (27.8%) of all the pathogens isolated from the post-operative wound in the different operations.

Bertrand et al.[15] recorded prevalent rate of 19.1%. The result of our study is higher than that reported by[15]. This could be attributed to differences in geographical location and hygienic measures.

The results of the study shows that the overall infection rate was slightly influenced by age and the general health of the patients and these results are in agreement with the observation by[19], in which the overall rate of infection was influenced by the age and health of the patients. Since the majority of the population in our study was within the same age that has been reported in the literature. 55 of our patients (83.3%) were over 28 years of age. McEwin[20] reported that postoperative infection increases with the period of time over which the patient has been in hospital before operation, presumably exposed to skin colonization by "hospital" bacteria.

In the present study, data showed that, there was no difference between sexes with regard to the susceptibility to infection (Table 5). This is not consistent with the previous finding[21].

Since, the percentage of wound infection increased as the duration of operation increased, from 43 % at less than 60 min, up to 57% at more than 90 min intervals (Table 4).This means that chances of exposure to bacteria was high, which increased the overall rate of postoperative wound infection.

This also revealed the increasing incidence of Pseudomonas aeruginosa in post-operative wound infections as observed by other scientists especially in recent years. Joshi et al.[15] quoting Najak stated that Pseudomonas aeruginosa has almost replaced Staphylococcus aureus in post-operative wound infection and reported that Najak documented 16.8% for Pseudomonas aeruginosa and 5.6% for Staphylococcus aureus. It is thus clear that the prevalent rate of Pseudomonas aeruginosa recorded in this study is in agreement with that obtained in other hospitals.

The susceptibility pattern of the 32 isolates of Pseudomonas aeruginosa to some commonly used antibiotics as reported in this study is similar to that found reported in the literature[22].

Hasseigren et al.[23] studied 112 patients to find the sources of bacteria causing wound infection. They found that the patients were the sources of bacteria in all cases of wound infection. The increase in postoperative infections was due to high penicillin-resistant carrier rate in hospital personnel and patients as a result of widespread use of Penicillin[23]. However, Krieger et al.[21] reported that the scrubbed team and patients were the major source of wound contamination.

Conclusion

This study shows that there is an increased rate of incidence of Pseudomonas aeruginosa in post-operative wound infections. The most causative agent of post operation infections were P. aeruginosa, followed by E. coli, S. aureus, Acinetobacter calcoaceticus and Klebsiella spieces. The lowest causative agents of post operation infections were, Streptococcus pyogenes, Enterococcus faecalis and Citrobacter frenudii. This is in agreement with survey studies carried out in various hospitals.

The infection appears to be common in hospitals with relaxed hygienic measures and is dependent on age, sex and duration of stay in the hospital. The reason for this increase in postoperative infection rate with prolonged preoperative hospitalization is primarily due to colonization of patients with hospital-acquired resistant microorganisms.

ACKNOWLEDGEMENT

We are grateful to the staff of all primary hdoiealth care centers and all patients included in this study for their support and assistance.

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