Thesis (M.Sc.(Medical Sciences)) -- University of Limpopo, 2022 / Background: Wound infections continue to be problematic in clinical practice where empiric treatment of infections is a routine, with non-healing wounds being a burden to the health care system. A gap has been noted between antimicrobial resistance and demographic factors as an existing relationship. This necessitates an investigation of patterns of isolates and susceptibility profiles of microorganisms in wounds to modify the preventative and therapeutic strategies against the resistant strains leading to the stall of wound healing, which could aid in empiric treatment. Objective: The aim of this study was to determine the antimicrobial patterns and their associated demographic determinants in bacteria isolated from patients with non healing wounds at Pietersburg and Mankweng Hospitals, Limpopo Province. Methods: The study was conducted using antimicrobial susceptibility data collected from National Health Laboratory Service through Academic Affairs and Research Management System for the period 2016-2020. A total of 797 Antimicrobial Susceptibility Test results were analysed using Statistical Package for Social Sciences version 27.0. The susceptibility rates for the bacterial isolates by age and gender were calculated. The mean percentages for sensitivity and resistance were also calculated. Pearson’s Chi-square test was used to compare age and gender with drug susceptibility. A p-value of ≤ 0.05 was considered significant. Results: Of the 797 patient Antimicrobial Susceptibility Test results, 372 (46.7%) were males and 425 (53.3%) females, with mean age of 31.42 ± 21.75 years. The most common isolates were, Klebsiella pneumoniae (23%), Pseudomonas aeruginosa (21.7%), Escherichia coli (16%) and Proteus mirabilis (13.5%). Highest percentage of resistance to any antibiotic was amoxicillin, ampicillin (85.15%) then trimethoprim sulfamethoxazole (60.85%), amoxicillin ampicillin (49.1%), tigecycline (46.35%), cefepime (32.7%), gentamycin (25.4%), ciprofloxacin (22.5%), colistin (17.6%), and meropenem (12.3%). Furthermore, the general view of the study is no statistically clinical significance on the effect of age and gender on bacterial resistance although statistical significance was noted on age the resistance Acinetobacter baumannii vi (p=0.018), and gender on K. pneumoniae (p=0.015), P. mirabilis (p=0.024). Major resistance to A. baumannii, K. pneumoniae and P. mirabilis were from female patients. Conclusions: The most effective antibiotics were meropenem, colistin, and ciprofloxacin. The highest number of isolates were K. pneumoniae, E. coli, P. aeruginosa, P. mirabilis and A. baumannii with the most effective antibiotics gentamycin, meropenem, ciprofloxacin, and cefepime. Although the general view of the study is that no statistically clinical significance was noted on the effect of age and gender on bacterial resistance, it is important to note the significant observation that there was an observed relation of age to amoxicillin-clavulanic acid and Ciprofloxacin and gender to amoxicillin ampicillin. As such, there is insufficient evidence that supports the effect of age and gender on antimicrobial susceptibility. The study suggests caution against the use of amoxicillin ampicillin in the treatment of wound infections as it confers low levels of efficacy and high resistance and ultimately the call to revise minimum inhibitory concentrations and critical concentrations of all less effective drugs to increase their efficacy. / National Research Foundation (NRF)

Submitted by Johnny Rodrigues (johnnyrodrigues@ufcg.edu.br) on 2018-05-28T17:03:48Z No. of bitstreams: 1 THALITA SÉVIA SOARES DE ALMEIDA - DISSERTAÇÃO PPGSA PROFISSIONAL 2015..pdf: 916106 bytes, checksum: 8c69c3650a1e87351c7825822c8b1b17 (MD5) / Made available in DSpace on 2018-05-28T17:03:48Z (GMT). No. of bitstreams: 1 THALITA SÉVIA SOARES DE ALMEIDA - DISSERTAÇÃO PPGSA PROFISSIONAL 2015..pdf: 916106 bytes, checksum: 8c69c3650a1e87351c7825822c8b1b17 (MD5) Previous issue date: 2015-12-17 / O fruto da Licania rigida Benth, popularmente “oiticica”, é possuidora de substâncias químicas utilizadas por vários segmentos industriais, tais como, alimentícia, química, produtos manufaturados, cosméticos e fármacos. A amêndoa se destaca pelo alto teor lipídico e o óleo é composto de gorduras mono e poli-insaturadas, sendo utilizado na produção de tintas, vernizes, esmaltes finos e lonas. Pouco se sabe quanto à constituição do fruto, o que justifica a necessidade de melhor avaliação quantitativamente e qualitativamente de seus teores. Portanto, objetivou-se o presente estudo analisar características físico-químicas do fruto da oiticica e proceder a testes de antibiograma com o óleo. Os frutos foram colhidos de espécies vegetais na área rural do Município de Pombal e conduzidos ao Centro Vocacional Tecnológico da Universidade Federal de Campina Grande, campus Pombal, onde as amostras foram separação em epicarpo-mesocarpo (E-M), endocarpo (E) e amêndoa (A), posteriormente processadas e armazenadas em sacos plásticos estéreis. Determinou-se os índices de potencial hidrogeniônico (pH), condutividade elétrica (CE), acidez total titulável (ATT), teor de umidade, teor de cinzas, sólidos solúveis totais (SST), proteínas e lipídios do fruto. Para o óleo, empregou-se o teste de antibiograma com o óleo e antimicrobianos, frente aos agentes biológicos Streptococcus pyogenes (C003), Staphilococcus aureos (A001) e Cândida albicans (CAA001). Os resultados das análises físico-químicas das partes do fruto apresentaram valores máximos de pH (5,8) e umidade (65,8%) para amostra E-M, teor proteico (2,9%) e de SST (19,1º Brix), ATT (27,2%), CE (461,2 mS.g-1cm-1) e cinzas (6,4%) para a amostra E, teor lipídico (54,2%) para a amostra A. Os testes de sensibilidade com o óleo de oiticica demonstrou importante potencial inibitório frente às bactérias e a levedura, permitido estimar a susceptibilidade sensível e susceptibilidade intermediária dos microorganismos, e Concentração Inibitória Mínima (CIM) do óleo. O estudo aponta alternativas para a utilização da oiticiqueira, principalmente o seu potencial oleaginoso que,além da importância socioeconômica já reconhecida, pode ser aplicada em microorganismos infecciosos, necessariamente com a comprovação por estudos e pesquisas subsequentes. / The fruit of Licania rigida Benth, popularly "oiticica", possesses chemical substances used by several industrial segments, such as, food, chemistry, manufactured products, cosmetics and pharmaceuticals. The almond stands out for the high lipid content and the oil is composed of mono and polyunsaturated fats, being used in the production of paints, varnishes, fine enamels and tarpaulins. Little is known about the constitution of the fruit, which justifies the need for a better quantitative and qualitative evaluation of its contents. Therefore, the objective of this study was to analyze the physico-chemical characteristics of the oiticica fruit and to perform antibiogram tests with the oil. The fruits were harvested from plant species in the rural area of Pombal and conducted to the Technological Vocational Center of Campina Grande Federal University, Pombal campus, where the samples were epicarp-mesocarp (EM), endocarp (E) and almond (A), subsequently processed and stored in sterile plastic bags. The values of hydrogenation potential (pH), electrical conductivity (EC), total titratable acidity (TFA), moisture content, ash content, total soluble solids (TSS), fruit proteins and lipids were determined. For the oil, the antibiogram test with the oil and antimicrobials was used, against the biological agents Streptococcus pyogenes (C003), Staphilococcus aureos (A001) and Candida albicans (CAA001). The results of the physico-chemical analyzes of the fruit parts presented maximum pH values (5.8) and humidity (65.8%) for MS, protein content (2.9%) and SST (19.1 ° Brix) , ATT (27.2%), EC (461.2 mS.g-1cm-1) and ashes (6.4%) for sample E, lipid content (54.2%) for sample A. The tests Of sensitivity with oiticica oil showed an important inhibitory potential against bacteria and yeast, allowed to estimate the susceptibility sensitive and intermediate susceptibility of the microorganisms, and Minimum Inhibitory Concentration (MIC) of the oil. The study points out alternatives to the use of oiticiqueira, especially its oleaginous potential, which, in addition to the already recognized socioeconomic importance, can be applied in infectious microorganisms, necessarily with the proof of studies and subsequent research.

Made available in DSpace on 2014-07-29T15:04:30Z (GMT). No. of bitstreams: 1 dissertacao marleneandrade.pdf: 776220 bytes, checksum: 89f7e969fbef687591092b3ded9dd40a (MD5) Previous issue date: 2008-04-30 / Assessing patients with chronic wounds poses a challenge to professionals and doubts still persist concerning characterization of the wound infection status. We believe that the Basic Health Units are in places of reference for the public to submit chronic wounds and should have full attendance and resolution were objectives of this study: characterizing patients with chronic wounds attended as spontaneous demand in the bandage room; characterizing patients chronic wounds regarding the presence of classical signs and additional infection criteria; isolating and identifying aerobic bacteria and fungi in the samples of chronic wounds clinically signaling to infection; verifying strains susceptibility when isolated before antimicrobial agents often used in praxis as well as new antibiotics and analyzing the relationship of local factors with infection status. This is a cross-sectional study, carried out in ambulatory bandage rooms in basic health units with emergency service in the municipality of Goiânia. Data was collected from June to July, in 2007. Data was obtained through the use of structured interviews containing questions about characterization of patients and a check list for the assessment of chronic wounds through the signs and clinical symptoms indicating infection and analysis of wound samples by using swabs in accordance with Levine s technique. After consent and approval of the ethics committee, 46 patients were evaluated and 60 wound samples were assessed. Data bank was organized in Excel table and statistics analysis in SPSS- 15.0. The average age was 55 years, 37 (80.4%) male, 20 (43.5%) belonging to E social class, 23 (50%) retired people having basic sanitation items. 28 (61%) presented venous ulcerated lower limbs, 31 (67.4%) performed the bandage both in the BHU and at home. 45 (75%) out of 60 wounds were infected and 15 (25%) noninfected. Through bivariate analysis we verified an association of the infection status with the following characteristics: width depth of tissular damage, necrotic tissue and exudate amount. Among signs and symptoms, classical ones occurred in a frequency higher than 65% both in the infected and noninfected group. Regarding the additional ones, we verified variance in occurrence in both wound groups. Staphylococcus aureus was predominat in 65% of cases and was sensitive to most antibiotics tested. Among Gram-negative bacteria the most frequent were: Pseudomonas aeruginosa (23%), resistant to amoxylin +clavulanic acid, cefalexin and cefotaxim; Proteus mirabilis (16.6%) and Proteus vulgaris (15.0%), all sensitive to gentamicin, aztreonam, ciprofloxacin, and amicacin. These results indicate the need to structure an integrated net to treat patients with chronic wounds and evidence additional criteria to be employed in the elaboration of service protocols pursuing improvement of quality of assistance given in basic health units. / A avaliação de pacientes com feridas crônicas representa um desafio para os profissionais, e dúvidas, ainda persistem em torno da caracterização do status de infecção, nessas lesões. As Unidades Básicas de Saúde constituem-se locais de referência para a população portadora de feridas crônicas, onde deveriam ter atendimento integral e resolutividade. Objetivos deste estudo: caracterizar os pacientes com feridas crônicas, atendidos como demanda espontânea, na sala de curativos; caracterizar as feridas crônicas dos pacientes atendidos em relação à presença de sinais clássicos e critérios adicionais de infecção; isolar e identificar bactérias aeróbias e fungos das amostras de feridas crônicas, com indícios clínicos de infecção; verificar a susceptibilidade das cepas isoladas, frente aos antimicrobianos freqüentemente utilizados na prática e novos antibióticos, e analisar a relação de fatores locais, com o status de infecção. Trata-se de estudo transversal, realizado em Salas de Curativos Ambulatoriais de Unidades Básicas de Saúde (UBS), com atendimento de urgência do Município de Goiânia. Os dados foram coletados no período de junho a julho de 2007 e obtidos por meio de entrevista com roteiro estruturado, contendo questões de caracterização dos pacientes e de um check-list, para a avaliação das feridas crônicas, por meio dos sinais e sintomas clínicos indicativos de infecção, e análise de amostras de feridas utilizando o swab, mediante técnica de Levine. Após aprovação pelo Comitê de Ética e Consentimento, foram avaliados 46 pacientes, e analisadas amostras de 60 feridas. Os programas computacionais utilizados para organizar e analisar estatisticamente os dados foram: o Excel e o SPSS (versão 15.0), respectivamente. A média de idade foi de 55 anos, 37 (80,4%) eram do sexo masculino, 20 (43.5%) pertenciam à classe social E, 23 (50%) eram aposentados e possuíam itens de saneamento básico, 28 (61%) apresentaram úlceras venosas, localizadas nos membros inferiores, 31 (67,4%) realizavam o curativo nas UBS ou em domicílios. Das 60 lesões, 45 (75%) estavam infectadas e 15 (25%) não infectadas. Mediante análise bivariada, verificaram-se associação com o status de infecção as seguintes características: profundidade da extensão do dano tissular, quantidade de tecido necrótico e exsudato. Dentre os sinais e sintomas, os clássicos ocorreram numa freqüência superior a 65%, tanto no grupo de infectadas quanto não infectadas, e nos adicionais verificou-se variação na ocorrência, em ambos os grupos de feridas. Houve predominância do Staphylococcus aureus em 65% dos casos e a maioria sensível aos antibióticos testados. Entre as bactérias Gram-negativas, as mais freqüentes foram: Pseudomonas aeruginosa (23,3%), resistentes à amoxicilina+ácido clavulânico, cefalexina e cefotaxima; Proteus mirabilis (16,6%) e Proteus vulgaris (15,0%) sensíveis a gentamicina, aztreonam, ciprofloxacino e amicacina. Estes resultados indicam a necessidade de se estruturar uma rede integrada, para o atendimento dos pacientes com feridas crônicas. Também evidenciam critérios adicionais que podem ser empregados na elaboração do protocolo de atendimento, buscando a melhoria da qualidade da assistência prestada nas unidades básicas de saúde.