title: Antimicrobial resistance among aerobic biofilm producing bacteria isolated from chronic wounds in the tertiary care hospitals of Peshawar, Pakistan.
abstract: OBJECTIVE
  Chronic wound infections impose major medical and economic costs on health-care systems, cause significant morbidity, mortality and prolonged hospitalisation. The presence of biofilm producing bacteria in these wounds is considered as an important virulence factor that leads to chronic implications including ulceration. The undertaken study aimed to isolate and identify the biofilm aerobic bacterial pathogens from patients with chronic wound infections, and determine their antibiotics resistance profiles Method: During this study, swab specimens were collected from patients with chronic wounds at teaching hospitals of Peshawar, Pakistan between May 2013 and June 2014. The isolated aerobic bacterial pathogens were identified on the basis of standard cultural characteristics and biochemical tests. Antibiotics resistance profiles of biofilm producing bacteria against selected antibiotics were then determined.
  
  
  RESULTS
  Among the chronic wound infections, diabetic foot ulcers were most common 37 (37%), followed by surgical ulcers 27 (27%). Chronic wounds were common in male patients older than 40 years. Among the total 163 isolated bacterial pathogens the most prevalent bacterial species were Pseudomonas aeruginosa 44 (27%), Klebsiella pneumoniae 26 (16%), Staphylococcus species 22 (14%) and Streptococcus spp. 21 (13%). The isolation rate of bacterial pathogens was high among patients with diabetic foot ulcers 83 (50.9%). Among bacterial isolates, 108 (66.2%) were observed as biofilm producers while 55 (33.8%) did not form biofilm in our model. The investigated biofilm producing bacterial isolates showed comparatively high resistance against tested antibiotics compared to non-biofilm producing bacterial isolates. The most effective antibiotics were amikacine and cefepime against all isolates.
  
  
  CONCLUSIONS
  Increased multidrug resistance in biofilm producing bacteria associated with chronic wounds was observed in this study. Judicious use of antibiotics is needed to control the wound associated biofilm associated pathogens.
authors: Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan.
authors: K
authors: K
authors: Rahim
authors: Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan.
authors: M
authors: M
authors: Qasim
authors: Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan.
authors: H
authors: H
authors: Rahman
authors: Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan.
authors: T A
authors: TA
authors: Khan
authors: Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan.
authors: I
authors: I
authors: Ahmad
authors: Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan.
authors: N
authors: N
authors: Khan
authors: Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan.
authors: A
authors: A
authors: Ullah
authors: Department of Microbiology, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan.
authors: A
authors: A
authors: Basit
authors: Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa Kohat, 26000, Pakistan.
authors: S
authors: S
authors: Saleha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects*; D001424:Bacterial Infections / Q000188:drug therapy*; D018441:Biofilms / Q000187:drug effects*; D002908:Chronic Disease / Q000188:drug therapy; D017719:Diabetic Foot / Q000188:drug therapy* / Q000382:microbiology*; D004352:Drug Resistance, Microbial / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010154:Pakistan; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents
keywords: Pakistan; antibiotic resistance; bacterial profile; biofilm; chronic wound infections