Keywords
microbial colonization
Polymicrobial infection
Antibiotic resistance
aerobes
anaerobes
How to Cite
Abstract
A wound is a rupture in the skin exposing the underlying subcutaneous tissue. It creates a moist, warm, and nutritive environment that is conducive to microbial colonization and proliferation. Depending on the time it takes for the wound to heal, it can be categorized as either acute or chronic. Infection in a wound elongates the healing period, causes longer hospital stays and higher treatment costs. The majority of open wound infections are polymicrobial containing both aerobic and anaerobic microorganisms, which should be taken into account when choosing antimicrobials. Due to the increasing prevalence of antibiotic resistance, the control of wound infections has become more challenging. In Nigeria, this challenge is exacerbated due to limited epidemiological data on the microbial agents causing wound infections. Thus, it is necessary to understand the microbes prevalent in infected wounds in order to encourage proper antimicrobial selection for the offending microbe and enhance better treatment and management outcomes. In this review, the bacteriology of wound infections, susceptibilities to routinely prescribed antibiotics and the effects of the presence of these bacterial species in wound management were discussed.
References
World Health Organisation (2011). Report on the burden of endemic health care-associated infection worldwide. Geneva: World Health Organization, 2011.http://apps.who.int/iris/bitstream/10665/80135/1/9789241501507_eng.pdf(accessed Oct 9, 2016).
Allegranzi, B., Bagheri, N. S., Combescure, C., et al.( 2011). Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet; 377: 228–41.
European Center for Disease Control (2013). Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. Stockholm: European Centre for Disease Prevention and Control, 2013. http://ecdc.europa.eu/en/publications/Publications/ healthcare-associated-infections-antimicrobial-use-PPS.pdf
Magill, S.S., Edwards, J.R., Bamberg, W., et al. (2014). Multistate point-prevalence survey of health care-associated infections. N Engl J Med; 370: 1198–208.
Amoran, OE, Sogebi, AO, Fatugase, OM (2013). Rates and Risk Factors Associated with Surgical Site Infection in a Tertiary Care Center in South-West Nigeria. International Journal of Tropical Disease and Health. 3(1): 25-36.
Abubakar, I., Maikaje, D.B., Orukotan, A.A., Gana, E.N., and Ibrahim, H.A. (2018). Characterization and Antibiogram of Bacteria Isolated from Surgical Wounds of Patients Attending Ibrahim Badamasi Babangida Specialist Hospital Minna, Niger State, Nigeria. Journal of Advances in Microbiology 9(1): 1-9.
Olowo-okere, A , Ibrahim, Y. K. E., Sani, A. S. and Olayinka, B. O. (2018). Occurrence of Surgical Site Infections at a Tertiary Healthcare Facility in Abuja, Nigeria: A Prospective Observational Study. Med. Sci. 6, 60
Taiwo, SS, Okesina, AB, Onile, BA (2002). Invitro antimicrobial susceptibility pattern of bacterial isolates from wound infection in university of Ilorin Teaching Hospital Afr J Clin Exp Microbiol. 3(1): 6-10.
Azzopardi EA, Azzopardi E, Camilleri L, Villapalos J, Boyce DE, et al. (2014) Gram Negative Wound Infection in Hospitalised Adult Burn Patients- Systematic Review and Metanalysis-. PLoS ONE 9(4): e95042. doi:10.1371/journal.pone.0095042
Van Delden, C, Iglewski, BH (1998). Cell-to-cell signaling and Pseudomonas aeruginosa infections. Emerg. Infect. Dis. 4:551–560.
Dionigi, R, Rovera, F, Dionigi, G, Imperatori, A, Ferrari, A, Dionigi, P, Dominion, I (2001).Risk factors in Surgery. J. Chemother. 13: 6-11.
Pallavali RR, Degati VL, Lomada D, Reddy MC, Durbaka VRP (2017) Isolation and in vitro evaluation of bacteriophages against MDR- bacterial isolates from septic wound infections. PLoS ONE 12(7): e0179245. https://doi.org/10.1371/journal.pone.0179245
Gottrup, F (2004). A specialized wound-healing center concept: importance of a multidisciplinary department structure and surgical treatment facilities in the treatment of chronic wounds. Am J Surg. 187(5A):38S–43S.
Diabetea Atlas (2012). International Diabetes Federation. The IDF Diabetes Atlas. 5th edition. A summary of the figures and key findings. www.idf.org/diabetesatlas/papers.
Bowler, P, Duerden, B, Armstrong, D (2001). Wound microbiology and associated approaches to wound management. Clin Microbiol Rev. 14: 2, 244-269.
Sawdekar, H., Sawdekar, R., Wasnik, V.R. (2015). Antimicrobial susceptibility pattern of bacterial isolates from wound infection and their sensitivity to antibiotic agents at super specialty hospital, Amravati city, India Int J Res Med Sci; 3(2):433-439
Shittu, AO, Kolawole, DO, Oyedepo, ER (2002). A study of wound infections in two health institutions in Ile-Ife, Nigeria. Afr. J. Biomed. Res. 5: 97-10.
World Health Organization. Surveillance standards for antimicrobial resistance (2016). Available from: http:// www.who.int/csr/resources/publications/drugresist/whocdscsrdrs20015.
Nasir, I.A., Babyo, A., Emeribe, A.U., and Sani, N.O. (2015). Surveillance for Antibiotic Resistance in Nigeria: Challenges and Possible Solutions. Trends in Medical Research 10 (4): 106-113, 2015
Kooistra-Smid, M, Nieuwenhuis, M, van Belkum, A, Verbrugh, H (2009). The role of nasal carriage in Staphylococcus aureus burn wound colonization. FEMS Immunol Med Microbiol. 57: 1-3.
Akinjogunla, OJ, Adegoke, AA, Mboto, CI, Chukwudebelu, IC, Udokang, IP (2009), Bacteriology of automobile accident wounds infection. International Journal of Medicine and Medical Sciences. 1(2): 023-027.
Iregbu, KC, Uwaezuoke, NS, Nwajiobi-Princewell, IP, Eze, SO, Medugu, N, Shettima, S, Modibbo, Z (2013). A profile of wound infections in National Hospital Abuja. Afr J Clin Exp Microbiol. 4(3): 160-163.
Saini S, Gupta N, Lokveer A, Griwan MS (2004). Surgical Infections: A Microbiological Study. The Brazilian J Infect Dis. 8(2): 118-125.Bowler and Davies, 1999.
Bowler, PG, Davies, BJ (1999) The microbiology of infected and noninfected leg ulcers. Int J Dermatol. 38: 573-578.
Gethin, G, Cowman, PS (2008). Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or hydrogel: an RCT. J Wound Care. 17: 241-247.
Allegranzi, B., Bischoff, P., de Jonge, S., Kubilay, N. Z., Zayed, B., Gomes, S. M., Abbas, M., Atema, J. J., Gans, S., van Rijen, M., Boermeester, M. A., Egger, M., Kluytmans, J., Pittet, D., Solomkin, J. S. and the WHO Guidelines Development Group (2016a). New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis http://dx.doi.org/10.1016/S1473-3099(16)30398-X
Allegranzi, B., Bischoff, P., de Jonge, S., Kubilay, N. Z., Zayed, B., Gomes, S. M., Abbas, M., Atema, J. J., Gans, S., van Rijen, M., Boermeester, M. A., Egger, M., Kluytmans, J., Pittet, D., Solomkin, J. S. and the WHO Guidelines Development Group (2016b) New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016 http://dx.doi.org/10.1016/S1473-3099(16)30398-X
Berríos-Torres, S. I., Umscheid, C. A.,. Bratzler, D.W., Leas, B., Stone, E. C., Kelz, R. R., Reinke, C. E., et al. (2017).. Guideline for the Prevention of Surgical Site Infection, Centers for Disease Control and Prevention for the Healthcare Infection Control Practices Advisory Committee. JAMA Surg. 2017;152(8):784-791.
Osariemen, IJ, Olowu, SS, Adevbo, E, Omon, EE, Victoria, O, Imuetinyan, EJ, Adesuwa, E (2013). Aerobic Bacteria Associated With Diabetic Wounds In Patients Attending Clinic In A Rural Community In Nigeria. Global Res J Microbiol. 3(1): 8 – 12.
Mofikoya, BO, Neimogha, MI, Ogunsola, FT, Atoyebi, OA (2009). Bacterial Agent of Abdominal Site Infections in Lagos, Nigeria. European Journal of Scientific Research. 38(3): 509-513.
Akinkunmi, E. O., Adesunkanmi, A, Lamikanra, A. (2014). Pattern of pathogens from surgical wound infections in a Nigerian hospital and their antimicrobial susceptibility profiles. African Health Sciences; 14(4): 802-809.
Mordi, RM, Momoh, MI (2009). Incidence of Proteus species in wound infections and their sensitivity pattern in the University of Benin Teaching Hospital. Afr J Biotech. 8(5): 725-730.
Mahdi, SEI, Ahmed, AOA, Boelens, H, Ott, A, Abugroun, ES, van Belkum, A, Zijlstra, E, Verbrugh, H, Fahal, A (2000). An epidemiological study of the occurrence of Staphylococcus aureus in superficial abscesses of patients presenting for surgery in a teaching hospital in Khartoum, Sudan. FEMS Immunology and Medical Microbiology. 29: 155-162.
Etok, CA, Edem, EN, Ochang, E (2012). Aetiology and antimicrobial studies of surgical wound infections in University of Uyo Teaching Hospital (UUTH) Uyo, Akwa Ibom State, Nigeria. Open Access Scientific Reports. 1(7): 341.
Kehinde, AO, Ademola, SA, Okesola, AO, Oluwatosin, OM, Bakare, RA (2004). Pattern of bacterial pathogens in burn wound infections in Ibadan Nigeria. Ann. Burns Fire Disasters. 17(1): 12-15.
Krumkamp R, Oppong K, Hogan B, Strauss R, Frickmann H, Wiafe-Akenten C, et al. (2020) Spectrum of antibiotic resistant bacteria and fungi isolated from chronically infected wounds in a rural district hospital in Ghana. PLoS ONE 15(8): e0237263. https://doi.org/10.1371/journal.pone.0237263
Ezekiel K. Vicar, Samuel E. K. Acquah, Walana Williams, Eugene D. Kuugbee, Courage K. S. Saba and Gloria Ivy Mensah (2021). Antibiotic Resistant Bacteria Infecting Wounds of Rural Community Dwellers in Northern Ghana. European Journal of Medical and Health Sciences. 3 : 112-117; DOI: http://dx.doi.org/10.24018/ejmed.2021.3.1.678
Be, N. A., Allen, J. E., Brown, T. S., Gardner, S. N., McLoughlin, K. S., Forsberg, J. A., Kirkup, B. C., Chromy, B. A., Luciw, P. A., Elster, E. A., Jainga, C. J. (2014). Microbial Profiling of Combat Wound Infection through Detection Microarray and Next-Generation Sequencing. Journal of Clinical Microbiology; 52(7): 2583–2594
Auwaerter, P (2008). Antibiotic guide. Johns Hopkins ABX (antibiotic) Guide, Baltimore, MD.
Makanjuola, O. B., Olowe, O. A., Adeyankinnu, A. F. (2013). Bacterial Agents of Surgical Site Infections in South-Western Nigeria. Am. J. Biomed. Sci. 2013, 5(4), 217-225
Abdu A.B.1, Egbagba J.2, Fente B.G.3 Identification and antimicrobial susceptibility profile of bacterial pathogens isolated from wound infections in a tertiary hospital, Bayelsa South southern, Nigeria. Tropical Journal of Pathology & Microbiology. Volume 06 – Issue 04, August 2018
Moro, D. D., Bello, H. O. and Akano, S. O. (2018). Incidence and Antibiotic Resistance Pattern of Bacteria Associated with Wound infection in some Hospitals in Lagos, Nigeria. Asian Journal of Applied Sciences (ISSN: 2321 – 0893) Volume 06 – Issue 04, August 2018
Schultz, G.S., Sibbald, R.G., Falanga, V., et al. (2003). Wound bed preparation: a systematic approach to wound management. Wound Repair Regen;11 Suppl 1:S1-S28.
Clinton, A., Carter, T. (2015). Chronic Wound Biofilms: Pathogenesis and Potential Therapies; Lab Medicine 46 (4): 277-284.
World Health Organization. Prevention and management of wound infection. Guidance from WHO’s Department of Violence and Injury Prevention and Disability and the Department of Essential Health. Technologies. https://www.who.int/hac/techguidance/tools/guidelines_prevention_and_management_wound_infection.pdf
Wolcott, R, Rhoads, D, Dowd, S (2008). Biofilms and chronic wound inflammation. J Wound Care. 17: (8) 333-341.
Percival, SL, Bowler, P, Woods, EJ (2008). Assessing the effect of an antimicrobial wound dressing on biofilms. Wound Repair Regen. 16(1):52–57.
Wolcott, RD, Kennedy, JP, Dowd, SE (2009). Regular debridement is the main tool for maintaining a healthy wound bed in most chronic wounds. J Wound Care. 18(2):54–56.
Agom, D.A., Agom, J. D., Anyigor C.N (2014). Using Maggot Therapy in Treatment of Wounds: A Review of Its Effectiveness and Patients’ Experiences. MSCR; 2(10): 2749-2760
Choudhary, V., Choudhary, M., Pandey, S., Chauhan, V.D., Hasnani, J.J. (2016) Maggot debridement therapy as primary tool to treat chronic wound of animals. Veterinary World; 9(4): 403-409.
Naik, G., Harding, K. G. (2017). Maggot debridement therapy: the current perspectives. Chronic Wound Care Management and Research; 4: 121–128
Bexfield, A, Bond, AE, Roberts, EC, Dudley, E, Nigam, Y, Thomas, S, Newton, RP, Ratcliffe, NA (2008). The antibacterial activity againstMRSA strains and other bacteria of a <500 Da fraction from maggot excretions/secretions of Lucilia sericata (Diptera: Calliphoridae). Microbes Infect. 10(4):325–333.
Huberman, L, Gollop, N, Mumcuoglu, KY, Breuer, E, Bhusare, SR, Shai, Y, Galun, R (2007). Antibacterial substances of low molecular weight isolated from the blowfly, Lucilia sericata. Med Vet Entomol. 21(2):127–131.
Blueman, D., Bousfield, C.( 2012). The use of larval therapy to reduce the bacterial load in chronic wounds. J Wound Care.;21:244–253.
Sun, X., Jiang, K., Chen, J., et al. (2014). A systematic review of maggot debridement therapy for chronically infected wounds and ulcers. Int J Infect Dis.;25:32–37.
Cazander, G., van Veen, K.E., Bernards, A.T., Jukema, G.N. (2009). Do maggots have an influence on bacterial growth? A study on the susceptibility of strains of six different bacterial species to maggots of Lucilia sericata and their excretions/secretions. J Tissue Viability;18: 80–87.
van der Plas, MJ, Jukema, GN,Wai, SW, Dogterom-Ballering, HC, Lagendijk, EL, van Gulpen C, van Dissel, JT, Bloemberg, GV, Nibbering, PH (2008). Maggot excretions/secretions are differentially effective against biofilms of Staphylococcus aureus and Pseudomonas aeruginosa. J Antimicrob Chemother. 61(1):117–122.
Leid, JG, Shirtliff, ME, Costerton, JW, Stoodley, AP (2002). Human leukocytes adhere to, penetrate, and respond to Staphylococcus aureus biofilms. Infect Immun. 70(11):6339–6345.
Gbeneol T J. Vigilant injuries: Battered adult male in Enugu, Nigeria. J Exp Clin Anat 2014;13:26-8
Evans, J., Harris, C., Jenkins, M, et al. (2017). The all Wales guidance for the use of larval debridement therapy (ldt): All Wales Tissue Viability Nurse Forum and Biomonde; 2017, London.
Steenvoorde, P., van Doorn, L.P. (2008). Maggot debridement therapy: serious bleeding can occur: report of a case. J Wound Ostomy Continence Nurs; 35:412–414.
White, R, Cooper, R, Kingsley, A (2001).Wound colonization and infection. B J Nurs. 10: 563-578.
Kalmeijer, MD, Coertjens, H, van Nieuwland-Bollen, PM, Bogaers-Hofman, D, de Baere, GA, Stuurman, A, et al (2002). Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clin Infect Dis. 35:353–358.
Sani R. A.1, Garba S. A.2, Oyewole O. A.2,*, Ibrahim A. Antibiotic Resistance Profile of Gram Positive Bacteria Isolated from Wound Infections in Minna, Bida, Kontagora and Suleja Area of Niger State. Journal of Health Sciences 2012, 2(3): 19-22
Kalita, S., Devi, B., Kandimalla, R., Sharma, K. K., Sharma, A., Kalita, K., Kataki, A. C., Kotoky, J. (2015). Chloramphenicol encapsulated in poly-ε- caprolactone–pluronic composite: nanoparticles for treatment of MRSA-infected burn wounds. International Journal of Nanomedicine; 10 2971–2984
Heal, C F., Buettner, P. G., Cruickshank, R., Graham, D., Browning, S., Pendergast, J., Drobetz, H., Gluer, R., Lisec C. (2009). Does single application of topical chloramphenicol to high risk sutured wounds reduce incidence of wound infection after minor surgery? Prospective randomised placebo controlled double blind trial. BMJ 2009;338:a2812 doi:10.1136/bmj.a2812
McHugh1, S. M., Collins, C. J., Corrigan, M. A., Hill, A. D. K., and Humphreys, H. (2011). The role of topical antibiotics used as prophylaxis in surgical site infection prevention. J Antimicrob Chemother; 66: 693–701
WH Organization (2014) Antimicrobial resistance global report on surveillance: 2014 summary.
Wang Z, Zheng P, Ji W, Fu Q, Wang H (2016) SLPW: A Virulent Bacteriophage Targeting Methicillin- Resistant Staphylococcus aureus In Vitro and In Vivo. Frontiers in microbiology 7: 934. https://doi.org/ 10.3389/fmicb.2016.00934
Haq IU, Chaudhry WN, Akhtar MN, Andleeb S, Qadri I (2012) Bacteriophages and their implications on future biotechnology: a review. Virology journal 9: 1.
Jido, TA, Garba, ID (2013). Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Annals of Medical and Health Sciences Research. 2(1): 33-36.
Dessen, A, Mouz, N, Gordon, E, Hopkins, J, Dideberg, O (2001). Crystal structure of PBP2x from a highly penicillin resistant Streptococcus pneumonia clinical isolate. Journal of Biological Chemistry. 45 (2): 106-121.
World Health Organization. Surveillance standards for antimicrobial resistance (2016). Available from: http:// www.who.int/csr/resources/publications/drugresist/whocdscsrdrs20015.
Sandar, W.-P.; Saw, S.; Kumar, A.M.V.; Camara, B.S.; Sein, M.-M. (2021). Wounds, Antimicrobial Resistance and Challenges of Implementing a Surveillance System in Myanmar: A Mixed-Methods Study. Trop. Med. Infect. Dis. 2021, 6, 80. https://doi.org/10.3390/tropicalmed6020080
Novak, R, Henriques, B, Charpentier, E, Normark, S, Tuomanen, E (1999). Emergence of Vancomycin tolerance in Stretococcus pneumonia, Nature. 399 (6736): 590-593.
Walsh, C (2000). Molecular mechanisms that confer antibacterial drug resistance. Nature. 406(23): 775-781.
Idowu, O. J., Onipede, A. O., Orimolade, A. E., Akinyoola, L. A., and Babalola, G. O. (2011). Extended-spectrum Beta-lactamase Orthopedic Wound Infections in Nigeria. J Glob Infect Dis. 3(3): 211–215.
Wolcott, R, Rhoads, D, Dowd, S (2008). Biofilms and chronic wound inflammation. J Wound Care. 17: (8) 333-341.
Phillips, P.L., Wolcott, R.D., Fletcher, J., Schultz, G.S. (2010). Biofilms made easy. Wounds Int.;1(3).
James, GA, Swogger, E, Wolcott, R, Pulcini, E, Secor, P, Sestrich, J, Costerton, JW, Stewart, PS (2008). Biofilms in chronic wounds. Wound Repair Regen. 16(1):37–44.
Kirketerp-Moller, K, Jensen, PO, Fazli, M, Madsen, KG, Pedersen, J, Moser, C, Tolker-Nielsen, T, Hoiby, N, Givskov, M, Bjarnsholt, T (2008). Distribution, organization, and ecology of bacteria in chronic wounds. J Clin Microbiol. 46(8):2717–2722.
Bjarnsholt T, Kirketerp-Moller K, Jensen PO, Madsen KG, Phipps R, Krogfelt K, Hoiby N, GivskovM (2008). Why chronic wounds will not heal: a novel hypothesis. Wound Repair Regen. 16(1):2–10.
Neopane, P., Nepal, H. P., Shrestha, R., Uehara, O., Abiko, Y. (2018). In vitro biofilm formation by Staphylococcus aureus isolated from wounds of hospital-admitted patients and their association with antimicrobial resistance. International Journal of General Medicine 2018:11 25–32
Papasian, CJ, Kragel, PJ (1997). The microbiology laboratory’s role in life-threatening infections. Crit. Care Nurs. Q. 20:44–59.
Washington, JA (1999). The role of the microbiology laboratory in antimicrobial susceptibility testing. Infect. Med. 16:531–532.
Clinical and Laboratory Standards Institute (2018). Performance Standards for Antimicrobial Susceptibility Testing. 28th ed. CLSI supplement M100 (ISBN 1-56238-838-X [Print]; ISBN 1-56238-839-8 [Electronic]). Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087 USA, 2018