ANALYSIS OF SKIN GRAFT FOR BACTERIAL INFECTION IN A TERTIARY HEALTH CARE CENTRE

Abstract

An intact human skin surface is vital to the preservation of bodily fluid homeostasis, thermoregulation, and the host’s protection against infection. Any breach in the skin will lead to compromise in health and well-being of the patient, successful skin grafting is the key to patient survival. But most of the times transplant recipients are predisposed to wide variety of bacterial, viral, fungal and parasitic infections because of immunosuppressant’s administration there by prolonging the duration of wound healing. Our objective is to analyze the periodic bacterial infection that occurs in skin graft patients and to evaluate anti-microbial susceptibility testing on the bacteria isolated from the skin graft infection. 300 swabs from 50 skin graft cases were collected from the patients admitted in plastic surgery unit of S.S. Institute of Medical Sciences and Research Centre, Davangere. Periodic swabs were taken on Day 0, week 1, week 2, week 3, week 4 and week 5. The isolates were identified by standard microbiological techniques and antimicrobial susceptibility testing was done as per CLSI guidelines. Detection of Extended-spectrum beta-lactamase (ESβL), Metallo-β-lactamase (MβL) and Amp C-type β-lactamase were done according to standard guidelines. The tissue defects were grouped according to the cause as follows: vascular ulcers (9.2%), burns (14.5%), traumatic tissue defects (36.6%), and flap donor-site defects (39.7%). Pseudomonas aeruginosa was isolated in 38.9% of the cases followed by Klebsiella pneumoniae in 25.9% cases, Staphylococcus aureus in 18.5% of cases. Other organisms isolated are E.coli, Streptococcus pyogenes, CoNS, Acinetobacter baumannii. In all the cases, the preoperative evaluation indicated an adequate wound-bed preparation. However, graft loss secondary to infection was recorded in 12 patients (24%) and more common in grafts applied to the lower extremities ulcers in case of diabetic foot or when performed at multiple sites in case of burn infections. All the isolates were multi drug resistant. Among Gram negative bacteria, 17.9% were ESβL, 7.7% were AmpC and 21.6% were MβL producers. Pseudomonas aeruginosa was the predominant ESβL and MβL producer. 40% of the isolates were MRSA producers as skin transplant infection being a major problem, it becomes important to detect the specific pattern of graft microbial colonization and the antimicrobial sensitivity profiles so to reduce graft rejection.