Bacterial infections in burn wound patients at a tertiary teaching hospital in Accra, Ghana

Intact human skin surface is essential for protection against infection, preservation of body fluid homeostasis and thermoregulation. Burn injury compromises the skin barrier and enables bacterial infection, hence delaying burn wound healing. This study aimed to determine the microbial profile of burn wounds, and resistance patterns of microbes with respect to the source of the injured patient's wound. Fifty wound swab samples were collected from fifty burn patients at the Korle-Bu Teaching Hospital, Accra (KBTH). Sterile swabs moistened with sterile saline were used to swab burn wounds. The swabs were plated on blood agar and MacConkey agar for 24 hrs at 37°C. Biochemical tests were carried out on the representative isolate on each plate, and antibacterial sensitivity pattern was determined using the Kirby-Bauer disc diffusion method. The study revealed that the main source of burns was gas flames (66%) and scalds (28%). Out of the 50 samples analysed, 86% were culture positive and 14% were culture negative for bacteria. The predominant organisms isolated were Pseudomonas sp. (30.2%) and Acinetobacter sp. (20.9%). Proteus mirabillis (2.3%) and Staphylococcus aureus (2.3%) were the least frequently isolated bacteria. Although Pseudomonas sp. showed varying resistance levels to gentamicin, cotrimoxazole and ciprofloxacin, all the Acinetobacter sp. were resistant to most of the tested antibiotics used. Resistant gram negative bacteria are the most common isolates associated with burn wounds in Accra, Ghana. Hence a careful selection of antibiotics to control the wound infection is required for proper management of burn wounds in order to help reduce morbidity and mortality.

Surveillance of Bacterial Pathogens of Diarrhoea in Two Selected Sub Metros Within the Accra Metropolis

BACKGROUND

In recent years, many localities within the Greater Accra Region (GAR) have witnessed several episodes of cholera outbreaks, with some deaths. Compared to previous epidemics, which usually followed heavy rains, recent outbreaks show no seasonality.

OBJECTIVES

To investigate infective bacterial diseases in selected sub metros within the GAR.

METHODS

We used existing disease surveillance systems in Ghana, and investigated all reported cases of diarrhoea that met our case-definition. A three-day training workshop was done prior to the start of study, to sensitize prescribers at the Korle-Bu Polyclinic and Maamobi General hospital. A case-based investigation form was completed per patient, and two rectal swabs were taken for culture at the National Public Health and Reference Laboratory. Serotyping and antibiogram profiles of identified bacteria were determined. Potential risk factors were also assessed using a questionnaire.

RESULTS

Between January and June 2012, a total of 361 diarrhoeal cases with 5 deaths were recorded. Out of a total of 218 rectal swabs cultured, 71 (32.6%) Vibrio cholerae O1 Ogawa serotypes, and 1 (0.5%) Salmonella (O group B) were laboratory confirmed. No Shigella was isolated. The Vibrio cholerae isolates were susceptible to ciprofloxacin and tetracycline. Greater than 80% of patients reported having drank sachet water 24 h prior to diarrhoea onset, and many (144/361) young adults (20-29 years) reported with diarrhoea.

CONCLUSION

Enhanced surveillance of diarrhoeal diseases (enteric pathogens) within cholera endemic regions, will serve as an early warning signal, and reduce fatalities associated with infective diarrhoea.