University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya.
School of Public Health, Makerere University, Kampala, Uganda.
Antimicrob Resist Infect Control. 2022 Nov 13;11(1):142. doi: 10.1186/s13756-022-01181-0.
Post-exposure treatment for dog bites in humans aims at alleviating the risk of rabies and promoting wound healing. Wound healing may be complicated by bacteria. This study identified the different bacteria and their antibiotic susceptibilities in infected dog bite wounds (DBWs) in Uganda.
A cross-sectional study was conducted among 376 dog bite patients. Wound swabs from patients with infected DBWs were collected and inoculated into recommended media. They were cultured for both aerobic and anaerobic bacteria. All isolated bacteria were identified based on colony characteristics, gram stain, and standard biochemical tests. Molecular identification was performed for strains that were resistant to three or more antibiotics. Antibiotic susceptibility testing was conducted using the disc diffusion method following the modified Kirby-Bauer method. The data were analysed using Stata version 15 software.
Approximately half of the patients (52.9%, 199/376) presented with infected wounds. Majority of the swabs (84.4%, 168/199) were culture positive, and yielded a total of 768 isolates where about half (52.9%, 406/768) were gram positive bacteria, and about two-thirds (64.6%, 496/768) were recovered from category II wounds. Among the gram positive bacteria, 339 (83.5%) were aerobes where Staphylococcus aureus (103, 30.4%), Coagulase-negative staphylococci (68, 20.1%), and Corynebacterium spp (33, 9.7%) had the highest prevalence. For the 362 Gram negative isolates, 217 (59.9%) were aerobes and the commonest isolates were P. maltocida (64, 29.5%), Capnocytophaga canimorsus (36, 16.6%) and P. canis (26, 12.0%). Gram-positive isolates were resistant to metronidazole (93.6%), oxacillin (68.5%), ceftriaxone (14.6%) and amoxicillin/clavulanic acid (14.0%). Gram negative isolates were resistant to metronidazole (100%), ampicillin (30.7%), oxacillin (29.3%), and doxycycline (22.9%). Multidrug resistance was in 105 (29.0%) and 121/406 (29.8%) of the gram-negative and gram-positive isolates, respectively. All gram-positive isolates were susceptible to vancomycin and ciprofloxacin.
Infection rates of DBWs in Uganda are high and the dominant bacterial isolates are Staphylococcus aureus, Pasteurella spps, and Capnocytophaga canimorsus. Multidrug resistance to commonly used antibiotics is high. The recommendation in the Uganda Clinical Guidelines to use metronidazole in the management of DBWs should be reviewed. DBWs should be enlisted for routine antimicrobial resistance surveillance and rational use of antimicrobial agents should be promoted.
对人类的狗咬伤进行暴露后治疗旨在减轻狂犬病的风险并促进伤口愈合。伤口愈合可能会因细菌感染而变得复杂。本研究旨在确定乌干达感染的狗咬伤（DBW）中的不同细菌及其抗生素敏感性。
对 376 名狗咬伤患者进行了横断面研究。从患有感染性 DBW 的患者的伤口拭子中采集样本，并接种到推荐的培养基中。对其进行需氧菌和厌氧菌的培养。根据菌落特征、革兰氏染色和标准生化试验对所有分离的细菌进行鉴定。对耐药性达三种或以上抗生素的菌株进行分子鉴定。采用改良 Kirby-Bauer 法的纸片扩散法进行抗生素敏感性试验。使用 Stata 版本 15 软件进行数据分析。
约一半的患者（52.9%，199/376）出现感染伤口。约 84.4%（168/199）的拭子培养呈阳性，共分离出 768 株细菌，其中约一半（52.9%，406/768）为革兰氏阳性菌，约三分之二（64.6%，496/768）来自 II 类伤口。在革兰氏阳性菌中，339 株（83.5%）为需氧菌，其中金黄色葡萄球菌（103 株，30.4%）、凝固酶阴性葡萄球菌（68 株，20.1%）和棒状杆菌属（33 株，9.7%）的检出率最高。在 362 株革兰氏阴性菌中，217 株（59.9%）为需氧菌，最常见的分离物为麦芽糖普雷沃菌（64 株，29.5%）、卡他莫拉菌（36 株，16.6%）和犬小杆菌（26 株，12.0%）。革兰氏阳性菌对甲硝唑（93.6%）、苯唑西林（68.5%）、头孢曲松（14.6%）和阿莫西林/克拉维酸（14.0%）耐药。革兰氏阴性菌对甲硝唑（100%）、氨苄西林（30.7%）、苯唑西林（29.3%）和强力霉素（22.9%）耐药。105 株（29.0%）革兰氏阴性菌和 121 株（29.8%）革兰氏阳性菌存在多药耐药性。所有革兰氏阳性菌均对万古霉素和环丙沙星敏感。
乌干达 DBW 的感染率较高，主要的细菌分离株为金黄色葡萄球菌、巴氏杆菌属和卡他莫拉菌。对常用抗生素的多药耐药性很高。乌干达临床指南建议在 DBW 管理中使用甲硝唑，应予以审查。DBW 应纳入常规抗菌药物耐药性监测，应促进合理使用抗菌药物。
