The pattern of bacterial isolates and drug sensitivities of infected ulcers in patients with leprosy in ALERT, Kuyera and Gambo hospitals, Ethiopia.
BACKGROUND
Leprosy remains a public health problem, mainly in Africa, Asia and Latin America. Leprosy has many complications that include leprosy reactions, development of plantar and hand ulcerations, lagophthalomus and corneal anesthesia.


OBJECTIVE
In Ethiopia there is scarce information on the pattern of bacterial isolates and drug sensitivities of infected ulcers in patients with leprosy. This study was undertaken to identify the bacteriology of infected ulcers and to determine their antimicrobial susceptibility pattern.


METHODS
A descriptive cross-sectional study was conducted in 245 informed and consented leprosy patients with infected ulcers visiting ALERT, Kuyera and Gambo hospitals during the period August 2006 to May 2007.


METHODS
Wound aspirate specimens were collected from ulcers of each patient aseptically and inoculated into standard bacteriological media. Antimicrobial susceptibility testing was performed for all isolates according to the criteria of the National Committee for Clinical Laboratory Standards (NCCLS) by disk diffusion method.


RESULTS
Of the 245 patients investigated, 64.1% were males and 35.9% females (P < 0.05). The average age of the patients was 50 years (age range 13 to 92 years). According to Ridley-Jopling classifications, patients presented with TT (3.7%), BT, (31.4%), BL (44.5%) and LL (15.9%) types of leprosy. Plantar and hand ulcers were observed in 92.2% and 7.8% of patients, respectively. According the patients, the commonest cause of their ulcers was 'spontaneous' (56.7%). There were 44% Gram-positive and 56% Gram negative bacteria (P > 0.05). Proteus spp. accounted for 29.5% of the total isolates followed by Staphylococcus spp. (28.8%), beta-hemolytic streptococci (15.1%) and different types of Gram-negative bacteria (26.2%). Multiple organisms (two or three) were isolated from 19.6% patients. Of the 212 wound samples cultured anaerobically, 5.2% were positive for anaerobic culture. In this study both Gram-positive and Gram negative bacteria showed decreased sensitivity to most antimicrobial agents tested.


CONCLUSIONS
Proteus spp. was the most common isolate from infected ulcers. Ciprofloxacin, norfloxacin and gentamicin were the most effective drugs against the tested bacteria mainly for Gram-negative bacteria. This refers to the in vitro-sensitivity during the study period. The results of this study may help inform clinicians about the selection of an antibiotic in situations where use of an antibiotic may be indicated.
Armauer Hansen Research Institute (AHRI), Addis Ababa University, Medical Faculty, African Leprosy, Tuberculosis, Rehabilitation, and Training Center, P.O. Box. 1005, Ethiopia. rbpt21@yahoo.com
Tsehaynesh
T
Lema
Yimtubezenash
Y
Woldeamanuel
Daniel
D
Asrat
Mesfin
M
Hunegnaw
Ataklitie
A
Baraki
Yegermu
Y
Kebede
Lawrence
L
Yamuah
Abraham
A
Aseffa
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002939:Ciprofloxacin / Q000494:pharmacology; D003430:Cross-Sectional Studies; D003470:Culture Media; D052978:Disk Diffusion Antimicrobial Tests; D024901:Drug Resistance, Multiple, Bacterial; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005839:Gentamicins / Q000494:pharmacology; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity; D006761:Hospitals / Q000639:trends; D006801:Humans; D007258:Informed Consent; D007917:Leprostatic Agents / Q000494:pharmacology*; D007918:Leprosy / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D014456:Ulcer / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D055815:Young Adult
D003470:Culture Media; D005839:Gentamicins; D007917:Leprostatic Agents; D002939:Ciprofloxacin