Bacterial types, antibiotic use, and their antimicrobial sensitivity patterns in chronic wound in selected health facilities, Uasin Gishu County, Kenya.

Abstract

Background: Bacterial infections are one of the causes of slow and non-healing wounds. Adding to the increase in incidences of chronic wounds because of other patient factors and the current challenge of antimicrobial resistance experienced worldwide, the management of infected wounds is a challenge. Notwithstanding; the presence of Infection Prevention Control Programs (IPCs) and the practice of prophylactic therapy, infections are still a challenge in these selected Hospitals in Eldoret Town, especially in clinical practice where empirical treatment of infections is routine because of cost challenges that come with targeted therapy. Objectives: To identify the bacteria isolated from infected chronic wounds, the proportions of the individual strain isolated, the antibiotics used to manage such infected wounds, and their sensitivity patterns against the isolated strains in selected Health facilities, Eldoret town, Uasin Gishu County. Methods: A cross-sectional study on patients with chronic wounds was adopted, examining microbiology laboratory data on culture and sensitivity tests and patient records of chronic-wound swab culture and sensitivity test results. The sample size for this study was determined using Fischer's formula, taking an average prevalence of 90% of pathogenic bacteria from wound swabs taken from the previous similar studies done in Kenya; at Kenyatta National Hospital (KNH). From this formula, files and records of 138 chronic-wound patients; whereby files that are easy to reach were sampled and recorded first in order of the year the tests were conducted. Sequential sampling of the laboratory data on chronic wound culture and sensitivities was the ideal procedure beginning with the most recent data. The data was collected from Moi Teaching and Referral Hospital (MTRH), Eldoret Hospital, Reale Hospital, and St Luke's Hospital in Eldoret Town Uasin, Gishu County. The sampling order of these hospitals depended on; the number of chronic wound patients they admitted, beginning with the one with the highest numbers. The samples obtained were, therefore, proportionate to the patient numbers. The data was collected retrospectively from April 2022 using a data abstraction form. Collected data was validated, entered, and stored in a Microsoft Excel spreadsheet and analyzed using the statistical software STATA version 16. Frequencies and percentage proportions were calculated to determine the distribution of the demographic variables. To test the independence and the significance of differences between sex, age in years, cause of the wound, and comorbidities against the number of bacteria isolated, we used canonical correlation analysis to explore this relationship. P-values less than 0.05 were considered significant. Results: Moi Teaching and Referral Hospital provided the most data (75.4%). Most of the wounds were caused by Trauma/Accident, with 65.2% having comorbidities. A total of 19 bacterial strains were isolated. The majority of the bacteria identified were Gram-negative strains. However, Gram-Positive Staphylococcus aureus was present in all the mixed isolates. 90.6% indicated the use of antibiotics, both prophylaxis and treatment. Ceftriaxone was the most prescribed antibiotic (16.4%). Less than half of the antibiotics showed susceptibilities above 50% against the bacterial strains tested. High sensitivities were registered by less frequently used antibiotics. Based on Wilks` Lambda test statistics, the cause of the wound, age, and sex did not affect the proportions of bacterial strains isolated. Conclusion: Polymicrobial bacterial infections were noted in both gram stains. Multiple Drug Resistance (MDR) registered by the most prescribed antibiotics. Staphylococcus aureus isolates were definitive of Methicillin-resistant Staphylococcus aureus (MRSA) strains as they were resistant to all the Penicillins. Recommendations: Penicillins are not recommended in managing chronic wound infections. More studies to validate viability of off-patent (generic) antibiotics. Antibiotic combination therapy is recommended based on the established localized antibiogram.