背景:子弹相关的细菌伤口感染可由高速子弹和弹片损伤引起。在埃塞俄比亚,据报道,可能导致严重伤口感染的重大伤害,持续的全身感染,可能导致截肢和死亡。幅度,抗菌药物敏感性概况,与子弹相关损伤患者的细菌伤口感染相关的因素尚未研究,特别是在BahirDar的医疗机构,埃塞俄比亚西北部。因此,这项研究旨在确定患病率,细菌概况,抗菌药物敏感性概况,以及在BahirDar的转诊医疗机构中与子弹相关的伤害患者中与细菌感染相关的因素,埃塞俄比亚西北部。
方法:2022年5月25日至7月27日,在BahirDar的三个转诊医疗机构进行了一项基于医院的横断面研究。共有384名子弹相关损伤患者被纳入研究。使用结构化问卷收集社会人口统计学和临床数据。无菌收集伤口拭子,并按照细菌学标准在血液和MacConkey琼脂上培养。根据2021年临床实验室标准研究所(CLSI)指南,使用Kirby-Bauer圆盘扩散技术在MullerHinton琼脂上进行生化测试以区分阳性培养的细菌,并对分离物进行抗菌敏感性。使用Epi-Info版本7.3输入数据,并使用SPSS版本25进行分析。描述性数据使用频率,百分比,数字,和图表。进行Logistic回归以确定与细菌伤口感染相关的因素。P值<0.05被认为具有统计学意义。
结果:巴希尔达尔市3家转诊医院的子弹相关细菌伤口感染率为54.7%。最常见的分离的革兰氏阴性菌是克雷伯菌属49(23.3%),而在革兰氏阳性菌中,金黄色葡萄球菌58(27.6%)和凝固酶阴性葡萄球菌(CONS)18(8.6%)。污染,住院和吸烟习惯与子弹相关性细菌性伤口感染的存在显著相关.鉴定出超过97%的多药耐药(MDR)细菌分离株,大肠杆菌,变形杆菌物种,柠檬酸杆菌,金黄色葡萄球菌高度耐药。
结论:这项研究发现子弹相关的细菌性伤口感染的患病率增加。金黄色葡萄球菌其次是克雷伯菌属是最常见的分离细菌。对氨苄青霉素的高抗性频率,苯唑西林,头孢吡肟,头孢曲松,头孢他啶,万古霉素,观察到诺氟沙星。因此,正确处理子弹伤,迅速调查细菌感染,药物敏感性模式和抗生素使用的监测至关重要.
BACKGROUND: Bullet-related bacterial wound infection can be caused by high-velocity bullets and shrapnel injuries. In Ethiopia, significant injuries were reported that may cause severe wound infections, persistent systemic infections and may lead to amputation and mortality. The magnitude, antimicrobial susceptibility profiles, and factors associated with bacterial wound infections among patients with bullet-related injuries are not yet studied particularly at health facilities in Bahir Dar, Northwest Ethiopia. Therefore, this study was aimed to determine the prevalence, bacterial profiles, antimicrobial susceptibility profiles, and factors associated with bacterial infections among patients with bullet-related injuries at referral health facilities in Bahir Dar, Northwest Ethiopia.
METHODS: A Hospital-based cross-sectional study was conducted among patients with bullet-related injuries at three referral health facilities in Bahir Dar from May 25 to July 27, 2022. A total of 384 patients with bullet-related injuries were included in the study. Sociodemographic and clinical data were collected using a structured questionnaire. Wound swabs were collected aseptically and cultured on Blood and MacConkey agar following bacteriological standards. Biochemical tests were performed to differentiate bacteria for positive cultivation and antimicrobial susceptibility profiles of the isolates were done on Muller Hinton agar using the Kirby-Bauer disk diffusion technique according to the 2021 Clinical Laboratory Standard Institute (CLSI) guideline. The data were entered using Epi-Info version 7.3 and analyzed using SPSS version 25. Descriptive data were presented using frequency, percentages, figures, and charts. Logistic regression was carried out to identify factors associated with bacterial wound infections. P-value < 0.05 was considered statistically significant.
RESULTS: The prevalence of bullet-related bacterial wound infection among three referral hospitals in Bahir Dar city was 54.7%. The most commonly isolated Gram-negative organism was Klebsiella spps 49 (23.3%) while among Gram-positive organism, Staphylococcus aureus 58 (27.6%) and coagulase-negative staphylococci (CONS) 18 (8.6%). Contamination, hospitalization and smoking habit were significantly associated with the presence of bullet-related bacterial wound infections. Over 97% multidrug resistant (MDR) bacterial isolates were identified and of theses, E. coli, Proteus species, Citrobactor, and Staphylococcus aureus were highly drug resistant.
CONCLUSIONS: Increased prevalence of bullet-related bacterial wound infection was noticed in this study. S. aureus followed by Klebsiella species were most commonly isolated bacteria. High frequency of resistance to Ampicillin, Oxacillin, Cefepime, Ceftriaxone, Ceftazidime, Vancomycin, and Norfloxacin was observed. Therefore, proper handling of bullet injuries, prompt investigation of bacterial infections, monitoring of drug sensitivity patterns and antibiotic usage are critical.