Bacteriological profile of wound swab and their antibiogram pattern in a tertiary care hospital, Saudi Arabia

Azzah S. Alharbi

doi:10.15537/smj.2022.43.12.20220681

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Table 1

- Characteristics of the study population stratified by culture positivity from wound specimens (N=305).

Characteristics	Positive culture n (%)	Negative culture n (%)	Total n (%)	P-value
Gender				0.082
Female	85 (60.7)	55 (39.3)	140 (45.9)
Male	86 (52.1)	79 (47.9)	165 (54.1)
Total	171 (56.1)	134 (43.9)	305 (100)
Nationality				0.441
Saudi	88 (55.3)	71(44.7)	159 (52.1)
Non Saudi	83 (56.8)	63 (43.2)	146 (47.9)
Total	171 (56.1)	134 (43.9)	305 (100)
Age groups (years)				0.001*
0 to 18	25 (35.7)	45 (64.3)	70 (23.0)
19-40	42 (57.5)	32 (42.5)	74 (24.3)
41-59	41 (59.4)	28 (40.6)	69 (22.6)
≥ 60	63 (67.7)	30 (32.3)	93 (30.5)
Total	171 (56.1)	134 (43.9)	305 (100)

Data are reported as number (%). Test used=Chi-square test. *Significant differences between groups (p<0.05).

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Table 2

- Microbial species isolated from wound infections, and their distribution stratified for gender, nationality and age of the patients.

Microbial species	Gender			Nationality		Age group
Microbial species	Total n(%)	Female n (%)	Male n (%)	Saudi n (%)	Non Saudi n (%)	0 to 18 n (%)	19-40 n (%)	41-59 n (%)	≥60 n (%)
Gram positive bacteria
Staphylococcus aureus	32 (17.1)	18(9.6)	14(7.5)	27 (14.4)	5 (2.7)	5 (2.7)	18(9.6)	5(2.7)	4 (2.1)
Staphylococcus epidermidis	2 (1.1)	0 (0)	2 (1.1)	2 (1.1)	0 (0)	0 (0)	0 (0)	1(0.5)	1(0.5)
Streptococcus agalactiae	6 (3.2)	2 (1.1)	4 (2.1)	5 (2.7)	1(0.5)	1 (0.5)	1(0.5)	2(1.1)	2(1.1)
Streptococcus pyogenes	3 (1.6)	0 (0)	3 (1.6)	1 (0.5)	2 (2.7)	0 (0)	1 (0.5)	1(0.5)	1(0.5)
Enterococcus faecalis	8 (4.3)	3 (1.6)	5 (2.7)	4 (2.2)	4 (2.15)	1 (0.5)	1 (0.5)	3(1.6)	3(1.6)
Enterococcus faecium	3 (1.6)	1(0.5)	2 (1.1)	1 (0.5)	2 (1.1)	2 (1.1)	0 (0)	1 (0.5)	0 (0)
Enterococcus gallinarum	3 (1.6)	1(0.5)	2 (1.1)	3 (1.6)	0 (0)	0 (0)	1 (0.5)	0 (0)	2 (1.1)
Total	57 (30.5)	25 (13.4)	32 (17.1)	43 (23.0)	14 (7.48)	9 (4.8)	22 (11.8)	13 (7.0)	13 (7.0)
Gram negative bacteria
Klebsiella pneumoniae	26 (13.9)	11 (5.9)	15 (8.0)	8 (4.3)	18 (9.6)	4 (2.2)	6 (3.2)	3 (1.6)	13 (7)
Pseudomonas aeruginosa	26 (13.9)	16 (8.6)	10 (5.4)	15 (8.0)	11(5.9)	6 (3.2)	4(2.2)	8 (4.3)	8 (4.3)
Escherichia coli	24 (12.8)	10 (5.4)	14 (7.5)	13 (7.0)	11(5.9)	2(1.1)	7 (3.7)	2 (1.1)	13 (7.0)
Acinetobacter baumannii	10 (5.3)	3 (1.6)	7 (3.5)	6 (3.2)	4 (2.1)	0(0)	1 (0.5)	5 (2.7)	4 (2.1)
Serratia marcescens	8 (4.3)	4 (2.2)	4 (2.2)	6 (3.2)	2 (1.1)	0 (0)	2 (1.1)	5 (2.7)	1 (0.5)
Morganella morganii	4 (2.1)	1(0.5)	3 (1.6)	2 (1.1)	2 (1.1)	0 (0)	0 (0)	1 (0.5)	3 (1.6)
Enterobacter cloacae	6 (3.2)	3 (1.6)	3(1.6)	0 (0)	6 (3.2)	2 (1.1)	1 (0.5)	1 (0.5)	2(1.1)
Enterobacter aerogenes	2 (1.1)	2(1.1)	0 (0)	0 (0)	2 (1.1)	0 (0)	2 (1.1)	0 (0)	0 (0)
Citrobacter freundii	3 (1.6)	0 (0)	3 (1.6)	0 (0)	3 (1.6)	0 (0)	0 (0)	1(0.5)	2 (1.1)
Proteus mirabilis	3 (1.6)	2 (1.1)	1(0.5)	2 (1.1)	1 (0.5)	0 (0)	0 (0)	1 (0.5)	2 (1.1)
Stenotrophomonas maltophilia	3 (1.6)	2 (1.1)	1 (0.5)	0 (0)	3 (1.6)	1 (0.5)	0 (0)	0 (0)	2 (1.1)
Providencia sp.	1 (0.5)	1 (0.5)	0 (0)	0 (0)	1 (0.5)	0 (0)	0 (0)	1 (0.5)	0 (0)
Total	116 (62.0)	55 (29.4)	61 (32.6)	52 (27.8)	64 (34.2)	15 (8.0)	23 (12.3)	28 (14.9)	50 (26.7)
Fungi	14 (7.5)	10 (5.4)	4 (2.2)	5 (2.7)	9 (4.8)	2 (1.1)	0 (0)	2 (1.1)	10 (5.4)
Total	187 (100)	90 (48.1)	97(51.9)	100 (53.5)	87 (46.5)	26 (13.9)	45 (24.0)	43 (23.0)	73 (39.0)

Data reported as number and percentages (%). Test used=fisher exact test, p-value of 0.215 with gender, <0.001 with nationality and age groups, sp.- species

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Table 3

- Antimicrobial profile of gram-positive bacterial isolates.

Antibiotics	S. aureus n=(32)			S. epidermidis n=(32)			E. faecalis n=(32)			E.f aecium n=(32)			E. gallinarum n=(32)
Antibiotics	T	R	S	T	R	S	T	R	S	T	R	S	T	R	S
Ciprofloxacin	32	4 (12.5)	28 (87.5)	2	1 (50.0)	1 (50.0)	-	-	-	-	-	-	-	-	-
Trimethoprim-Sulfamethoxazole	32	4 (12.5)	28 (87.5)	2	0 (0)	2 (100)	-	-	-	-	-	-	-	-	-
Clindamycin	31	1 (3.2)	30 (96.8)	2	0 (0)	2 (100)	-	-	-	-	-	-	-	-	-
Erythromycin	31	7 (22.6)	24 (77.4)	2	1 (50.0)	1 (50.0)	-	-	-	-	-	-	-	-	-
Oxacillin	31	9 (29.0)	22 (71.0)	2	2 (100)	0 (0)	-	-	-	-	-	-	-	-	-
Gentamycin	-	-	-	-	-	-	6	2 (33.3)	4 (66.7)	2	1 (50.0)	1 (50.0)	3	0 (0)	3 (100)
Vancomycin	12	0 (0)	12 (100)	1	0 (0)	1 (50)	-	-	-	3	2 (66.7)	1 (33.3)	3	2 (66.7)	1 (33.3)
Ampicillin	-	-	-	-	-	-	7	0 (0)	7 (100)	3	3 (100)	0 (0)	3	0 (0)	3 (100)
Linezolid	-	-	-	-	-	-	-	-	-	2	1 (50)	1 (50.0)	2	0 (0)	2 (100)
Piperacillin tazobactam	-	-	-	-	-	-	2	0 (0)	2 (100)	-	-	-	-	-	-

Data are reported as number and percentage (%). T: total number of isolates tested against each antibiotic, R: number of isolates resistance to antibiotic, S: number of isolates sensitive to antibiotic, - : not done

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Table 4

- Antimicrobial profile of Gram-negative bacterial isolates.

Antibiotics	Klebsiella pneumonia n=(26)			Pseudomonas aeruginosa n=(26)			Escherichia coli n=(24)			Acinetobacter baumannii n=(10)			Serratia marcescens n=(8)
Antibiotics	T	R	S	T	R	S	T	R	S	T	R	S	T	R	S
Meropenem	13	12 (92.3)	1 (7.7)	9	6 (66.7)	3 (33.3)	4	0 (0)	4 (100)	7	7 (100)	0 (0)	-	-	-
Amikacin	9	6 (66.7)	3 (33.3)	4	4 (100)	0 (0)	9	0 (0)	9 (100)	5	2 (40.0)	3 (60.0)	-	-	-
Ciprofloxacin	25	17 (68.0)	8 (32)	24	9 (37.5)	15 (62.5)	21	17 (81)	4 (19)	10	7 (70.0)	3 (30.0)	8	2 (25.0)	6 (75.0)
Gentamicin	24	10 (41.7)	14 (58.3)	24	4 (16.7)	20 (83.3)	24	8 (33.3)	16 (66.7)	7	1 (14.3)	6 (85.7)	8	0 (0)	8 (100)
Imipenem	13	12 (92.3)	1 (7.7)	8	6 (75)	2 (25)	4	0 (0)	4 (100)	7	7 (100)	0 (0)	-	-	-
Trimethoprim-sulfamethoxazole	25	15 (60.0)	10 (40.0)	-	-	-	24	10 (41.7)	14 (58.3)	10	7 (70)	3 (30)	8	2 (25)	6 (75.0)
Ertapenem	11	6 (54.5)	5 (45.5)	-	-	-	12	0 (0)	12 (100)	-	-	-	4	0 (0)	4 (100)
Cefepime	1	1 (100)	0 (0)	5	5 (100)	0 (0)	2	0 (0)	2 (100)	7	7 (100)	0 (0)	8	0 (0)	8 (100)
Piperacillin tazobactam	8	1 (12.5)	7 (87.5)	24	7 (29.0)	17 (71.0)	11	1 (9.0)	10 (91.0)	10	7 (70.0)	3 (30.0)	-	-	-
Amoxicillin/clavulanic acid	8	1 (12.5)	7 (87.5)	-	-	-	11	4 (36.4)	7 (63.6)	-	-	-	-	-	-
Cefazoline	8	1 (12.5)	7 (87.5)	-	-	-	9	3 (33.3)	6 (66.7)	3	0 (0)	3 (100)	-	-	-
Tigecycline	3	3 (100)	0 (0)	-	-	-	-	-	-	1	0 (0)	1 (100)	-	-	-
Ceftazidime	-	-	-	24	5 (20.8)	19 (79.2)	1	1(100)	0 (0)	7	7 (100)	0 (0)	-	-	-
Cefuroxime	1	-	1 (100)	-	-	-	4	3 (75)	1 (25)	-	-	-	-	-	-

Data reported as number and percentage (%). T: total number of isolates tested against each antibiotic, R: number of isolates resistance to antibiotic, S: number of isolates sensitive to antibiotic, – represents ‘not done’

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Table 4

- Antimicrobial profile of Gram-negative bacterial isolates (continuation).

Antibiotics	Morganella morganii n=(4)			Enterobacter cloacae n=(6)			Proteus mirabilis n=(3)			Providencia sp. n=(1)
Antibiotics	T	R	S	T	R	S	T	R	S	T	R	S
Meropenem	-	-	-	1	1 (100)	0 (0)	-	-	-	-	-	-
Amikacin	1	0 (0)	1 (100)	1	1 (100)	0 (0)	-	-	-	1	0 (0)	1 (100)
Ciprofloxacin	4	3 (75.0)	1 (25.0)	6	2 (33.3)	4 (66.7)	2	1 (50.0)	1 (50.0)	1	1 (100)	0 (0)
Gentamicin	4	0 (0)	4 (100)	6	1 (16.7)	5 (83.3)	2	0 (0)	2 (100)	1	1 (100)	0 (0)
Imipenem	-	-	-	1	1 (100)	0 (0)	-	-	-	-	-	-
Trimethoprim-sulfamethoxazole	4	2 (50.0)	2 (50.0)	6	2 (33.3)	4 (66.7)	2	1 (50.0)	1 (50.0)	1	1 (100)	0 (0)
Ertapenem	1	0 (0)	1 (100)	3	1 (33.3)	2 (66.7)	-	-	-	1	0 (0)	1 (100)
Cefepime	4	0 (0)	4 (100)	5	0 (0)	5 (100)	-	-	-	1	0(0)	1 (100)
Piperacillin tazobactam	-	-	-	-	-	-	1	0 (0)	1 (100)	-	-	-
Amoxicillin/clavulanic acid	-	-	-	-	-	-	1	0 (0)	1 (100)	-	-	-
Cefazoline	-	-	-	-	-	-	1	0 (0)	1 (100)	-	-	-
Tigecycline	-	-	-	-	-	-	-	-	-	-	-	-
Ceftazidime	-	-	-	-	-	-	-	-	-	-	-	-
Cefuroxime	-	-	-	-	-	-	-	-	-	-	-	-

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Table 5

- Distribution of bacterial isolates stratified by number of resistances.

Microbial species	Number of resistance
Microbial species	Total	R₀	R₁	R₂	R₃	R₄	R₅	R_≥6	MDR
Gram positive bacteria
Staphylococcus aureus	32 (17.1)	18 (56.2)	7 (21.9)	3 (9.4)	4 (12.5)	-	-	-	4 (12.5)
Staphylococcus epidermidis	2 (1.1)	-	-	2(100)	-	-	-	-	-
Streptococcus agalactiae	6 (3.2)	6 (100)	-	-	-	-	-	-	-
Streptococcus pyogenes	3 (1.6)	3 (100)	-	-	-	-	-	-	-
Enterococcus faecalis	8 (4.3)	6 (75.0)	2 (25.0)	-	-	-	-	-	-
Enterococcus faecium	3 (1.6)	-	1(33.3)	1(33.3)	-	1 (33.3)	-	-	-
Enterococcus gallinarum	3 (1.6)	1 (33.3)	2 (66.7)	-	-	-	-	-	-
Total	57 (30.5)	34 (59.7)	12 (21.1)	6 (10.5)	4 (7.0)	1 (1.75)	-	-	4 (7.0)
Gram negative bacteria
Klebsiella pneumoniae	26 (13.9)	7 (26.9)	2 (7.7)	3 (11.5)	2 (7.7)	5 (19.2)	3 (11.5)	4 (15.4)	14 (53.9)
Pseudomonas aeruginosa	26 (13.9)	14 (53.8)	4 (15.4)	3 (11.5)	1 (3.8)	-	-	4 (15.4)	5 (19.3)
Escherichia coli	24 (12.8)	5 (20.8)	6 (25.0)	7 (29.2)	3 (12.5)	-	-	3 (12.5)	6 (25.0)
Acinetobacter baumannii	10 (5.3)	3 (30.0)	-	-	-	-	-	7 (70.0)	7 (70.0)
Serratia marcescens	8 (4.3)	4(50.0)	4 (50.0)	-	-	-	-	-	-
Morganella morganii	4 (2.1)	1(25.0)	1(25.0)	2 (50.0)	-	-	-	-	-
Enterobacter cloacae	6 (3.2)	3 (50.0)	-	2 (33.3)	-	1 (16.7)	-	-	1(16.7)
Enterobacter aerogenes	2 (1.1)	2 (100)	-	-	-	-	-	-	-
Citrobacter freundii	3 (1.6)	3 (100)	-	-	-	-	-	-	-
Proteus mirabilis	3 (1.6)	2 (66.7)	-	1 (33.3)	-	-	-	-	-
Stenotrophomonas maltophilia	3 (1.6)	3 (100)	-	-	-	-	-	-	-
Providencia sp.	1 (0.1)	-	-	-	1 (100)	-	-	-	1 (100)
Total	116 (62.0)	47 (40.6)	17 (14.7)	18 (15.5)	7 (6)	6 (5.2)	3 (2.6)	18 (15.5)	34 (29.3)

Values are presented as number and percentage (%). The total number of the microbial isolates is more than the number of samples duo to the polymicrobial infection. R0: no resistance against antimicrobial agents, R1: resistance for 1 class of antimicrobial agents, R2: resistance for 2 classes of antimicrobial agents, R3: resistance for 3 classes of antimicrobial agents, R4: resistance for 4 classes of antimicrobial agents, R5: resistance for 5 classes of antimicrobial agents, R≥6: resistance for 6 or more classes of antimicrobial agents, MDR: multidrug-resistant pathogen

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Table 6

- Distribution of microbial resistance stratified for gender, nationality and age of the patients.

Characteristics		Number of resistance
Characteristics	Total	R₀	R₁	R₂	R₃	R₄	R₅	R_≥6	MDR	P-value
Gender										0.192
Female	90 (48.1)	51 (53.7)	9 (31)	9 (37.5)	8 (72.7)	3 (42.9)	1 (33.3)	9 (50.0)	21 (23.3)
Male	97 (51.9)	44 (46.3)	20 (69.0)	15 (62.5)	3 (27.3)	4 (57.1)	2 (66.7)	9 (50.0)	18 (18.6)
Total	187 (100)	95 (100)	29 (100)	24 (100)	11 (100)	7(100)	3 (100)	18 (100)	39 (20.9)
Nationality										0.188
Saudi	100 (53.5)	53 (55.8)	20 (69)	11 (45.8)	5 (45.5)	1(14.3)	1 (33.3)	9 (50.0)	16 (16.0)
Non Saudi	87 (46.5)	42 (44.2)	9 (31)	13 (54.2)	6 (54.5)	6 (85.7)	2 (66.7)	9 (50.0)	23 (26.4)
Total	187 (100)	95 (100)	29 (100)	24 (100)	11 (100)	7 (100)	3 (100)	18 (100)	39 (20.9)
Age groups (years)										0.101
0 to 18	26 (13.9)	19 (20)	3 (10.3)	1 (4.2)	0 (0)	3 (42.9)	0 (0)	0 (0)	3 (11.5)
19-40	46 (24.6)	22 (23.2)	7 (24.1)	6 (25)	4 (36.4)	1 (14.3)	1 (33.3)	5 (27.8)	11 (24.0)
41-59	44 (23.5)	20 (21.1)	12 (41.4)	5 (20.8)	1 (9.1)	2 (28.6)	0 (0)	4 (22.2)	7 (16.0)
≥60	71 (38.0)	34 (35.8)	7 (24.1)	12 (50.0)	6 (54.5)	1 (14.3)	2 (66.7)	9 (50.0)	18 (25.3)
Total	187 (100)	95 (100)	29 (100)	24 (100)	11 (100)	7 (100)	3 (100)	18 (100)	39 (20.9)

Data reported as number (%); Test used= Chi-square test.,R0, no resistance against antimicrobial agents; R1, resistance for 1 class of antimicrobial agents; R2, resistance for 2 classes of antimicrobial agents; R3, resistance for 3 classes of antimicrobial agents; R4, resistance for 4 classes of antimicrobial agents; R5, resistance for 5 classes of antimicrobial agents;R≥6, resistance for 6 or more classes of antimicrobial agents; The total number of the microbial isolates is more than the number of samples duo to the polymicrobial infection.

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Appendix 1

- Microbial species isolated from wound infections.

Microbial species	n (%)
Gram positive bacteria
Staphylococcus aureus	32 (17.1)
Staphylococcus epidermidis	2 (1.1)
Streptococcus agalactiae	6 (3.2)
Streptococcus pyogenes	3 (1.6)
Enterococcus faecalis	8 (4.3)
Enterococcus faecium	3 (1.6)
Enterococcus gallinarum	3 (1.6)
Total	57 (30.5)
Gram negative bacteria
Klebsiella pneumoniae	26 (13.9)
Pseudomonas aeruginosa	26 (13.9)
Escherichia coli	24 (12.8)
Acinetobacter baumannii	10 (5.3)
Serratia marcescens	8 (4.3)
Morganella morganii	4 (2.1)
Enterobacter cloacae	6 (3.2)
Enterobacter aerogenes	2 (1.1)
Citrobacter freundii	3 (1.6)
Proteus mirabilis	3 (1.6)
Stenotrophomonas maltophilia	(1.6)
Providencia specie	1 (0.1)
Total	116 (62.0)
Polymicrobial 1
Mixed gram-positive/gram-negative bacteria	16 /171 (9.4)
Fungi	14 (7.5)
Total	187 (100)

The total number of the microbial isolates is more than the number of samples duo to the polymicrobial infection, where Mixed gram-positive/gram-negative bacteria have been detected.1 Details of polymicrobial infections are shown in Appendix 2.

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Appendix 2

- Details of polymicrobial infections.

Polymicrobial	n (%)
Escherichia coli and Gram-negative bacteria	2 (12.5)
Escherichia coli and Gram-positive bacteria	4 (25.0)
Pseudomonas aeruginosa and Gram-positive bacteria	4 (25.0)
Pseudomonas aeruginosa and Gram-negative bacteria	2 (12.5)
Mixed Gram-positive and negative bacteria	3 (18.8)
Mixed Gram-positive bacteria	1 (6.3)
Total	16 (100)