Pattern of pathogens from surgical wound infections in a Nigerian hospital and their antimicrobial susceptibility profiles

Background: In surgical patients, infection is an important cause of morbidity and mortality. A prospective study to find the pattern of microorganisms responsible for post operative wound infections and their antibiotic susceptibility profile was therefore conducted.Setting and Methods: Surgical wards in Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Isolation, identification and antimicrobial susceptibility screening of organisms were done employing standard microbiological techniques.Results: Bacterial pathogens were isolated from all the specimens while the yeast Candida species (spp) was isolated from 12.4%. Staphylococcus aureus was the most frequent organism isolated accounting for 23 (18.3%) of a total of 126 isolates. Other organisms were Pseudomonas aeruginosa and Bacillus spp 11.1% each; Escherichia coli 10.3%; Candida spp 8.7%; Coagulase negative staphylococci 8.7%; Pseudomonas spp 6.3%; Serratia odorifera 4.7%; Bacteroides 4.0%; Enterococcus spp 3.2%; the remaining isolates were other enterobacteria. Sensitivity of the bacterial isolates to antibiotics varied. In general, resistance to the β-lactam antibiotics was above 98%, whilst more than 70% of isolates were resistant to erythromycin, fusidic acid and tobramycin.Conclusions:The infections were polymicrobic and multidrug resistant. The quinolones, ciprofloxacin and ofloxacin, should be used as frontline drugs in the management of surgical wound infections at the hospital.Keywords: surgical wound infections, susceptibility, bacterial pathogens, antibiotic

Generalized peritonitis secondary to typhoid ileal perforation: Assessment of severity using modified APACHE II score

BACKGROUND: Generalized peritonitis from typhoid ileal perforation is a common cause of surgical emergency in the developing countries, associated with high morbidity and mortality. The severity assessment of a disease condition is often useful to prioritise treatment and reduce morbidity and mortality. High severity scores are usually associated with high morbidity and mortality; therefore, these patients may require more intensive treatment than those with low severity scores. AIM: The purpose of this study was to assess the severity of generalized peritonitis from typhoid ileal perforation using modified APACHE II score. SETTING AND STUDY DESIGN: A teaching hospital unit serving the rural and semi-urban Nigerian community. It is a prospective study of patients with generalized peritonitis from typhoid ileal perforation. MATERIALS AND METHODS: Over a period of 7 years, patients had severity of illness assessed using modified APACHE II score. Demographic, clinical, preoperative, operative and postoperative data on each patient were entered into a prepared proforma. Each patient had postoperative outcome and severity of illness were compared to determine the significance of the severity of illness on postoperative outcome. RESULTS: The mean age was of 23.6 \ub1 15.5 years, with 4:1 male: female ratio. Morbidity rate ranged from 8.8-71.3% and mortality in 17.5%. Modified APACHE II score ranged from 0-19, with a mean of 8.2 \ub1 4, 7.6 \ub1 4 for survivors and 9.4 \ub1 2 in those who died. There was no death among the patients who scored 0-4, whereas mortality was 13% in those who scored 5-9, 41.2% in those who scored 10-14, and 50% in patients who scored 15-19 (P<0.05). The modified APACHE II Score significantly influenced mortality, but did not influence the incidence of other postoperative complications. CONCLUSION: A high APACHE II score was associated with high mortality, but did not predict morbidity rate in the patients studied. More study is needed involving a larger number of patients to further validate our findings

Why honey is effective as a medicine. 1. Its use in modern medicine

Honey has been used as a medicine for thousands of years and its curative properties are well documented. However, modern medicine turned its back on honey and it is only now, with the advent of multi-resistant bacteria, that the antibiotic properties of honey are being rediscovered

Modified Alvarado Scoring System as a diagnostic tool for Acute Appendicitis at Bugando Medical Centre, Mwanza, Tanzania

<p>Abstract</p> <p>Background</p> <p>Decision-making in patients with acute appendicitis poses a diagnostic challenge worldwide, despite much advancement in abdominal surgery. The Modified Alvarado Scoring System (MASS) has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. However, differences in diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting.</p> <p>Methods</p> <p>A cross-sectional study involving all patients suspected to have acute appendicitis at Bugando Medical Centre over a six-month period between November 2008 and April 2009 was conducted. All patients who met the inclusion criteria were consecutively enrolled in the study. They were evaluated on admission using the MASS to determine whether they had acute appendicitis or not. All patients underwent appendicectomy according to the hospital protocol. The decision to operate was the prerogative of the surgeon or surgical resident based on overall clinical judgment and not the MASS. The diagnosis was confirmed by histopathological examination. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software.</p> <p>Results</p> <p>A total number of 127 patients were studied. Their ages ranged from eight to 76 years (mean 29.64 ± 12.97). There were 37 (29.1%) males and 90 (70.9%) females (M: F = 1:2.4). All patients in this study underwent appendicectomy. The perforation rate was 9.4%. Histopathological examination confirmed appendicitis in 85 patients (66.9%) and the remaining 42 patients had normal appendix giving a negative appendicectomy rate of 33.1% (26.8% for males and 38.3% for females). The sensitivity and specificity of MASS in this study were 94.1% (males 95.8% and females 88.3%) and 90.4% (males 92.9% and females 89.7%) respectively. The Positive Predictive Value and Negative Predictive Value were 95.2% (males 95.5% and females 90.6%) and 88.4% (males 89.3% and females 80.1%) respectively. The accuracy of MASS was 92.9% (males 91.5% and females 87.6%).</p> <p>Conclusion</p> <p>The study shows that use of MASS in patients suspected to have acute appendicitis provides a high degree of diagnostic accuracy and can be employed at Bugando Medical Centre to improve the diagnostic accuracy of acute appendicitis and subsequently reduces negative appendicectomy and complication rates. However, additional investigations may be required to confirm the diagnosis in case of atypical presentation.</p

The management of intra-abdominal infections from a global perspective : 2017 WSES guidelines for management of intra-abdominal infections

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.Peer reviewe

Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study.

The CIAOW study (Complicated intra-abdominal infections worldwide observational study) is a multicenter observational study underwent in 68 medical institutions worldwide during a six-month study period (October 2012-March 2013). The study included patients older than 18 years undergoing surgery or interventional drainage to address complicated intra-abdominal infections (IAIs).1898 patients with a mean age of 51.6 years (range 18-99) were enrolled in the study. 777 patients (41%) were women and 1,121 (59%) were men. Among these patients, 1,645 (86.7%) were affected by community-acquired IAIs while the remaining 253 (13.3%) suffered from healthcare-associated infections. Intraperitoneal specimens were collected from 1,190 (62.7%) of the enrolled patients.827 patients (43.6%) were affected by generalized peritonitis while 1071 (56.4%) suffered from localized peritonitis or abscesses.The overall mortality rate was 10.5% (199/1898).According to stepwise multivariate analysis (PR = 0.005 and PE = 0.001), several criteria were found to be independent variables predictive of mortality, including patient age (OR = 1.1; 95%CI = 1.0-1.1; p &lt; 0.0001), the presence of small bowel perforation (OR = 2.8; 95%CI = 1.5-5.3; p &lt; 0.0001), a delayed initial intervention (a delay exceeding 24 hours) (OR = 1.8; 95%CI = 1.5-3.7; p &lt; 0.0001), ICU admission (OR = 5.9; 95%CI = 3.6-9.5; p &lt; 0.0001) and patient immunosuppression (OR = 3.8; 95%CI = 2.1-6.7; p &lt; 0.0001). © 2014 Sartelli et al.; licensee BioMed Central Ltd

Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion

Abstract Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The “surgeon champion” can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.https://deepblue.lib.umich.edu/bitstream/2027.42/145433/1/13017_2018_Article_198.pd