1.0 INTRODUCTION/LITERATURE REVIEW
1.1 INTRODUCTION
A wound results following disruption of the skin which can be intentional or accidental (Giacometti, et al., 2000). Wound infections cause a burden of disease and morbidity for both the patient and the health services. To the patient it causes pain, discomfort, inconvenience, disability, financial drain, and even death due to complications such as septicemia. It causes financial strain on the health services due to the required high cost of hospitalization and management of the patients.
A number of factors contribute to wound infection; however microorganisms are the major cause with bacteria being the most prevalent (Obuku, et al., 2012). Early recognition of wound infection and appropriate management is important. Antibiotic therapy and surgical management are the cornerstone measures whereby antibiotics offer adjuvant treatment. Wound infection can be caused by single bacteria or multiple microorganisms. Surgical site infections are the second most common cause of nosocomial infections after urinary tract infections (Perencevich, et al., 2003; De Lissovoy et al., 2009). Most surgical site infections occur in ambulatory patients after discharge from the hospital and therefore beyond the hospital infection control surveillance programs (Perencevich, et al., 2003). Prolonged pre-operative hospital stay and exposure to diagnostic procedures has been associated with increased rate of SSI. In clean surgical procedures, Staphylococcus aureus is the most common pathogen while Pseudomonas aeruginos is the most common gram negativebacilli. A number of studies indicate an increase in antibiotic resistant microorganisms in surgical patients. Resistant bacteria causes severe infections that are expensive to diagnose and difficult to treat. The mechanism by which resistance develops is complex and can result in multi-drug resistant bacterial strains due to simultaneous development of resistance to several antibiotics. Determination of local bacterial sensitivity patterns to antibiotics is important in providing a guide for antibiotic selection.
There are factors that increase the risk of wound infection which include patient characteristics such as; age, obesity, malnutrition, endocrine and metabolic disorders, smoking, hypoxia, anaemia, malignancies and immunosuppressants. Other factors are the state of the wound which includes non viable tissue in the wound, foreign bodies, tissue is chaemia,and formation of haematomas, long surgical procedures, and contamination during operation, poor surgical techniques, hypothermia and prolonged pre-operative stay at the hospital.
Wound infections can be prevented by restoring blood circulation as soon as possible, relieving pain, maintaining normal body temperature, avoiding tourniquets, performing surgical toilet and debridement of the wound as soon as possible, administration of antibiotic prophylaxis for deep wound and high risk infections. High risk wounds include contaminated wounds, penetrating wounds, abdominal trauma, compound fractures, wounds with devitalized tissue; high risk anatomical sites such as hands and feet. Antibiotic prophylaxis should be started two hours before the surgical procedures.
Establishment of the causative microorganism is important and treatment should be initiated based on the bacterial sensitivity patterns. Topical silver dressings have been used to treat infected wounds however; there is no evidence for their efficacy due to multiple microbial aetiologies (Vermenlen, et al., 2007). To achieve optimum antimicrobial therapy, the biofilm load should be reduced to enhance drug concentration at the wound site (Strup, et al., 2007).
Bacterial wound infections are a common finding in open injuries. Severe and poorly managed infections can lead to gas gangrene and tetanus which may cause long-term disabilities (Strup et al., 2007). Chronic infection can cause septicemia or bone infection which can lead to death. Sepsis as satiated encephalopathy increases morbidity and mortality especially in the ICU patients (Maramattom, 2007).
1.2 Significance of Study
Septic wounds are a common cause of morbidity. Despite improvement in the practice of medicine and attempts to provide aseptic conditions in the surgical wards, the incidences of wound infection are increasing. Management of wound infection remains a challenge in the surgical areas with the increasing resistance to antimicrobials. Antimicrobial resistance can lead to complications which depending on severity can cause disability or death and increased cost of hospitalization and management. In children, this impacts negatively on the quality of life at a tender age. The antibiotic sensitivity patterns have not been studied fully. It was therefore important to identify the causative organisms and determine the antimicrobial sensitivity patterns to help reduce infections and ensure appropriate use of antimicrobials.
1.3 AIM AND OBJECTIVES
The study is aimed at determining the bacteriological study of wound spesis.
OBJECTIVES
The main objectives of this study are;