title: Secondary bacterial isolates from previously untreated Buruli ulcer lesions and their antibiotic susceptibility patterns in Southern Nigeria.
abstract: Mycolactones, secreted by Mycobacterium ulcerans, were previously believed to prevent super infection in Buruli ulcer lesions. However, little is known about secondary bacterial infections in these lesions. This study evaluated contaminating bacterial flora and their antibiotic susceptibility patterns in cases of previously untreated Buruli ulcer disease from three states in Southern Nigeria.
  
  
  METHODS
  A prospective analysis was conducted between January and June of 2015 using wound swabs from eligible patients with Buruli ulcer disease, confirmed by quantitative-polymerase chain reaction, with active ulcers. Microbiological analyses including isolation of bacteria, species identification of isolates, and drug susceptibility tests were performed.
  
  
  RESULTS
  Of 51 patients, 27 (52.9%) were female. One or more bacterial species of clinical importance was isolated from each patient. A total of 17 different microbial species were isolated; 76.4% were Gram-negative and 23.6% were Gram-positive isolates. The most common bacterial species detected was Staphylococcus aureus (24%), followed by Aeromonas hydrophila (13%), Pseudomonas aeruginosa (13%), and Klebsiella pneumoniae (11%). Drug susceptibility tests showed a particularly high frequency of resistance to commonly used antimicrobials in Nigeria for Staphylococcus aureus.
  
  
  CONCLUSIONS
  Super bacterial infections occur in Buruli ulcer lesions in Nigeria, and these infections are associated with high rates of resistance to commonly used antibiotics in the country.
authors.affiliation: Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria.
authors.forename: Moses Chibueze
authors.initials: MC
authors.lastname: Anyim
authors.affiliation: Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria.
authors.forename: Anthony Obiamaka
authors.initials: AO
authors.lastname: Meka
authors.affiliation: Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria.
authors.forename: Joseph Ngozi
authors.initials: JN
authors.lastname: Chukwu
authors.affiliation: Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria.
authors.forename: Charles Chukwunalu
authors.initials: CC
authors.lastname: Nwafor
authors.affiliation: Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria.|Department of Community Health and Psychiatry, University of West Indies, Mona, Kingston 7, Jamaica.
authors.forename: Daniel Chukwunweolu
authors.initials: DC
authors.lastname: Oshi
authors.affiliation: Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria.
authors.forename: Nelson Okechukwu
authors.initials: NO
authors.lastname: Madichie
authors.affiliation: Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria.
authors.forename: Ngozi
authors.initials: N
authors.lastname: Ekeke
authors.affiliation: Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria.
authors.forename: Chukwuka
authors.initials: C
authors.lastname: Alphonsus
authors.affiliation: Medical Department, German Leprosy and Tuberculosis Relief Association, Enugu State, Nigeria.
authors.forename: Obinna
authors.initials: O
authors.lastname: Mbah
authors.affiliation: Department of Microbiology, National Orthopaedic Hospital, Enugu State, Nigeria.
authors.forename: Chinenye
authors.initials: C
authors.lastname: Nwaekpe
authors.affiliation: St Benedict's Tuberculosis & Leprosy Rehabilitation Hospital, Ogoja, Cross River State, Nigeria.
authors.forename: Martin
authors.initials: M
authors.lastname: Njoku
authors.affiliation: St Benedict's Tuberculosis & Leprosy Rehabilitation Hospital, Ogoja, Cross River State, Nigeria.
authors.forename: Dare
authors.initials: D
authors.lastname: Fakiyesi
authors.affiliation: St Joseph's Hospital Adazi-Nnukwu, Anambra State, Nigeria.
authors.forename: Vitalis
authors.initials: V
authors.lastname: Ulodiaku
authors.affiliation: Anambra State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Anambra State, Nigeria.
authors.forename: Ignatius
authors.initials: I
authors.lastname: Ejiofor
authors.affiliation: Ogun State Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Ogun State, Nigeria.
authors.forename: Adeniyi Hakeem
authors.initials: AH
authors.lastname: Bisiriyu
authors.affiliation: Department of Medicine, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria.
authors.forename: Kingsley Nnanna
authors.initials: KN
authors.lastname: Ukwaja
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D054312:Buruli Ulcer / Q000382:microbiology*; D002648:Child; D060085:Coinfection; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009549:Nigeria; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents