EFFECT OF MOST COMMON ANTIBIOTICS AGAINST BACTERIA ISOLATED FROM SURGICAL WOUNDS IN ADEN GOVERNORATE HOSPITALS, YEMEN

Objective: The increased antibiotics resistance of pathogenic bacteria isolated from surgical wound is the major health threats challenge the patients especially in developing countries like Yemen. This work was aimed to determine and identify the bacteria associated with surgical wound infections and their resistance to commonly used antibiotics. Methods: One hundred and twenty swabs were sampled from surgical wound patients at Aden City, Yemen. The pathogenic bacteria were isolated and identified according to standard microbiological methods. Also, antibiotic susceptibility tests were determining by using Kirby-Bauer disc diffusion technique. Results: The results showed that out of 120 samples, 68 (56.67%) showed bacterial growth. It was found that the most isolated bacteria was Sylococcus aureus 27 (39.70%) followed by Escherichia coli 19(27.94%), Pseudomonas aeruginosa 13 (19.12%), and Proteus mirabilis 9 (13.24%). All isolated bacteria were recorded to be extremely resistant to the most tested antibiotics. S. aureus was reported to be susceptible to cefotaxime, vancomycin, and ciprofloxacin and highly resistant to ceftazidime, nalidixic acid, erythromycin, and tetracycline. The E. coli isolates showed resistance (100%) to vancomycin and tetracycline and moderately sensitive to ceftazidime and gentamycin. P. aeruginosa showed from high to moderate resistance to most tested antibiotics except gentamycin and cefotaxime. Most of P. mirabilis isolates were sensitive to ceftazidime, cefotaxime, ciprofloxacin, and gentamycin and highly resistant to amoxicillin, erythromycin, and vancomycin. Conclusion: The current study findings that the reduced sensitivity of isolated bacteria to commonly used antibiotics is an alarming and threat upsurge of infections caused by antibiotic-resistant bacteria.


INTRODUCTION
The wound infections consider to be one of the most common nosocomial infections and are a significant cause of morbidity and account for 70-80% mortality 1,2 . Wound infections were caused by several pathogenic microorganisms that are bacteria, fungi, and parasites as well as virus 3 . Enterococci, Escherichia, Pseudomonas, Klebsiella, Enterobacter, Proteus and Acinetobacter were recorded the most common infecting wounds 4, 5 . Advances in infections control of wound have become more challenging resulting from prevalent of microorganism's resistance to antibiotics, and to a more occurrence of infections caused by methicillin-resistance S. aureus and polymicrobial flora 6 . The problem of antimicrobial resistance is challenging in low-income countries resulting from high occurrence of infections, misuses of antimicrobials, over the counter availability of drugs and lack of diagnostic laboratories for susceptibility testing of antibiotics 7 . Also, the antibacterial resistance can increase problems and expenses associated with digenesis and treatment 8 . However, very limited information is available on the type of isolated bacteria and their antibacterial resistance associated with infected wound in Aden Hospitals, Yemen. So, the present investigation was ISSN: 2456- 8058 22 carried out to isolate and identify the pathogenic bacteria from surgical wound infections and determine their sensitivity to common antibiotics.

MATERIALS AND METHODS Samples Collection
One hundred and twenty (120) samples were collected from wound patients that undergo a surgical operation in three general hospitals, Algomhori, Khalifa, and Alsadaka, in Aden City of Yemen. By using a sterile cotton swab, the wound samples were swabbed gently from the superficial, medium or deep of the infected area and the samples were immediately transported to the laboratory. Each sample was inoculated on McConkey agar, Nutrient agar and Blood agar (Himedia, India) and then incubated for 24 hrs 37°C.

Figure 2: The percentage of bacterial growth in media
The isolated E. coli from wounds indicated 100% resistant to vancomycin and tetracycline. Also, E. coli showed high resistance nalidixic acid (73.7%), erythromycin and amoxicillin (68.4%), nitrofurantoin and cefotaxime (63.2%). It was moderately resistant to gentamycin at 36.8% as listed in Table 2. The P. mirabilis isolates showed sensitive to ceftazidime at 88.9% followed by cefotaxime ciprofloxacin, and gentamycin at 77.8% for each. Most of the P. mirabilis were highly resistant to amoxicillin, erythromycin, and vancomycin at 100% and followed by nitrofurantoin at 88.9% as listed in Table 4. P. aeruginosa showed high resistance to amoxicillin and vancomycin at 100%, followed by tetracycline at 92.3%, erythromycin at 84.6%, nalidixic acid and nitrofurantoin at 76.9%, ciprofloxacin at 69.2%. P. aeruginosa was sensitive to gentamycin (76.9) and cefotaxime (69.2) as shown in Table 3.

DISCUSSION
The infection of wounds by different bacteria resulting from nosocomial infection and treatment of wound infections remains an important concern for surgeons. The type and cell number of bacteria play an significant role in developing of wound infection 11 . In the present study, it was revealed that the 88 samples (73.33%) were collected from males and 32 samples (26.67%) from females. This result is similar to the findings by Anthony et al. 12 who recorded that the up of 40 samples were collected from males and 24 from females. Of 120 samples processed, 68 samples (56.67%) were recorded as positive growth and 52 samples (43.33%) were observed as negative growth. In a study by Farrag et al. 11 revealed that the 41 samples (82%) collected from wound infections were reported as positive growth for bacteria and only 9 samples were showed no growth for bacteria.  The P. mirabilis bacteria was found in hospitals and it has an active role in bringing about infections of wounds and burns 15 . Most of the bacteria that exhibited higher rates of antibacterial resistance are human normal flora and biofilm-forming pathogens such as S. aureus, P. aeruginosa, and E. coli 17 . In this study, the S. aureus showed high resistance against many antibiotics that used to treat the S. aureus infection such as erythromycin and tetracycline. In contrast, S. aureus showed very high sensitivity to cefotaxime, vancomycin, and ciprofloxacin. These findings are in consistent with the study of Adcock et al. 18 and Sani et al. 19 who recorded that pathogenic Staphylococci are resistant to several antibiotics. Resistance of this bacterium to erythromycin group tends to develop so rapidly. Therefore, it should not be used these group of antibiotics singly for the treatment of chronic infection.

CONCLUSION
In conclusion, the increase of isolated bacteria resistance to used antibiotics due to unrestrained, mismanagement, extensive incorrect, and misuse of antimicrobial agents in hospitals and whole of country. Also, this is promoted by the absence of polices for National antibiotics and over-the-counter antibiotic obtain ability in Yemen. Hence, it is essential to establish the national antibiotic policies that regulate the operation for giving the patients antibiotics before performance the antibiotics sensitivity test to know the effective antibiotic.