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Objective: To determine the pattern of orthopaedic wound infection and the influence of environmental factors on the distribution of the etiologic bacterial agents., Design: A prospective observational study., Setting: Department of Orthopaedic Surgery and Traumatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria., Subjects: Sixty patients with orthopaedic wound infections and orthopaedic ward environment., Results: Thirty- nine males (mean age 33.31+2SD) and 21 females (mean age 27.47 + 2SD) with orthopaedic wounds. Three hundred and ten bacteria (190 from patients and 120 from ward environment) were isolated. The pattern of bacterial isolates from patients' wounds was different from that of the airborne bacterial isolates irrespective of the length of stay on the ward. There was a significant difference in the distribution and resistance pattern of bacterial isolates from the patient's wounds and ward environment., Conclusion: There is a high incidence of antibiotic resistance of bacterial isolates from samples cultured from patients compared with isolates from ward environment at this centre. The extensive use of pre-operative prophylactic and post-surgical antibiotics in various combinations at this centre needs to be re-examined to reduce the preponderance of antibiotic resistance.

Objective: To identify bacterial isolates from superficial swabs of open fracture wounds at presentation and after infection has been established, and to determine if there are correlations between them., Method: Patients who presented with open fractures at the Wesley Guild Hospital, Ilesa, Nigeria between December 2004 and May 2006 were recruited into this prospective study. Superficial wound swabs were taken at presentation and if patient showed evidence of wound infection., Results: Sixty patients had open fractures. The initial bacteria culture of wound swabs taken on the day of presentation was positive in 41 (68.3%) patients. Of these, 19 (46.3%) yielded one bacteria isolate, 17 (41.5%) yielded two and 5 (12.2%) yielded three, making a total of 68 organisms. The most common organism was Staphylococcus aureus. However, as a group, more aerobic Gram-negative rods were isolated than any other bacteria groups. Eleven (18.3%) patients developed wound infections, all of which were polymicrobial. In 10 (90.9%) of these, the microbial isolate of the final wound swab included at least one organism that was present in the initial wound culture. No patient with an initial negative culture went on to develop a wound infection. The mean presentation interval of patients with wounds that became infected was 15.2 ± 7.9 hours (95% CI 9.8-20.5 hours) compared with 2.9 ± 3.1 hours (95% CI 2.0-3.8 hours) for those who did not develop a wound infection (p>0.01)., Conclusion: In a resource-poor setting, where pre-hospital care is unavailable and patients present late, superficial wound swabs are effective in predicting subsequent organisms that may cause wound infections., Conflict of Interest: None.

This open prospective study compared the bacterial flora of superficial and deep-wound biopsies and swabs over a 2-year period in 4 different samples cultured from open fracture wounds at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Samples were taken from 47 patients with factures graded according to Gustilo and Anderson's classification as grade 1 (2.1%), grade II (29.8%), grade IIIA (36.2%), and grade IIIB (31%). A total of 248 samples were cultured using standard techniques. The incidence of open fracture wounds was 78.7% in male patients and 21.3% in female patients. Tibia fractures constituted 66.1%. A total of 203 bacterial isolates were cultured from 248 samples. Gram-negative bacteria constituted 53.2% of isolates, with Escherichia coli being predominant (12.8%). Staphylococcus aureus were the predominant Gram-positive cocci (15.3%), and Staphylococcus epidermidis (13.3%) may be considered to be the major source of open fracture wound contamination. The bacterial species cultured from superficial and deep-wound swabs and biopsies were similar. Resistance to antimicrobials was high for penicillins (amoxicillin and cloxacillin), with values of 68.6% and 58.3%, respectively, for superficial bacterial species and 58.2% and 31.9%, respectively, for deep-wound biopsies.

Background: The objective of this study is to determine the pattern of bacterial isolates and antibiotic sensitivity profile in open fractures. Fifty-nine patients with open fractures of the lower limb long bones were studied. The majority of the cases were Gustilo and Anderson types II 21(35.6%), and IIIA 16(27.1%)., Method: The patients were assessed by history taking, physical examination, and plain radiographs. Wound swabs were taken for bacteriological studies. Other necessary investigations were also done. During wound debridement open fractures were classified into Grades I, II and III using the Gustilo-Anderson method of classification., Results: The infection rate was 45.8%. Gram-positive cocci and Gram-negative rods were isolated. On the whole Staphylococcus aureus 13(25%), and Coagulase-negative staphylococci (CONS) 14(26.9%), were the commonest organisms isolated. The commonest Gram-negative rods that were isolated from the wounds were Proteus mirabilis 9(17.3%), and Pseudomonas aeruginosa 8(15.4%). Multiple organisms were commonly isolated from the wounds. While all the organisms isolated showed very good sensitivity to gentamicin, cloxacillin and ofloxacin, most of the organisms were resistant to penicillin, ampicillin and tetracycline. The sensitivity ranged from 62.5% to 100%. Coagulase-negative Staphylococci (CONS) showed sensitivity to the widest range of antibiotics which included penicillin, ampicillin, chloramphenicol, gentamicin, cloxacillin and ofloxacin. The sensitivity ranged from 35.7% to 100%. There was statistically significant difference between the open tibial and femoral fracture cases with respect to the interval between injury and debridement time (p = 0.008); the rate of wound infection (p = 0.021); and the occurrence of osteomyelitis (p = 0.023). The commonest complications observed were wound infection 27(45.8%), and delayed fracture union 26(44.1%), which were commoner in the open tibial fractures., Conclusion: This study shows that Staphylococcus aureus and coagulase-negative staphylococci (CONS) were the commonest organisms associated with open fracture of the lower limbs in our centre and that delay in the initial wound debridement was a major predisposing factor to wound infection.

The incidence of acute otitis media (AOM) in a comprehensive healthcare setting was investigated in Ile-Ife, Nigeria. Out of the 617 children examined, 53 (11.64 per cent) suffered from the condition based on the criteria used. Staphylococci constituted the predominant organisms associated with the condition with Staphylococcus aureus (25.0 per cent) being the most frequent single microbe recovered from the subjects. This was followed by Proteus mirabilis (16.2 per cent), Staphylococcus sp. (8.8 per cent), Streptococcus pneumoniae (8.8 per cent), Pseudomonas aeruginosa and Haemophilus influenzae (7.4 per cent each). Most isolates tested were multiply resistant to the antibiotics commonly employed in treating infections caused by these organisms. The study highlights the prevalence of multi-resistant organisms amongst the subjects and recommends prompt therapeutic intervention to avert ineffectiveness of antibiotics when used in treating infections caused by these organisms in the community.

The incidence of septicaemia among neonates categorized as being at high risk was 55 per cent in Ile-Ife, Nigeria. Gram-positive organisms, specifically Staphylococcus aureus, were predominant (33.8 per cent) among bacteria cultured from proven cases of septicaemia. Other coagulase-negative staphylococci also contributed 21 per cent, with Staphylococcus epidermidis occurring in 5 per cent of the isolates. Listeria monocytogenes was cultured from 8.4 per cent of septic neonates. Pseudomonas aeruginosa was cultured from 3 per cent, Klebsiella pneumoniae from 14 per cent, and Escherichia coli from 7 per cent. Other Gram-negative bacilli cultured were Enterobacter aerogenes (5 per cent), Citrobacter freundii, Salmonella sp., and Proteus sp. (2 per cent each). The bacterial isolates were relatively resistant to antibiotics traditionally employed to treat cases of septicaemia. The study shows a high prevalence of neonatal bacterial sepsis at the centre and the emerging role of Listeria monocytogenes in the aetiology of neonatal sepsis. It highlights the preponderance of multiple antibiotic resistant organisms among these neonates early in life which is of epidemiological importance in the control of the infectious agents.

Background: The acquired immunodeficiency syndrome (AIDS) is of major public health concern worldwide more so in sub-Saharan Africa where there is an upsurge in the incidence of the disease. Reports from developed countries have shown that a close link exists between the human immunodeficiency virus (HIV) and pulmonary tuberculosis. No such study has ever been carried out in Ile-Ife, Nigeria., Objective: The study was designed to determine the prevalence of HIV infection among randomly selected tuberculosis patients seen in a Nigerian chest clinic using third generation ELISA kits that detect HIV-1 and HIV-2 strains., Results: Of the 79 subjects with confirmed active tuberculosis, 12.7% tested positive for HIV antibodies compared with 2.0% of subjects without tuberculosis designated as the control group--a value that is statistically significant (p < 0.05). Farmers, artisans and students contributed a large proportion of the seropositive sera. Although the seroprevalence rate of 12.7% is low compared with the rates from eastern and southern African countries, this value was threefold higher than 5.2% value reported in metropolitan Lagos--suggesting concern about the spread of HIV in a semi-urban centre such as Ile-Ife., Conclusion: This study suggests that a close link exists between active tuberculosis and HIV infection in Ile-Ife, Nigeria which underscores the urgent need to monitor tuberculosis patients as the increase in the rate of new cases may indicate the spread of HIV infection. The study also recommends that an aggressive public awareness programme be undertaken to enlighten communities about the risk of TB/HIV infection.

Three hundred and ninety-six E. coli isolates obtained from apparently healthy school children in Ile-Ife, Nigeria, were tested for their susceptibility to 11 different antibiotics. Of these, only gentamicin, cefotaxime and nalidixic acid were found to have significant in vitro activity against most of the isolates. The incidence of antibiotic resistances encountered varied between 24% for trimethoprim and 55.5% for the sulphonamide. It was further observed that 47.5% of the isolates were identified as being multiply resistant, since they were simultaneously resistant to at least three different antibiotics. The 86 trimethoprim-resistant isolates tested were found to be able to transfer this resistance trait together with resistance genes of to other antibiotics, into a plamidless strain of E. coli by conjugation. Seventy-seven of the trimethoprim-resistant isolates were also found to be classifiable into the types of dihydrofolate reductases responsible for the observed resistance on the basis of hybridization experiments. The results of this study indicate that there is a large reservoir of antibiotic resistances within the community, and that the resistance genes were easily transferable to other strains even without direct exposure to antibiotics.

The pattern and frequency of bacterial isolates cultured from 687 clinical specimens from four University teaching hospitals in South Western Nigeria were determined. A total of 707 bacterial isolates were cultured from 18 different clinical sources giving an average of 1.03 bacteria per sample identified in this collection. Of these, gram negative rods constituted 78.1% and the rest were staphylococci. The most common organism isolated in urine samples was E. coli (32.1%) whilst S. aureus (28.9%) was the most frequently isolated organism from wounds. An interesting observation was the significant occurrence of Aeromonas hydrophilia and Klebsiella pneumoniae in urine samples.

Clinical laboratory records and case files of 1,038 cases of urinary tract infections (UTI) were examined for the spectrum of bacterial and candida isolates for age and sex distribution of the UTI cases and antibiotic susceptibility pattern of isolates. The results show that 867 (83.5%) of the cases were aged 21 years and above, of which 81.3% in that age group were females. While only 20.7% of the cases were males, 74.0% of those in that category were also 21 years and older. Eleven organisms were isolated, with E. coli, Klebsiella spp and Staphylococcus aureus respectively representing 36.1%, 22.8% and 15.4% of the total bacterial isolates. The prevalence of S. aureus isolates in cases of UTI in this centre suggests the increasing role of these microorganisms in the aetiology of urinary tract infections in Nigeria.

The incidence of postsurgical clean wound infection in 101 consecutive operations was 1.98%. Staphylococci were the predominant bacteria cultured from the anterior nares of the patients and attending surgical personnel--and were found to colonize the wounds. The nasal carriage rates of Staphylococcus aureus amongst the patients and surgical staff were 12.1% and 17.% respectively. Group III and non-typeable (NT) S. aureus strains accounted for about 65% of S. aureus isolates cultured from the anterior nares. A low incidence of nasal carriage of S. aureus isolates correlated with low incidence of wound sepsis. The operating room air seemed considerably contaminated but this did not reflect in high incidence of postsurgical wound sepsis. Our results suggest patients microflora and operating room air were the major sources of intra-operative bacterial colonization of wound at this centre.

Of 166 strains of Staphylococcus aureus isolated from hospital patients and staff in Ile-Ife, Nigeria, 32% were non-typable (NT). The strains were isolated from skin lesions, eye infections, wounds and nasal flora. Isolates from skin lesions or eye and wound infections were more likely to produce protease (95% and 78% respectively) than nasal isolates (11%). Nearly all (99%) of the strains isolated were resistant to penicillin and 78% were resistant to tetracycline. Streptomycin resistance occurred in 25% of isolates; 19% were resistant to chloramphenicol and 9% to methicillin.

The nasal carriage rate of Staphylococcus aureus among maternal-infant pairs was 18% compared with 39% among hospital staff in Ile-Ife, Nigeria during a 12-week survey. Of the newborns, 46% tested positive compared with 26% of their mothers. The S. aureus phage types recovered were predominantly of the group III type (38%); however, 28% of the strains isolated were non-typable. All the S. aureus strains were resistant to penicillin, 84% to tetracycline, and 35 and 24% were resistant to streptomycin and chloramphenicol, respectively. Altogether 19% of the strains tested were resistant to methicillin.

The bacteriology of intra-abdominal abscess in 30 Nigerian children showed anaerobic bacteria constituted 52 per cent of total microflora with Bacteroides fragilis and anaerobic streptococci (19 per cent each) being predominant. E. coli and S. aureus were the predominant facultative bacteria isolated occurring in 24 and 11 per cent, respectively. The incidence of abscess was higher in males than in females and these predominant bacteria were relatively resistant to penicillins, suggesting caution in the use of penicillins in the treatment of intra-abdominal infections.

Of 190 isolates of Escherichia coli from children aged up to 5 years with diarrhoea, 72 (37.9%) were resistant to trimethoprim and of the 70 isolates tested, 38 transferred high level trimethoprim resistance (MIC greater than 1000 mg/L) into E. coli EC 1005. Of the enterotoxigenic isolates from which trimethoprim resistance was transferred, 41.2% also contained transmissible toxigenic characteristics. All the trimethoprim-resistant isolates were resistant to other antibiotics.

Of the nine hundred and twenty patients clinically diagnosed of having septicaemia at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria between 1980-1987, 233 (25.3%) had blood samples positive by culture. Thirteen different bacterial species were identified from positive blood cultures of which six predominated: Staphylococcus aureus (30.5%), Coliforms (17.6%), Klebsiella spp. (14.2%), Pseudomonas aeruginosa (9.2%), Escherichia coli (7.9%) and Salmonella typhi (5.9%). The in vitro antibiotic, disc sensitivity pattern of the isolates showed they were relatively resistant to ampicillin and penicillin G but comparatively sensitive to antibiotics commonly used in the treatment of infections caused by these organisms. Septicaemia cases were recorded in all age groups but incidence in females was slightly but not significantly higher than in males (p less than 0.05). The study reveals the predominance of S. aureus strains in case of septicaemia in Nigeria.

The incidence of enterotoxigenic Escherichia coli (ETEC) was investigated at oral rehydration therapy clinics in Ibadan and Ile-Ife. The incidence rate of ETEC was 74 (21.3%) of the 347 diarrhoeal stool samples examined. ETEC incidence rate was 25.1% in Ibadan and 12.0% in Ile-Ife. Children aged between 0 and 18 months appeared most susceptible in both centres. A higher incidence of ETEC occurred among the male (31.9%) than female (17.0%) subjects at Ibadan but no such difference was obtained at Ile-Ife where 12.5% of males and 11.4% of female subjects were infected. The results obtained in this study suggest ETEC played a prominent role in infantile diarrhoea in the two centres studied.

Fruit bats (Eidolon helvum) were collected from three different localities in Western Nigeria: Oti, Ibadan and Idanre. Fifty serum samples were analyzed using a modified rapid fluorescent focus inhibition technique against rabies, Mokola, Lagos bat and Duvenhage viruses. Twenty-five brain samples were screened for rabies and related lyssavirus antigens by direct fluorescent antibody microscopy and by an indirect fluorescent antibody technique with rabies anti-nucleocapsid monoclonal antibodies. All brain samples were negative. Two serum samples had relatively high anti-rabies activity; no neutralizing activity was detected against Mokola, Lagos bat or Duvenhage viruses.

A total of 247 bacterial isolates were obtained from diarrhoeal patients aged 0-60 months in an oral rehydration therapy clinic in Ibadan and tested for sensitivity to 11 antibiotics using the disc diffusion method. Fifty isolates obtained from apparently healthy age-matched controls were similarly tested. The results show that 6(2.4%) of the isolates obtained from the diarrhoeal children were resistant to all the 11 antibiotics used in the test and that most of the others were resistant to several antibiotics. Similarly, a very considerable percentage of isolates obtained from children in the control group were found to be resistant to several antibiotics. It is therefore apparent that there is a high incidence of multiply-antibiotic-resistant isolates within the sample environment.

Children under 2 years of age are most susceptible to acute respiratory infections caused by Bordetella pertussis, Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria meningitidis. We analysed milk samples and sera from mother-infant pairs for specific antibodies that may enhance protection against the bacterial pathogens. The results show that the breast-milk samples contained significant titres of specific IgG and IgA antibodies to the four organisms, although the mean IgG antibody levels were higher in maternal sera than in breast-milk. On the other hand, the mean IgA antibody levels to the four organisms were higher in breast-milk than in both maternal and infant sera. IgM antibodies to these organisms were relatively low or absent in many milk and serum samples. Nevertheless, the significant concentrations of specific IgG and IgA antibodies in milk samples may indicate a protective role for breast-milk against the four infections in early childhood.