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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 244-248

Aerobic bacterial study of postoperative lower segment cesarean site wound infection


Department of Microbiology, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India

Date of Submission17-May-2021
Date of Acceptance09-May-2022
Date of Web Publication17-Sep-2022

Correspondence Address:
Dr. M B Nagmoti
Department of Microbiology, KLE Academy of Higher Education and Research, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_106_21

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  Abstract 


INTRODUCTION: Cesarean section wound infection illustrates a significant load to the health system as it carries an increased risk of infection as compared to normal vaginal delivery. Hence, it is necessary to identify the agents responsible as well as their extent of susceptibility for commonly used antibiotics.
MATERIALS AND METHODS: The study was carried out at the Department of Microbiology, Jawaharlal Nehru Medical College. The specimens were inoculated on the blood and MacConkey agar. The colonies were identified by their morphological characteristics and the biochemical tests, antibiotic susceptibility test was carried for the isolated aerobic bacterial isolates.
RESULTS: In the present study, Staphylococcus aureus (13, 56.68%) was the most common pathogen isolated, followed by Klebsiella pneumoniae (5, 21.9%). Gram-positive isolates showed greater sensitivity to tetracycline 11 (73.33%), followed by doxycycline (11, 73.33%) and clindamycin (9, 60%). Gram-negative bacteria showed the highest sensitivity meropenem (7, 77.78%), imipenem (6, 66.66%), and piperacillin + tazobactam (6, 66.66%).
CONCLUSION: Frequent antimicrobial audit and qualitative research could give an insight into the current antibiotic prescription practices and the factors governing the same.

Keywords: Lower segment Caesarean section, methicillin-resistant Staphylococcus aureus, surgical site infections


How to cite this article:
Pooja K, Nagmoti M B. Aerobic bacterial study of postoperative lower segment cesarean site wound infection. Indian J Health Sci Biomed Res 2022;15:244-8

How to cite this URL:
Pooja K, Nagmoti M B. Aerobic bacterial study of postoperative lower segment cesarean site wound infection. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 Sep 25];15:244-8. Available from: https://www.ijournalhs.org/text.asp?2022/15/3/244/356260




  Introduction Top


Lower segment Caesarean Section (LSCS) carry a 5–20-fold increased risk of infection as compared to normal vaginal delivery.[1] Cesarean section wound infection illustrates a significant load to the health system because it is related to increased morbidity, mortality, prolonged hospital state, secondary infertility, and increased economic cost for patient care.[2] It depends on several factors like microbial pathogenicity, host defenses, local environmental factors and surgical techniques etc.[3] SSI and endometritis is major cause of prolonged hospital stay and poses a burden to the health care system.[4] Antibiotics are used for treatment and prevention of infection[5] but irrational use of broad spectrum antibiotics resulting anti microbial resistance (AMR) has further deteriorated condition in this regard and the problem gets more complicated.[6] The previous knowledge of the infection and the causative organism will help to decide the antibiotic selection along with their resistance.[7] So, it is necessary to identify the agents responsible for cesarean sites infections as well as to determine their extent of susceptibility for commonly used antibiotics to make relevant health recommendations aimed at preventing, controlling, or managing cesarean section wound infections.[8],[9] The objective of our study is to determine the diversity of the microorganisms and the antibacterial susceptibility pattern among the patients suffering from LSCS wound infection in Obstetrics Department at Dr. Prabhakar Kore Charitable Hospital, Belagavi, Karnataka, India.


  Materials and Methods Top


Study center

The present study was conducted at the Department of Microbiology, Jawaharlal Nehru Medical College (JNMC), Belagavi.

Source of data

LSCS wound swabs were received from the patients suspected of bacterial infection in the Obstetrics Department at Dr. Prabhakar Kore Charitable Hospital, Belagavi.

Study design

The study design involves hospital-based study.

Study period

The study period was 1 year from January 2020 to March 2021.

Sample size

Universal sample was used.

Inclusion criteria

Inclusion criteria included clinically diagnosed or suspected cases of LSCS wound infection.

Exclusion criteria

Exclusion criteria included patients previously treated with systemic antibiotics.

Statistical analysis

Percentage was used to calculate the prevalence of organisms and their antibiotic sensitivity pattern.

Ethical clearance

The present research project was approved by the JNMC Institutional Ethics Committee on Human Subjects Research (Ref: MDC/DOME/338 Date 18/05/2020).

Collection of sample

Under aseptic condition, pus from the wound was collected with the help of a sterile swab from a suspected case of LSCS bacterial infection.

Samples were sent to the Department of Microbiology, JNMC, KLE'S (Karnataka Lingayat education) Academy of higher Education and Research, Belagavi.

Storage

Specimens should be refrigerated at 28°C if processing of the sample is delayed.

Examination of lower segment caesarean section wound swabs

Samples were further subjected to microscopic examination, i.e., Gram staining, for aerobic culture, they were inoculated onto blood agar and MacConkey agar. According to the CLSI guidelines, an antimicrobial susceptibility test was conducted for the bacterial isolates by Kirby–Bauer disk-diffusion method.


  Results Top


LSCS wound swabs were received in the Microbiology Department of JNMC, from Dr. Prabhakar Kore Charitable Hospital, Belagavi, of patients clinically diagnosed with cases of chronic suppurative otitis media. The samples were further processed for isolation, identification, and antibiotic sensitivity.

During this period, a total of 48 samples were processed and of which 30 (62.5%) culture-positive cases were yielded [Table 1].
Table 1: Bacterial culture-positive cases in the study

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Of 30 culture-positive cases, 14 (46.66%) of them showed polymicrobial growth, whereas 16 (53.34%) showed monomicrobial growth [Table 2].
Table 2: Distribution of growth in culture-positive cases

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Of 48 samples processed, 23 (47.92%) were bacterial isolates, 18 (37.5%) were culture-negative cases where no organisms were grown, and 07 (14.5%) were skin commensals [Table 3].
Table 3: Type of growth yielded in the study (n=48)

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Among the total of 23 isolates, 14 (60.87%) were Gram-positive cocci and 9 (39.13%) were Gram-negative bacilli [Table 4].
Table 4: Distribution of isolates in the study (n=48)

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Of 23 bacterial isolates of methicillin-resistant Staphylococcus aureus (MRSA), 8 (34.78%) were predominant followed by methicillin-susceptible S. aureus (MSSA) (5, 21.9%), Klebsiella pneumoniae (5, 21.9%), Pseudomonas aeruginosa (2, 8.69%), Escherichia coli (1, 4.35%), Citrobacter freundii (1, 4.35%), and coagulase-negative staphylococci (CoNS) (1, 4.35%) [Table 5].
Table 5: Number of bacterial isolates in the study

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Gram-positive bacteria showed greater sensitivity to tetracycline (11, 73.33%), followed by doxycycline (11, 73.33%) and clindamycin (9, 60%) [Table 6].
Table 6: Sensitivity pattern of Gram-positive bacteria (methicillin-resistant Staphylococcus aureus, methicillin-susceptible Staphylococcus aureus, and coagulase-negative staphylococci)

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Among the Gram-negative bacteria, meropenem 7 (77.78%) showed the highest sensitivity, followed by imipenem 6 (66.66%) and piperacillin + tazobactam 6 (66.66%) [Table 7].
Table 7: Sensitivity pattern of Gram-negative bacteria (Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Citrobacter freundii)

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  Discussion Top


A total number of 48 LSCS wound swabs were processed, which were received in the Department of Microbiology of JNMC from Dr. Prabhakar Kore Charitable Hospital, Belagavi.

The samples were processed for aerobic bacterial culture, of 48 samples, of which 30 (62.5%) culture-positive cases were culture positive. Of 30 culture-positive cases, 14 (46.66%) of them showed polymicrobial growth, whereas 16 (53.34%) showed monomicrobial growth. Of 48 samples processed, 23 (47.92%) were bacterial isolates, 18 (37.5%) were culture-negative cases where no organisms were grown, and 7 (14.5%) were skin commensals. Fourteen (60.87%) isolates were Gram-positive cocci and 9 (39.13%) isolates were Gram-negative bacilli. MRSA (8, 34.78%) was predominant, followed by MSSA (5, 21.9%), Klebsiella pneumoniae (5, 21.9%), P. aeruginosa (2, 8.69%), E. coli (1, 4.35%), C. freundii (1, (4.35%), and CoNS (1, 4.35%). Gram-positive bacteria revealed higher susceptibility to tetracycline (11, 73.33%), followed by doxycycline (11, 73.33%) and clindamycin (9, 60%). Most of them were resistant to ceftriaxone (90%), penicillin (70%), and cefazolin (70%). Among the Gram-negative bacteria, meropenem (7, 77.78%) showed the highest sensitivity, followed by imipenem (6 66.66%) and piperacillin + tazobactam (6, 66.66%). All of the Gram-negative bacteria were resistant to ampicillin (100%), amoxyclav (100%), and doxycycline (100%) and most of them were ceftriaxone (90%), tetracycline (90%), gentamicin (90%), cefepime (90%), tobramycin (80%), levofloxacin (70%), amikacin (70%), and ciprofloxacin (60%).

As per the study conducted by Divvy. P, monomicrobial bacterial growth type was seen in 74 (71.2%) and polymicrobial growth type was seen in 30 (28.8%). S. aureus was the most predominant organism isolated in this study (31.3%). Cefoxitin disk susceptibility revealed 12 (28.6%) MRSA of 42 S. aureus isolates. All staphylococcus isolates are sensitive to linezolid and vancomycin (100%), some of them are sensitive to amikacin and amoxyclav (61.9%).[10] As per the study conducted by Bajaj et al., Of 34 (28.57%) isolates of S. aureus, 26 isolates are MRSA followed by P. aeruginosa (26%), CoNS (10.92%), K. pneumoniae (8.4%), E. coli (7.56%), Enterococcus spp. (5.05%), C. freundii (5.05%), Klebsiella oxytoca (4.2%), Acinetobacter spp. (2.52%), and C. koseri (1.68%). All the Gram-positive bacteria isolated were almost resistant to ampicillin (80%) and ciprofloxacin (55.88%).[11] S. aureus (42%) is the most isolated organism in the study of Olukitibi and Adebolu due to their abundance on human skin as normal flora, and most of them are resistant to commonly used antibiotics such as penicillin, levofloxacin, chloramphenicol, gentamicin, and ciprofloxacin.[12] As per the study conducted by Dhar et al., a majorly isolated organism was S. aureus (66 31.27%), followed by E. coli (40, 18.95%). Among S. aureus, few were MRSA. Polymicrobial infection was seen in 42 (19.90%) cases. There were 47 (22.27%) cases where culture did not yield any organism may be due to the use of broad-spectrum antibiotics. Here, aminoglycoside drug class constituted the most sensitive antibiotic and also penicillin group of drugs.[13] In the study of Chares Obinna et al., the predominant organism isolated was S. aureus (37.3%), followed by K. pneumoniae (27.1%), E. coli (22.0%), P. aeruginosa (5.1%), K. oxytoca (5.1%), and Bacteroides (3.4%) and most of the isolates were sensitive to amikacin and imipenem and are resistant to cephalosporin, gentamicin, amoxyclav, and meropenem.[14] These all study results are almost similar to my study in a crisis of mostly isolated pathogen as S. aureus among them MRSA; eventually, some are polymicrobial, culture-negative specimens found in some cases, and commensals as normal flora on the skin, etc. As per the study conducted by Egbe Friday Andrew, E. coli was the most predominant organism isolated (13, 28.26%), followed by S. aureus (10, 21.74%), Staphylococcus epidermidis (8, 17.39%), Enterobacter (6, 13.04%), P. aeruginosa (4, 8.80%), Klebsiella species (3, 6.52%), and Proteus spp. (2, 4.35%). This study is a bit different from my study and related to other studies as E. coli is the predominant organism isolated here. Here, most of the Gram-positive bacteria were sensitive to ciprofloxacin, cefuroxime (83.3%), and erythromycin (66.7%) and resistant to tetracycline (83.3%). Most of the Gram-negative bacteria were resistant to tetracycline (92.3%), co-trimoxazole (84.6%), Augmentin (76.9%), and amoxyclav (53.4%).[15]

The results of the above studies support our study with a slight difference in the sensitivity pattern; however, it also depends on the geographical area.


  Conclusion Top


The present study revealed that MRSA (8, 34.78%) was predominant, followed by MSSA (5, 21.9%), K. pneumoniae (5, 21.9%), P. aeruginosa (2, 8.69%), E. coli (1, 4.35%), C. freundii (1, 4.35%), and CoNS (1, 4.35%). Irrational use of antibiotics induces the development of the bacteria, which shows resistance to the multiple drugs, which can also produce postoperative as well as primary infections.

Gram-positive bacteria revealed higher susceptibility to tetracycline 11 (73.33%) followed by doxycycline (11, 73.33%) and clindamycin (9, 60%). Most of them were resistant to ceftriaxone (90%), penicillin (70%), and cefazolin (70%). Among the Gram-negative bacteria, meropenem (7, 77.78%) showed the highest sensitivity, followed by imipenem (6, 66.66%) and piperacillin + tazobactam (6, 66.66%). All of the Gram-negative bacteria were resistant to ampicillin (100%), amoxyclav (100%), and doxycycline (100%) and most of them were ceftriaxone (90%), tetracycline (90%), gentamicin (90%), cefepime (90%), tobramycin (80%), levofloxacin (70%), amikacin (70%), and ciprofloxacin (60%).

Understanding the epidemiology of modern-day microbiological flora and their antibiotic sensitivity pattern of LSCS wound infections helps in the development of effective strategies for initial prevention and also decreases the complications, fatality, and morbidity rate. Results of this study help the local area in prescribing the empirical treatment by minimizing the expenditure of health care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gur R, Duggal SD, Rongpharpi SR, Srivastava R, Kumar A, Gupta V, et al. Post caesarean surgical site infections. Arch Clin Microbiol 2015;6:4.  Back to cited text no. 1
    
2.
Preethishree P, Rai R, Kumar KV. Aerobic bacterial profile of post-operative wound infections and their antibiotic susceptibility pattern. Int J Curr Microbiol App Sci 2017;6:396-411.  Back to cited text no. 2
    
3.
Kurhade A, Akulwar S, Mishra M, Kurhade G, Justiz-Vaillant A, Kurhade K, et al. Bacteriological study of post-operative wound infections in a tertiary care hospital. J Bacteriol Parasitol 2015;6:1.  Back to cited text no. 3
    
4.
Kawakita T, Landy HJ. Surgical site infections after cesarean delivery: Epidemiology, prevention and treatment. Matern Health Neonatol Perinatol 2017;3:12.  Back to cited text no. 4
    
5.
Mundhada AS, Tenpe S. A study of organisms causing surgical site infections and their antimicrobial susceptibility in a tertiary care government hospital. Indian J Pathol Microbiol 2015;58:195-200.  Back to cited text no. 5
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Vikrant N, Shekhar P, Deepak J, Munesh KS, Neelam S. Bacteriological profile of surgical site infections and their antibiogram: A study from resource constrained rural setting of Uttarakhand State, India. J Clin Diagn Res 2015;9:DC17-20.  Back to cited text no. 6
    
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Subrata R. Bacteiologica profile of postoperative wound infection. Asian J Biomed Pharm Sci 2016;6:44-6.  Back to cited text no. 7
    
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Rahman J, Sultana N, Hasan M, Begum HA. Factors of post-operative wound infection in abdominal surgeries of obstetrics and gynaecology department. J Dhaka Natl Med Coll Hosp 2012;18:39-42.  Back to cited text no. 8
    
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Verma AK, Kapoor AK, Bhargava A. Antimicrobial susceptibility pattern of bacterial isolates from surgical wound infections in tertiary care hospital in Allahabad, India. Internet J Med Update ejournal 2012;7.  Back to cited text no. 9
    
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Divya P. Prevalence and susceptibility pattern of Staphylococcus aureus in post-operative surgical wound infections at tertiary care hospital. Int J Health Sci Res 2015;5:129.  Back to cited text no. 10
    
11.
Bajaj A, Kukanur S, Kotigadde S, Meundi M. Gram positive cocci causing surgical site infection: Identification and antibiotic susceptibility pattern. IOSR J Dent Med Sci 2015;1:62-7.  Back to cited text no. 11
    
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Olukitibi TA, Adebolu TT. Antibiogram of bacteria isolated from post-operative wounds of mothers WHO underwent caesarean section at the mother and child hospital, Akure, Ondo State. Asian J Res Med Pharm Sci 2017:1-9.  Back to cited text no. 12
    
13.
Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, Oman. Sultan Qaboos Univ Med J 2014;14:e211-7.  Back to cited text no. 13
    
14.
Njoku CO, Njoku AN. Microbiological pattern of surgical site infection following caesarean section at the university of Calabar teaching hospital. Open Access Maced J Med Sci 2019;7:1430-5.  Back to cited text no. 14
    
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Andrew EF, Friday UN, Andrew EK, Isaiah LN, Silas EE, Unah UV. Prevalence and antimicrobial susceptibility profile of bacterial isolates from infected caesarean sites in three federal capital territory hospitals, Abuja Nigeria. Am J Biomed Life Sci 2018;6:90-5.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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