Department of Medical Laboratory Sciences, GAMBY Medical and Business College, Bahir Dar, Ethiopia.
Department of Medical Laboratory Sciences, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
BMC Microbiol. 2024 May 16;24(1):166. doi: 10.1186/s12866-024-03324-2.
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.
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.
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.
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.
高速子弹和弹片造成的与子弹相关的细菌伤口感染。在埃塞俄比亚，据报道有重大伤害可能导致严重的伤口感染、持续的全身感染，并可能导致截肢和死亡。在埃塞俄比亚西北的巴赫达尔的卫生机构中，与子弹相关的受伤患者中细菌伤口感染的流行程度、抗菌药物敏感性概况以及相关因素尚未得到研究。因此，本研究旨在确定在巴赫达尔的三个转诊医疗机构中，与子弹相关的受伤患者中细菌感染的患病率、细菌谱、抗菌药物敏感性概况以及与细菌感染相关的因素。
这是一项 2022 年 5 月 25 日至 7 月 27 日在巴赫达尔的三个转诊医疗机构中进行的基于医院的横断面研究。共纳入 384 名与子弹相关的受伤患者。使用结构化问卷收集社会人口统计学和临床数据。使用无菌技术采集伤口拭子，在血液和麦康凯琼脂上进行细菌培养，遵循细菌学标准。对阳性培养物进行生化试验以区分细菌，并根据 2021 年临床实验室标准协会（CLSI）指南使用 Muller Hinton 琼脂进行分离物的抗菌药物敏感性试验。使用 Epi-Info 版本 7.3 输入数据，并使用 SPSS 版本 25 进行分析。使用频率、百分比、数字和图表表示描述性数据。使用逻辑回归识别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。
巴赫达尔市三家转诊医院与子弹相关的细菌伤口感染的患病率为 54.7%。最常分离到的革兰氏阴性菌是 49 株克雷伯菌属（23.3%），而革兰氏阳性菌中最常分离到的是金黄色葡萄球菌 58 株（27.6%）和凝固酶阴性葡萄球菌（CONS）18 株（8.6%）。污染、住院和吸烟习惯与与子弹相关的细菌伤口感染的存在显著相关。超过 97%的多药耐药（MDR）细菌分离株被鉴定，其中大肠埃希菌、变形杆菌属、柠檬酸杆菌和金黄色葡萄球菌对多种药物高度耐药。
本研究中发现与子弹相关的细菌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分离到的细菌。对氨苄西林、苯唑西林、头孢吡肟、头孢曲松、头孢他啶、万古霉素和诺氟沙星的耐药率很高。因此，正确处理子弹伤、及时调查细菌感染、监测药敏模式和抗生素使用至关重要。
