Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Bartl, H.
Retrospective study of epidemiology, bacteriological background and resistance patterns in chronic ulcers of patients affected by leprosy in India
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2019. pp. 87
[OPEN ACCESS]
FullText
- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Grisold Andrea
- Altmetrics:
- Abstract:
- Background: Leprosy, also called Morbus Hansen, is a chronic granulomatous infectious disease caused by Mycobacterium leprae or Mycobacterium lepromatosis. It is nowadays classified as an orphan disease; even though, nearly 215 000 new cases per year are detected worldwide - the majority in India, Brazil and Indonesia. The mycobacteria mainly attack the peripheral nerves and the skin, but the eyes, upper airway mucosa or the testicles may also be affected. Due to the characteristic loss of sensibility, patients often suffer from trophic ulcers - in some cases this requires antibiotic treatment which has to be tailored to local resistance patterns. Objective: The purpose of this diploma thesis was to investigate the bacteriological profile and the resistance patterns of chronic lesions of leprosy patients followed by an evaluation of the output in view of the influence on empiric antimicrobial treatment, where necessary. Materials and Methods: For the present thesis a retrospective data analysis was carried out among 50 leprosy patients (15 women and 35 men) from Salem, district of Tamil Nadu, India. Thereto, 66 wound swabs from chronic lesions on the feet or lower legs of patients were collected. Subsequently, cultivations with the analysis of the bacteriological profile and resistance patterns were undertaken. Results: 95.5% of the samples contained two or more different bacteria strains; the median was at four bacteria per swab. The most commonly isolated organism was Pseudomonas aeruginosa (26/66; 39.4%) closely followed by Staphylococcus aureus (24/66 with 25 isolates; 36.4%) and β-haemolytic streptococci of group G and C, abbreviated GGS and GCS (20/66 and 5/66; 30.3% and 7.6%). Enterobacter cloacae (13/66; 19.7%), Klebsiella pneumoniae (11/66; 16.7%), Proteus mirabilis (9/66; 13.6%), Escherichia coli (6/66 with 8 isolates; 9.1%), Acinetobacter baumannii (8/66; 12.1%) and Proteus vulgaris (6/66; 9.1%) were also frequently detected. 27 (40.9%) of the 66 samples included at least one multi-resistant pathogen. Altogether 33 multi-resistant bacteria could be determined. The list of multidrug-resistant, MDR, organisms is headed by MRSA, methicillin-resistant Staphylococcus aureus, (23/33; 69.7%) and is continued by extended spectrum ß-lactamase (ESBL)-producing Proteus vulgaris (4/33; 12.1%). Additionally, there were three (9.1%) 3MRGN-E. coli, multi-resistant Gram-negatives (also ESBL-producing), one (3.0%) ESBL-producing E. coli as well as one (3.0%) ESBL-producing 3MRGN-Proteus mirabilis respectively one (3.0%) ESBL-producing Enterobacter cloacae. None of the microorganisms could be assigned to a 4MRGN strain. Conclusion: The quite high number of multidrug-resistant bacteria shows the importance of carefully considered antibiotic treatment. Based on the analysis of the present data from Salem, India, the high MRSA-rates have to be taken into account for oral empiric therapy: In this case oral fusidic acid, erythromycin or clindamycin are available. For Pseudomonas and Enterobacteriaceae ciprofloxacin or in some cases amoxicillin/ clavulanic acid or oral cephalosporins might be used. As similar studies revealed varying results, further research on local resistance rates may facilitate the choice of appropriate antibiotics for the respective medical institution.