ABSTRACT
The
isolation and identification of bacteria associated with 150ml sepsis studies were carried out to 250
patient at National Orthopedic Hospital Enugu. (250) Two hundred and fifty
patients with 150ml sepstis was grouped in to in patients and out
patients. The sample collected are wound pus and wound
exudates which were collected from patients with diabetic ulcer, surgery
wounds, sickle cell ulcers, gun shot wound, using sterile stent striates
to aspirate the wound exudates and
steete swab sticks to swab the wound prof. Population was sampled
According to wound
type and noting their differences sex
distributing palternage range (0-2_ years, (3-5_ years (608) years (9-11_
years, (12-14) years, (15-17) years, (18-20) years, and 21 years and above, in
sex distribution. (male and female), in predisposing factors and in any other
factor affecting it and also their anatibiotic sensitivity pattern. The samples collected were plated out to on
Mac conkey agar, Blood agar, Perory citrate agar (DCA) and further examination
was done such as motility test gram staining and some brolhemoceltest like
citrate, on and catalyset test foar confirmation. The results obtained from 250 patients smaples,
199 were positive pathogens and 51 were negative out of which 97 (48.890) were
staphylococcus aureus, Staphylococcus aureus was arecorded as the organism that
was the highest prevelence while galmorella species has the lowest prevalence
3(1.5%) In this study. The sensivity
patttern of the isolated organisms results show that pseudomonas aeruginosa
is resistant to more drugs than the staphylococcus aureus and
escherichris coli. Msot organisms
were sensitive ato ciprofloxacillin, Amplicillin, Oxfloxacillin, Erythroylin, Cotrimoxazole.
TABLE OF CONTENTS
Title page
Certification
Dedication
Acknowledgement
Abstract
Table of contents
List of tables
List of figures
CHAPTER ONE
1.0
Introduction
1.1 complication
1.2
Aim and objectives
1.3
Statement of problems
1.4
The significance of study
1.5
Hypothesis\
1.6
Scope of study
1.7
Limitation
CHAPTER TWO
2.0
Literature review
2.1 general incidence to wound sepsis
2.2
Actiological agends of wound sepsis
2.3
Diagnosis and pathogenesis of wound sepsis
2.4
Epideomology of wound sepsis
2.5
Age and sex incidence
2.6
Predisposing factor of wound sepsis
2.7
Chemo therapy of wound sepsis
CHAPTER THREE
3.0
Materials and methods
3.1 materials and culture media used
3.2
Collection and processing sample
3.3
Method
3.4
Biochemical characterization isolates
3.5
Gram staining
3.6
Catalase test
3.7
Coagulase test
3.8
Motilidy test
3.9
Oxidse test
3.10
Indole test
3.11
Methyl red test
3.12
Phenylative deamination test
3.13
Citrase utilization test
3.14
Antibigram
CHAPTER FOUR
4.0
RESULTS
CHAPTER FIVE
5.0 Discussion, suggestions,
conclusions and recommendation.
5.1
Discussion
5.2
Suggestion
5.3
Conclusions
5.4
Recommendation
LIST OF TABLES
1.
Subjects smapled accoridng to inpatients, out patients,
age and sex distribution
2.
Subjects sampled according to types of wounds, age and
sex distribution
3.
Paterns of organisms isolated in wounds sepsis in Enugu
4.
Age and sex distribution of isolates in wound sepsis
5.
Bacterial pathogens causing wound sepsis in patients
with sickle cell disease in Enugu
6.
Pattern of bacterial pathogens causing wound sepsis in
patients with surgical wounds.
7.
Bacterial isolated in patients with Gunshot wound
sepsis
8.
Bacterial isolated from patients with diabetes ulcers
9.
Antibiogram of bacterial isolates from wound sepsis in Enugu
10.
Biochemical reactions and identifications and
identification test on bacterial isolates from wound sepsis in Enugu
LIST OF FIGURES
1.
showing organisms isolated from wound sepsis in Enugu (piechart)
2.
Bacterial pathogenesis causing wound sepsis in patients
with sickle cell disease
3.
Bacterial pathogens causing wound sepsis in the
patients with surgical wounds (Barcharts)
4.
Bacterial isolates from patients with gunshot wound
(bar chart)
5.
Bacterial isolates from patients with diabetic ulcer
(Bar chart)
CHAPTER ONE
1.0 INTRODUCTION
Wound is any interruption, by
violence or by surgery, in the continuity of the external surfaces of the body
or of the surface of any internal or pan (madonald, 1990). According to him,
legally, the whole thickness of the skin must be broken, and creating an
internal injury wound. Is also a breach
of a coetaneous, mucous or serious surface (Charles 1979). Wound can also be
defied as injury to the skin or underlying tissues or organs by a blow or cut,
missile or stab which includes injury to the skin caused by chemicals, cold, friction, heat, pressure and rays, and manifestation
in the skin of internal conditions such as pressure sure and ulcers (Roper
1989).
Wound
sepsis is the infection of wound by phylogenic organisms (Roper, 1989). Wounds can be divided into Many types which
includes (a) Incised wounds: which are
produced by sharp scuttling instruments (There is aponeuetic fascia of the
scalp and most operations wounds are of a this category, Lacerased wounds
which may be produced in category, Lacerased wounds which may be
produced in road accidents, by factory machinery. This type of wound is frequently contaminated
and it supplies an excellent culture medium for microorganisms. There is more pain than in an incised wound
but bleeding may not be severe due to constriction of blood vessels. Punctured wound which may be inflicted by
sharp instrument, nails, edge’s teeth, knives and bullets. These wounds are specially susceptible to
injection from anaerobic organisms as those causing tetanus and gas gangrene
which start thriving when the aerotic organisms such as staphylococcus and
streptococcus have used up the available oxygen in the deep tissues.
Poisoned
wounds are those which occurs as a result of insect strings, snake bites and
dog bites and the inject bites produce swelling. Irritation and dis-comfort caused and
devitalized wounds are those that result for
industrial and severe road accidents and the area and depth of
devitalized tissue depends upon the area and weight of the coushing force and
the duration and velocity of impact.
Burns and scalids which results
from the destruction of tissue by dry heat fraction, electricity radiation or
corrosive fluid while scald results from the destruction of tissue by mist
heat. Bruise and confusion is a
superficient injury without damage to the skin and the swelling, pain and dis
comfort are dye to the extra-vacation of blood into tissues. Colour changes occur as a result of the
moglobin oxidatron.
Haematoma is the collection of
blood in the tissues which causes a swelling which when pressed on surrounding
structures, the haemotoma become readily injected by micro-organism
Sprain is another wound type
which involves the tearing of the capsule and ligaments round a joint with
subsequent exudation of fluids.
Wounds cab further be classified into clean wounds
with the amount of contamination being up 30% or more in dirty wounds. The class I (clean) wounds which are non
traumatic with no break in surgical technique without any septic folus or
viscera being opened. Classs II (clean
contaminated) wounds are non traumatic, with only minor breaker own in technique
being allowed orentry into a vucous without significant spillage. The class III (contaminated) are traumatic
wounds froma relatively clean source, or with a major break in technique or
significant spillage from an open viscous, or when acute non- purulent
infection is encountered. Class IV
(dirty) wounds are frammatic wounds from a dirty source following delayed
treatment or when acute bacterial contamination and releases of pus occur.
Micro organism of clinical
importance can be isolated from wounds and they include Achinomyces species. Bacteriodes species, clostridium
perfringes, Eschericha coli, other gram negative enteric bacilli, my
cobacterium species, pseudomonas aerug, nwa proteus vulgaaris, staphlococcus
aureus. Stapholococcus epidermis stretococcus faecalis, clostridium fetani
(Fischachi, 1987)
Wound sepis depends on the
opportunities for infection in different parts of the body which in turn
depends on the normal bacteria flora of the part, the size of the wound,
duration of the operation increase in the length of stay in the hospital and
can even result in patients death
1.1 COMPLICATION
Complication arising from wound sepsis are
suppurations which results when there is an
imbalance between the infective agent on one hand and the defensive
reaction on the other. The other
complications are cellulite which is characterized by a spreading infection,
necrosis and sloughing; septicemia, pyaemia and kaolin formation chilling worth
et al 1979). Others that can also result
from wound sepsis are gas gangrene, clostridia mystics, clostridical crepitate
celluslitis which is a type of mixed infection usually found as a complication
of wounds characterized by necrosis of the aveolar and fascia tissues with
progressive gangrenous changes in the skin secondary in thrombosis or nutrient vessels
repetition of the wound result from the formation of gas by the bacteria
synergistic gangrene which is a mixed infection caused by the synergistic
action of the acrobic hemolytic staphylococcus aurous and micro Europhilic
haemolytic streptococcus also occur as a senous complication peritonitis,
perforation and absences formation are other complications. Wound sepsis can be complicated by mixed
infection in which yeast and often fungal infection are involved (sabistan
1981) . other complications are diabetic
micro antipathy which involves the small vessels and capillaries an further
complicate diabetes Nellutus.
Distinct
and definitive thickening of the usement member inflammatory changes occur
lading to the impairment of the resistant of the skin to secondary infections
and delay the rate of healing following injures. Arkrosclerosis is another major complication
of diabetes mellitus. Corponary Vessels
are affected producing myscardid infection are the vessels of the lower extremities producing gangrene
of the toes and feets. The precipitating
causes of gangrene of the lower extremities resulting in ulceration, infliction
and subbasement gangrene..
In the
case of sickle cell disease leg ulcers, there is general reduction in the
oxygen carrying capacity of blood resulting.
In tissue dypoxia and parenthesis
of the extremities occurs but although certain compensatory adjustment of the
circulation occur the patients can become immemorially compromised in cases of
secondary infections due to blocking of small vessels by sickled cells and
infare of bones and joints which enhances the continued preponderance of any
infecting organism (Anderson 1985).
This work
is therefore an attempt to investigate bacteria associated with infection of
wounds noting their differences . in
distribution peltern, age range 10-2) years, (3-5) years, (6-8) years (9-11)
year (12-14) years, (15-17) years, (18-20) years and 21 years and above, sex
distribution (male and female) predisposing factor and any other factor affecting
in Nigeria where antibiotic sensitivity pattern especially in Nigeria where
drugs are takes indiscriminately without prescription
1.2
AIM &
OBJECTIVES
a.
The aim of this work is to isolate and identified
bacteria associated with wound sepsis
b.
And the objectives are to assess whether any
correlation exists between age, sex and different types of wound.
2.c To assess the antibiogram of different
bacteria associated with wound sepsis so as to offer advice on therapy.
1.3 STATEMENT OF PROBLEMS
Wound sepsis has really posed a
serious threat to both surgical and un-surgical wounds. There has been prevalence in wound sepsis
following iyunes and fome disease state, and may have failed to heal after
administration of common antibiotics resulting to foul smelling and petrifying
wounds owing to their discriminate use of drugs especially in togena.
This problems really propelled met know whether it
is because efln discriminate use of dmgs that contributed to sensitive
organisms to become resisted string to the drugs or could it be because of
mosconical injection which comes bystaying very long in the hospital. And why staphylococcus
has been the prechominant organisms threatening wounds.
1.4 THE
SIGNIFICANCE OF STUDY: standard clean sanitary condition is employed to avoid
mosconial infection
1.5 HYPOTHESIS
HO Staphocollus aureus is predominantly
associated with wound sepsis
H1 Staplococcus aureus is not predominantly associated with wound sepsis
HII: There
is correlation between age, sex and different types of wound sepsis.
1.5 SCOPE
OF STUDY
The scope of the study is to
isolate and identify bacteria associated with
wound seosis, noting their distribution pattern, age and sex
relationship,
predisposing factor and any other factor affecting it and also their
antibiotic
sensitivity
especially in Nigeria
where drugs are taken indiscriminately
without
prescription.
1.7 LIMITATIONS
This project work has been
limited on only surgical, sickle cell, ulcer,
Diabetic ulcer
and gun short
wound sepsis. Collection
of samples and
materials used
is limited to National orthopedic hospital Enugu
Metropolis.
This project
is also limited to open
wounds and to
patients t hat lactnot
stayed for a
long time, in the clinic to
eliminate nosconial infection
and
sense had not
used a lot of antibiotic which would have killed the
opportunistic
bacteria.
The significance of study.
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