ISOLATION AND IDENTIFICATION OF BACTERIA ASSOCIATED WITH WOUND SEPSIS

CHAPTER ONE

1.0     INTRODUCTION

          Wound is any interruption, by violence or by surgery, in the continuity of the external surfaces of the body or of the surface of any internal or pan (madonald, 1990). According to him, legally, the whole thickness of the skin must be broken, and creating an internal injury wound.  Is also a breach of a coetaneous, mucous or serious surface (Charles 1979). Wound can also be defied as injury to the skin or underlying tissues or organs by a blow or cut, missile or stab which includes injury to the skin caused by chemicals,  cold, friction, heat, pressure and rays, and manifestation in the skin of internal conditions such as pressure sure and ulcers (Roper 1989).

          Wound sepsis is the infection of wound by phylogenic organisms (Roper, 1989).  Wounds can be divided into Many types which includes (a) Incised wounds:  which are produced by sharp scuttling instruments (There is aponeuetic fascia of the scalp and most operations wounds are of a this category, Lacerased wounds which may be produced in category, Lacerased wounds which may be produced in road accidents, by factory machinery.  This type of wound is frequently contaminated and it supplies an excellent culture medium for microorganisms.  There is more pain than in an incised wound but bleeding may not be severe due to constriction of blood vessels.  Punctured wound which may be inflicted by sharp instrument, nails, edge’s teeth, knives and bullets.  These wounds are specially susceptible to injection from anaerobic organisms as those causing tetanus and gas gangrene which start thriving when the aerotic organisms such as staphylococcus and streptococcus have used up the available oxygen in the deep tissues.

          Poisoned wounds are those which occurs as a result of insect strings, snake bites and dog bites and the inject bites produce swelling.  Irritation and dis-comfort caused and devitalized wounds are those that result for  industrial and severe road accidents and the area and depth of devitalized tissue depends upon the area and weight of the coushing force and the duration and velocity of impact.

Burns and scalids which results from the destruction of tissue by dry heat fraction, electricity radiation or corrosive fluid while scald results from the destruction of tissue by mist heat.  Bruise and confusion is a superficient injury without damage to the skin and the swelling, pain and dis comfort are dye to the extra-vacation of blood into tissues.  Colour changes occur as a result of the moglobin oxidatron.

Haematoma is the collection of blood in the tissues which causes a swelling which when pressed on surrounding structures, the haemotoma become readily injected by micro-organism

Sprain is another wound type which involves the tearing of the capsule and ligaments round a joint with subsequent exudation of fluids.

Wounds  cab further be classified into clean wounds with the amount of contamination being up 30% or more in dirty wounds.  The class I (clean) wounds which are non traumatic with no break in surgical technique without any septic folus or viscera being opened.  Classs II (clean contaminated) wounds are non traumatic, with only minor breaker own in technique being allowed orentry into a vucous without significant spillage.  The class III (contaminated) are traumatic wounds froma relatively clean source, or with a major break in technique or significant spillage from an open viscous, or when acute non- purulent infection is encountered.  Class IV (dirty) wounds are frammatic wounds from a dirty source following delayed treatment or when acute bacterial contamination and releases of pus occur.

Micro organism of clinical importance can be isolated from wounds and they include Achinomyces species.  Bacteriodes species, clostridium perfringes, Eschericha coli, other gram negative enteric bacilli, my cobacterium species, pseudomonas aerug, nwa proteus vulgaaris, staphlococcus aureus. Stapholococcus epidermis stretococcus faecalis, clostridium fetani (Fischachi, 1987)

Wound sepis depends on the opportunities for infection in different parts of the body which in turn depends on the normal bacteria flora of the part, the size of the wound, duration of the operation increase in the length of stay in the hospital and can even result in patients death

1.1     COMPLICATION

           Complication arising from wound sepsis are suppurations which results when there is an  imbalance between the infective agent on one hand and the defensive reaction on the other.  The other complications are cellulite which is characterized by a spreading infection, necrosis and sloughing; septicemia, pyaemia and kaolin formation chilling worth et al 1979).  Others that can also result from wound sepsis are gas gangrene, clostridia mystics, clostridical crepitate celluslitis which is a type of mixed infection usually found as a complication of wounds characterized by necrosis of the aveolar and fascia tissues with progressive gangrenous changes in the skin secondary in thrombosis or nutrient vessels repetition of the wound result from the formation of gas by the bacteria synergistic gangrene which is a mixed infection caused by the synergistic action of the acrobic hemolytic staphylococcus aurous and micro Europhilic haemolytic streptococcus also occur as a senous complication peritonitis, perforation and absences formation are other complications.  Wound sepsis can be complicated by mixed infection in which yeast and often fungal infection are involved (sabistan 1981) .  other complications are diabetic micro antipathy which involves the small vessels and capillaries an further complicate diabetes Nellutus.

          Distinct and definitive thickening of the usement member inflammatory changes occur lading to the impairment of the resistant of the skin to secondary infections and delay the rate of healing following injures.  Arkrosclerosis is another major complication of diabetes mellitus.  Corponary Vessels are affected producing myscardid infection are the  vessels of the lower extremities producing gangrene of the toes and feets.  The precipitating causes of gangrene of the lower extremities resulting in ulceration, infliction and subbasement gangrene..

          In the case of sickle cell disease leg ulcers, there is general reduction in the oxygen carrying capacity of blood resulting.  In tissue dypoxia  and parenthesis of the extremities occurs but although certain compensatory adjustment of the circulation occur the patients can become immemorially compromised in cases of secondary infections due to blocking of small vessels by sickled cells and infare of bones and joints which enhances the continued preponderance of any infecting organism (Anderson 1985).

          This work is therefore an attempt to investigate bacteria associated with infection of wounds noting their differences .  in distribution peltern, age range 10-2) years, (3-5) years, (6-8) years (9-11) year (12-14) years, (15-17) years, (18-20) years and 21 years and above, sex distribution (male and female) predisposing factor and any other factor affecting in Nigeria where antibiotic sensitivity pattern especially in Nigeria where drugs are takes indiscriminately without prescription

1. 1. AIM & OBJECTIVES

1. The aim of this work is to isolate and identified bacteria associated with wound sepsis

1. And the objectives are to assess whether any correlation exists between age, sex and different types of wound.

2.c     To assess the antibiogram of different bacteria associated with wound sepsis so as to offer advice on therapy.

1.3     STATEMENT OF PROBLEMS

          Wound sepsis has really posed a serious threat to both surgical and un-surgical wounds.  There has been prevalence in wound sepsis following iyunes and fome disease state, and may have failed to heal after administration of common antibiotics resulting to foul smelling and petrifying wounds owing to their discriminate use of drugs especially in togena.

          This  problems really propelled met know whether it is because efln discriminate use of dmgs that contributed to sensitive organisms to become resisted string to the drugs or could it be because of mosconical injection which comes bystaying very long in the hospital. And why staphylococcus has been the prechominant organisms threatening wounds.

1.4     THE SIGNIFICANCE OF STUDY: standard clean sanitary condition is employed to avoid mosconial infection

1.5     HYPOTHESIS

HO    Staphocollus aureus is predominantly associated with wound sepsis

H1     Staplococcus aureus is not  predominantly associated with wound sepsis

          HII:   There is correlation between age, sex and different types of wound sepsis.

1.5     SCOPE OF STUDY

       The scope of the study is to isolate and identify bacteria associated with

wound seosis, noting their distribution pattern, age and sex relationship,

predisposing factor and any other factor affecting it and also their antibiotic

sensitivity especially in Nigeria where drugs are taken indiscriminately

without prescription.

1.7     LIMITATIONS

This project work has been limited on only surgical, sickle cell, ulcer,

Diabetic  ulcer  and  gun  short  wound  sepsis.  Collection  of  samples  and

materials used is limited to National orthopedic hospital Enugu  Metropolis. 

This project is also limited  to  open  wounds  and  to  patients t hat  lactnot

stayed for a long time, in the  clinic  to  eliminate  nosconial  infection  and

sense had not used a lot of antibiotic which would have killed the

opportunistic bacteria.

          The significance of study.