Antimicrobial Susceptibility Patterns for Bacteria Isolated From Infected Wounds in Patients Attending Mbale Regional Referral Hospital

Antimicrobial Susceptibility Patterns for Bacteria Isolated From Infected Wounds in Patients Attending Mbale Regional Referral Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Antimicrobial Susceptibility Patterns for Bacteria Isolated From Infected Wounds in Patients Attending Mbale Regional Referral Hospital Habert Mabonga, Joel Bazira, Frederick Byarugaba, Barbra Tuhamize This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5858549/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Approximately eight million people worldwide are estimated to have wounds, both infected and uninfected, with wound infections causing considerable illness and death. In Uganda, a notable prevalence of wound sepsis has been reported in the western region, along with a significant level of antibiotic resistance. Methods: a laboratory based descriptive cross-sectional study where 210 wound swab samples were collected, cultured which employed quantitative data collection method and analysis. Sample size 210 determined using Kish and Leslie formula (1965). Wound sample swaps collected, cultured, microscopic and antibiotic susceptibility testing done. Data analyzed using STATA version 12 software. Results: 41.9% (88/210) of the tested samples had bacterial growth of which 36.4% (32/88) had Staphylococcus spp, 25.0% (22/88) had Escherichia coli and 15.9% (14/88) had Klebsiella spp. Acinetobacter baumanii was the least observed in only 1.1% (1/88) samples. 16.2% (34/210) of the samples had gram positive bacteria, only 25.7% (54/210) had gram negative bacteria. There was no observed bacterial growth in 58.1% (122/210) of the analyzed samples. More than a third 37.5% (12/32) were Methicillin Resistant Staphylococcus aureus (MRSA) and 62.5% (20/32) were Methicillin sensitive Staphylococcus aureus. Conclusion: Antimicrobial susceptibility patterns of isolates bacteria such as Staphylococcus spp, Pseudomonas aeruginosa , and Klebsiella spp , were identified as the major culprits behind wound infections. Biological sciences/Microbiology Health sciences/Health care Antimicrobial agent susceptibility wound infections isolates bacteria Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction A wound is defined as any physical or thermal injury that results in damage or disruption to the epidermis of the skin or mucous membranes [ 5 ]. It's crucial to understand that wounds can occur from skin punctures caused by nails or thorns, as well as from abrasions or lacerations [ 18 ]. A wound infection occurs when bacteria settle and multiply in damaged tissue or skin, accompanied by a reaction from the host's immune system [ 14 ], it can lead to sepsis, which is a potentially life-threatening condition characterized by organ dysfunction [ 16 ] and this can result in multiple organ failure and death due to septic shock [ 1 ]. Worldwide, approximately eight million individuals are estimated to have wounds, whether infected or not [ 6 ] and wound infections contribute significantly to human illness and death, leading to issues such as sepsis, limb loss, extended hospitalizations, and increased medical expenses. [ 2 ], this may occur due to the exposure of subcutaneous tissue after the skin's integrity is compromised, creating a moist, warm, and nutrient-rich environment that promotes microbial colonization and growth [ 10 ]. In developing countries, wound infections resulting from surgical procedures are a leading cause of illness and death, impacting approximately 5.6% of the total population [ 15 ]. Antimicrobial resistance hinders the management of infectious diseases by diminishing the effectiveness of treatments, causing patients to remain infectious for extended periods and raising the risk of transmitting resistant microorganisms to others [ 19 ] and thus, there is a need to strengthen regulations on the use of antimicrobials, as they are the primary contributors to the emergence of drug-resistant pathogens [ 2 ] this results in a substantial burden of wounds affecting millions of people each year, along with complications such as dehiscence and problematic scarring [ 1 ]. In Sub-Saharan Africa, a higher number of child deaths exhibited signs and symptoms of sepsis or septic shock [ 2 ], with Ethiopia has the highest rate of surgical wound infections [ 9 ], 90% of recorded Gram-negative bacteria showed resistance to chloramphenicol [ 8 ], Isolates of Haemophilus influenzae exhibited resistance to amoxicillin, while the resistance rate for quinolones was 37.5%. Carbapenem resistance was prevalent in Acinetobacter spp. and Pseudomonas aeruginosa but rare in Enterobacteriaceae [ 17 ]. In Uganda, a high prevalence of wound sepsis was observed in the western region, with significant resistance noted against gentamicin, ceftriaxone, and ciprofloxacin [ 12 ] and at Mbarara Regional Referral Hospital in southwestern Uganda, 81.93% of the 83 wound sample swabs collected yielded positive cultures, while 18.07% showed negative cultures [ 13 ]. High prevalence of multidrug-resistant MRSA was observed in the burn unit of Mulago Hospital, putting patients at risk for infections with difficult-to-treat isolates and highlighting the necessity for enhanced infection control measures in this environment [ 7 ]. In Mbale Regional Referral Hospital, wound infections comprise 86.2%, with Staphylococcus aureus being the most common organism at 39.4%, followed by Escherichia coli at 21.2% and Klebsiella species at 14.4%. Of the 41 out of 104 isolated Staphylococcus aureus strains, 65.9% were MRSA, and 12.2% exhibited inducible resistance to clindamycin. The isolated Staphylococcus aureus demonstrated resistance to multiple drugs but remained susceptible to vancomycin and clindamycin [ 11 ]. METHODS Study population The study was a laboratory based cross sectional descriptive study, which included 210 out patients and inpatients with wounds at Mbale Regional Referral Hospital. For each of the consenting patient with an indication for a wound infection, a well labelled, sterile swab was collected. The samples were then packaged by inserting each container in a separate zip-lock bag and immediately transported to the Microbiology Laboratory. The swab samples were inoculated and streaked directly on culture media such as on Blood agar, MacConkey agar and Chocolate agar and then incubated aerobically at 37°C overnight for 24 hours. The plate reading was done for samples on the following day. Gram staining was done to differentiate between Gram positive and Gram-negative isolates. A series of biochemical tests were used to identify the different organisms. Gram positive isolates were identified using catalase, coagulase and DNase tests. Gram negative isolates were identified using Indole, Voges–Proskauer, Urease, Simmons Citrate Agar, Triple sugar iron agar (TSI), and Oxidase test. Organisms identified to be significant pathogens were set-up for antibiotic susceptibility testing using the disc diffusion method on Mueller-Hinton agar as per the Clinical and Laboratory Standards Institute (CLSI) (2023). The drugs tested included Piperacillin, Piperacillin/tazobactam, Vancomycin, Cefoxitin, Erythromycin, Clindamycin, Tetracycline, Meropenem, Ciprofloxacin, Gentamicin, Ceftriaxone, Amoxicillin/Clavulanic acid, Ampicillin. Zone diameters of inhibition around the disc were measured using a Vernier caliper. Interpretations were done using the CLSI, 2023. Cefoxitin was used as a surrogate test for MRSA. Agar disk diffusion (Kirby Bauer) technique on 4% sodium chloride Mueller Hinton Agar (BBL TM , BD). Source of Data Participants’ demographic data and clinical presentation were obtained using a well-structured questionnaire as well as collection of information from laboratory cultures and susceptibility testing. The questionnaire used was used was developed for this study and has never been used in any other studies. Statistical analysis Data was entered and analyzed using STATA version 12 software. Chi-square statistics were computed to check statistically significant difference between the dependent and independent variables, univariate, bivariate and multivariate analysis were done to get the statistically significant results from the study. Presentation of data was in form of tables, pi-charts and figures. Ethical Considerations This study was conducted in accordance with the Helsinki declaration guideline and ethical approval was done by Mbarara University of Science and Technology Research Ethics Committee (MUST-2023-795). Administrative clearance was by MUST faculty research committee (FRC) and Mbale district Health Office. Written informed consent/assent were obtained from participants, enrolment was voluntary and participants could withdraw from the study at any time without consequences. RESULTS Socio-demographic characteristics of study participants Mean age of study participants was 20 years with standard deviation of 10 years. About half 54.8% (115/210) were male and it is important to note that the highest percentage 82.4% (173/210) of the total patients had wounds resulting from a surgical procedure. Additionally, 80.5% (169/206) of the patients spent less than 5 days in admission (See table 1). Table 1 : Participants' socio-demographics Variable Frequencies (n=210) Percentages (%) Age (years) 1-17 83 46.1 18-30 64 35.6 31+ 33 18.3 Sex Female 91 44.2 Male 115 55.8 Wound cause Accident 5 3.6 Bite 14 10.1 Burn 12 8.6 Surgical 108 77.7 Etiological agents that cause wound infections among patients About 41.9% (88/210) of the tested samples had bacterial growth; of which 36.4% (32/88) had Staphylococcus spp, 25.0% (22/88) had Escherichia coli and 15.9% (14/88) had Klebsiella spp. Acinetobacter baumanii was the least observed in only one sample 1.1% (1/88) (table 2). Table 2 : Etiological agents that cause wound infections among patients Variable Frequencies (n=210) Percentages (%) Observed bacterial growth 88 41.9 No bacterial growth 122 58.1 Isolates (n=88) Staphylococcus spp 32 36.4 Streptococcus pyogenes 2 2.3 Acinetobacter baumanii 1 1.1 Pseudomonas aeruginosa 5 5.7 Escherichia coli 22 25.0 Klebsiella spp 14 15.9 Proteus spp 5 5.6 Citrobactor spp 7 8.0 Categories of bacteria observed. Of all the samples which had bacterial growth, about 60.2% had gram negative bacteria and only 39.8% had gram positive bacteria. In figure 1 shows bacteria isolated from infected wounds in which 60.2% of bacteria isolated were gram positive and 39.8% were gram negative. In figure 2 and figure 4, shows the sensitivity patterns were meropenem, vancomycin, and Piperacillin tazobactam were more sensitive to most of the bacteria isolates from wound swabs. In figure 3 and figure 5, these showed the resistance patterns, most antibiotics which had high resistance were Clindamycin, ampicillin, ceftriaxone, ciprofloxacin and amoxiclav Methicillin Resistant Staphylococcus aureus (MRSA) among patients. Of the 32 isolates of Staphylococcus aureus , more than a third 37.5% (12/32) were Methicillin Resistant Staphylococcus aureus (MRSA) and 62.5% (20/32) were Methicillin sensitive Staphylococcus aureus as shown in the figure below. In figure 6 shows bacteria isolated from infected wounds in which 62.5% were Methicillin sensitive Staphylococcus aureus (MSSA) and 37.5% were Methicillin Resistant Staphylococcus aureus (MRSA). DISCUSSION Socio-demographic characteristics of study participants The mean age of the study participants, which was 20 years with a standard deviation of 10 years, indicates that the population under investigation is relatively youthful. This observation aligns with the findings of a prior cross-sectional study conducted by [7], suggesting that younger individuals may be more susceptible to acquiring wounds. This susceptibility can be attributed to their potentially more active lifestyles, which can lead to a higher risk of injuries and subsequent wounds. A substantial portion of the wounds in this study (77.7%) originated from surgical procedures. This finding underscores the significance of healthcare-related factors in the context of wound infections. Surgical wounds are known to be particularly vulnerable to infection, and comprehending the patterns of susceptibility in this context is crucial for enhancing post-operative care and preventing complications. These findings are comparable with those from another cross-sectional study led by [3] where 71.2% of the wounds were linked to surgical procedures. Additionally, a noteworthy majority of participants (88.9%) had hospital stays of less than 5 days. This observation implies that a significant proportion of patients experienced relatively brief hospitalizations. This trend aligns with the results of a separate study conducted by [4], indicating that shorter hospital stays may reflect early positive responses to treatment options provided by healthcare providers, leading to early discharges. Etiological agents that cause wound infections among patients In this study, approximately 41.9% of the tested samples showed bacterial growth. This indicates that most of wound infections among patients in the study population are bacterial in nature. This finding highlights the importance of bacterial pathogens as a common cause of wound infections, which necessitates targeted antimicrobial therapy and infection prevention measures. The findings are however contrary to findings in a cross-sectional study carried out in Spain where only 5.1% showed bacterial growth. The latter study was however conducted in a developed setting in Europe where populations of higher socioeconomic status hence low chances of acquiring infections. Staphylococcus species were the most frequently identified bacteria, accounting for 36.4% of the bacterial infections observed. This finding has as well been observed in many similar studies with similar settings [4]. Staphylococcus spp are known pathogens commonly associated with skin and wound infections. The presence of Staphylococcus in a significant number of cases suggests that they play a prominent role in wound infections in this healthcare setting. It's important to note that Staphylococcus can include both methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) strains, which may have different implications for treatment and infection control. Pseudomonas aeruginosa and Klebsiella species were also identified in 5.7% and 15.9% of the bacterial infections, respectively. These bacteria are known for their ability to cause opportunistic infections, especially in healthcare settings. The presence of Pseudomonas aeruginosa is of particular concern because it is associated with multidrug resistance and can be challenging to treat. Klebsiella spp can also be opportunistic pathogens, and their presence in wound infections underscores the importance of infection control practices to prevent their spread. The findings from this study are comparable to those in a cross-sectional study by [1] which showed similar research findings. Acinetobacter baumannii was the least commonly observed bacterium, present in only 1.1% of the cases. While its occurrence was infrequent in this study, Acinetobacter baumannii is notorious for its ability to cause infections, including wound infections. Even a single case of Acinetobacter infection is noteworthy because it can indicate a potential problem with infection control practices or antibiotic resistance. The identification of MRSA in 37.5% of the Staphylococcus aureus isolates indicates a significant prevalence of antibiotic-resistant strains in the studied population. MRSA is a concern because it is often resistant to multiple classes of antibiotics, making it challenging to treat. This finding suggests that MRSA is a substantial public health issue in the studied area. They also highlight the importance of robust infection control measures in healthcare facilities. MRSA is often associated with healthcare-associated infections, and strict adherence to infection control protocols can help prevent its spread. Findings from this study are comparable to those in a separate cross-sectional study conducted in Kenya by [6] which showed similar results. Conclusion Bacterial pathogens, including Staphylococcus spp, Pseudomonas aeruginosa , and Klebsiella spp , were identified as the major culprits behind these infections. The presence of these bacteria underscores the importance of effective infection control measures, appropriate antibiotic selection, and ongoing surveillance to manage and prevent wound infections among patients. The rare observation of Acinetobacter baumannii highlights the need for vigilance in monitoring and controlling potential nosocomial pathogens. Abbreviations AMR: Antimicrobial Resistance, CLSI: Clinical Laboratory Standard Institute, MDR: Multiple Drug Resistant, MRRH : Mbale Regional Referral Hospital, MRSA: Methicillin-Resistant Staphylococcus Aureus, MUST: Mbarara University of Science and Technology, WHO: World Health Organization. Declarations Ethics approval and consent to participate This study was conducted in accordance with the Helsinki declaration guideline and ethical approval was done by Mbarara University of Science and Technology Research Ethics Committee ( MUST-2023-795 ). Administrative clearance was by MUST faculty research committee (FRC) and Mbale district Health Office. Written informed consent/assent were obtained from participants, enrolment was voluntary and participants could withdraw from the study at any time without consequences. Consent for publication Not applicable Availability of data and materials The data and materials utilized in this study are available, and all relevant data supporting the findings are included in this manuscript. Additionally, they can be accessed through the corresponding author. Other supplementary materials, such as raw data sets and consent forms, have been submitted to the system for access by the editorial team. Competing Interests The authors declare that there is no competing interest. Funding This study did not receive any specific funding, the research was carried out under the supervision of Mbarara University of Science of Science and Technology Faculty of Medicine, department of microbiology. Authors' contributions Habert Mabonga. He is the Principal investigator of the research study and he participated the protocol development. Associate Professor Joel Bazira. He participated the protocol development and manuscript review Professor Fredrick Byarugaba. He participated in the development of the research protocol and research supervisor at the proposal development Miss Tuhamize Barbra was the Co-Principal investigator for the research study and the research supervisor. Others Okot Hamson, Patrick Lulu and Butali Geofrey contributed to the data collection. All authors read and approved the final manuscript. Acknowledgements I thank the Almighty God for his grace, love, and faithfulness. It is with great pleasure and honor to take this special opportunity to thank my fantastic supervisors Miss Barbra Tuhamiza and Prof Byarugaba Fredrick for their continual advices, encouragements and generous support throughout my Masters project. I feel privileged to be with this excellent team in learning and getting guidance in world of microbiology. I extend my deepest gratitude to my colleague’s class of 2020 Mr. Robert Musisi, Mr. Francis Mumbowa, Miss. Akunda K Phiona, and Miss. Natuhwera Jemimah for the enthusiastic day-to-day guidance, attention to details and their commitment in assisting me to end this Master. I am also greatly indebted to Prof Joel Mbazira, Dr. Kabanda T, Mr. Kennedy Kasaza and entire staff of microbiology department MUST for their kind guidance and generous time in transferring knowledge and skills to me. am so grateful to the staffs Mbale Regional Referral Hospital especially in the department of microbiology Mr. Okot Hamson, Mr. Butali Geoffrey and the research nurses for their support during data collection. Special thanks to my friends Mr. Lulu Patrick D for his support from time I started studying MSc. Finally, I would like to offer my special thanks to my wife Miss Lydia Mabonga and my children Mabonga Jairus, Mabonga Jemimah, and Mabonga Joanah for their continual encouragement, prayers and support. References Ahmed, A.A. (2020) ‘Post Caesarean Wound sepsis and associated factors among patients attending a rural regional referral hospital in Western Uganda : A cross- sectional study’. doi:https://doi.org/10.21203/rs.2.24374/v1 License: Azene, K. (2011) ‘Bacteriology and antibiogram of pathogens from wound infections at Dessie Laboratory , North East Ethiopia’, 13(4), pp. 1–10. Bentounsi, Z. et al. (2021) ‘Surgical care in district hospitals in sub- ­ Saharan Africa : a scoping review’, pp. 1–11. doi:10.1136/bmjopen-2020-042862. Bhatta, D.R. et al. (2018) ‘Bacterial contamination of frequently touched objects in a tertiary care hospital of Pokhara , Nepal : how safe are our hands ?’, pp. 4–9. Chen, Y. et al. (2020) ‘Trends in microbial profile of burn patients following an event of dust explosion at a tertiary medical center’, pp. 1–11. Falcone, M. et al. (2021) ‘Journal of Global Antimicrobial Resistance Challenges in the management of chronic wound infections’, Journal of Global Antimicrobial Resistance , 26, pp. 140–147. doi:10.1016/j.jgar.2021.05.010. Kateete, D.P. et al. (2011) ‘High prevalence of methicillin resistant Staphylococcus aureus in the surgical units of Mulago hospital in Kampala , Uganda’. Leopold, S.J. et al. (2014) ‘Antimicrobial drug resistance among clinically relevant bacterial isolates in sub-Saharan Africa : a systematic review’, (May), pp. 2337–2353. doi:10.1093/jac/dku176. Lubega, A., Joel, B. and Lucy, N.J. (2017) ‘Incidence and Etiology of Surgical Site Infections among Emergency Postoperative Patients in Mbarara Regional Referral Hospital , South Western Uganda’, 2017. Mama, M., Abdissa, A. and Sewunet, T. (2014) ‘Antimicrobial susceptibility pattern of bacterial isolates from wound infection and their sensitivity to alternative topical agents at Jimma University’. Masifa, G. et al. (2018) ‘HHS Public Access’, 24(2). doi:10.9734/MRJI/2018/41690.Bacterial. Mohammed, A. et al. (2017) ‘Bacterial Isolates and Their Antimicrobial Susceptibility Patterns of Wound Infections among Inpatients and Outpatients Attending the University of Gondar Referral Hospital , Northwest Ethiopia’, 2017. Ngonzi, J. et al. (2018) ‘Incidence of postpartum infection , outcomes and associated risk factors at Mbarara regional referral hospital in Uganda’, pp. 1–11. Sandar, W. et al. (2021) ‘Wounds , Antimicrobial Resistance and Challenges of Implementing a Surveillance System in Myanmar : A Mixed-Methods Study’. Shiferaw, W.S., Aynalem, Y.A. and Akalu, T.Y. (2020) ‘Surgical site infection and its associated factors in Ethiopia : a systematic review and’, pp. 1–15. Slessor, M. (2016) ‘Bacterial pathogens associated with wound infections in Calabar, Nigeria’, (May). Tadesse, B.T. et al. (2017) ‘Antimicrobial resistance in Africa : a systematic review’, pp. 1–17. doi:10.1186/s12879-017-2713-1. Torpy, J.M., Burke, A. and Glass, R.M. (2015) ‘Wound Infections’, p. 7424. Available at: http://jama.jamanetwork.com. WHO (2014) ‘Antimicrobial resistance’. Available at: http://www.who.int/drugresistance/en/ ISBN. Additional Declarations No competing interests reported. Supplementary Files Susceptibilitypatternsofthemicrobes.pdf Sociodemographics.pdf Datasetofetiologicalagentsandsusceptibilitypatterns.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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06:32:36","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":297821,"visible":true,"origin":"","legend":"","description":"","filename":"Susceptibilitypatternsofthemicrobes.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5858549/v1/fc545093d4311df633291bb8.pdf"},{"id":80285462,"identity":"a4051c1a-130c-4550-a5e4-3cc2f7fa30b7","added_by":"auto","created_at":"2025-04-10 06:40:36","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":567651,"visible":true,"origin":"","legend":"","description":"","filename":"Sociodemographics.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5858549/v1/2e2f6e62cceb73180249003b.pdf"},{"id":80284436,"identity":"e0d8d5f1-4899-41cb-aca6-76cbadb916e3","added_by":"auto","created_at":"2025-04-10 06:32:36","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":874231,"visible":true,"origin":"","legend":"","description":"","filename":"Datasetofetiologicalagentsandsusceptibilitypatterns.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5858549/v1/6b8da609323c53db22567842.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAntimicrobial Susceptibility Patterns for Bacteria Isolated From Infected Wounds in Patients Attending Mbale Regional Referral Hospital\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA wound is defined as any physical or thermal injury that results in damage or disruption to the epidermis of the skin or mucous membranes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It's crucial to understand that wounds can occur from skin punctures caused by nails or thorns, as well as from abrasions or lacerations [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A wound infection occurs when bacteria settle and multiply in damaged tissue or skin, accompanied by a reaction from the host's immune system [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], it can lead to sepsis, which is a potentially life-threatening condition characterized by organ dysfunction [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and this can result in multiple organ failure and death due to septic shock [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWorldwide, approximately eight million individuals are estimated to have wounds, whether infected or not [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and wound infections contribute significantly to human illness and death, leading to issues such as sepsis, limb loss, extended hospitalizations, and increased medical expenses. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], this may occur due to the exposure of subcutaneous tissue after the skin's integrity is compromised, creating a moist, warm, and nutrient-rich environment that promotes microbial colonization and growth [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn developing countries, wound infections resulting from surgical procedures are a leading cause of illness and death, impacting approximately 5.6% of the total population [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Antimicrobial resistance hinders the management of infectious diseases by diminishing the effectiveness of treatments, causing patients to remain infectious for extended periods and raising the risk of transmitting resistant microorganisms to others [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and thus, there is a need to strengthen regulations on the use of antimicrobials, as they are the primary contributors to the emergence of drug-resistant pathogens [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] this results in a substantial burden of wounds affecting millions of people each year, along with complications such as dehiscence and problematic scarring [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Sub-Saharan Africa, a higher number of child deaths exhibited signs and symptoms of sepsis or septic shock [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], with Ethiopia has the highest rate of surgical wound infections [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], 90% of recorded Gram-negative bacteria showed resistance to chloramphenicol [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], Isolates of Haemophilus influenzae exhibited resistance to amoxicillin, while the resistance rate for quinolones was 37.5%. Carbapenem resistance was prevalent in Acinetobacter spp. and Pseudomonas aeruginosa but rare in Enterobacteriaceae [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Uganda, a high prevalence of wound sepsis was observed in the western region, with significant resistance noted against gentamicin, ceftriaxone, and ciprofloxacin [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and at Mbarara Regional Referral Hospital in southwestern Uganda, 81.93% of the 83 wound sample swabs collected yielded positive cultures, while 18.07% showed negative cultures [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. High prevalence of multidrug-resistant MRSA was observed in the burn unit of Mulago Hospital, putting patients at risk for infections with difficult-to-treat isolates and highlighting the necessity for enhanced infection control measures in this environment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Mbale Regional Referral Hospital, wound infections comprise 86.2%, with Staphylococcus aureus being the most common organism at 39.4%, followed by Escherichia coli at 21.2% and Klebsiella species at 14.4%. Of the 41 out of 104 isolated Staphylococcus aureus strains, 65.9% were MRSA, and 12.2% exhibited inducible resistance to clindamycin. The isolated Staphylococcus aureus demonstrated resistance to multiple drugs but remained susceptible to vancomycin and clindamycin [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003epopulation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc25349873\"\u003eThe study was a laboratory based cross sectional descriptive study, which included 210 out patients and inpatients with wounds at Mbale Regional Referral Hospital. For each of the consenting patient with an indication for a wound infection, a well labelled, sterile swab was collected. The samples were then packaged by inserting each container in a separate zip-lock bag and immediately transported to the Microbiology Laboratory.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe swab samples were inoculated and streaked directly on culture media such as on Blood agar, MacConkey agar and Chocolate agar and then incubated aerobically at 37\u0026deg;C overnight for 24 hours. The plate reading was done for samples on the following day. Gram staining was done to differentiate between Gram positive and Gram-negative isolates. A series of biochemical tests were used to identify the different organisms. Gram positive isolates were identified using catalase, coagulase and DNase tests. Gram negative isolates were identified using Indole, Voges\u0026ndash;Proskauer,\u0026nbsp;Urease, Simmons Citrate Agar, Triple sugar iron agar (TSI), and Oxidase test. Organisms identified to be significant pathogens were set-up for antibiotic susceptibility testing using the disc diffusion method on Mueller-Hinton agar as per the Clinical and Laboratory Standards Institute (CLSI) (2023). The drugs tested included Piperacillin, Piperacillin/tazobactam, Vancomycin, Cefoxitin, Erythromycin, Clindamycin, Tetracycline, Meropenem, Ciprofloxacin, Gentamicin, Ceftriaxone, Amoxicillin/Clavulanic acid, Ampicillin. Zone diameters of inhibition around the disc were measured using a Vernier caliper. Interpretations were done using the CLSI, 2023. Cefoxitin was used as a surrogate test for MRSA. Agar disk diffusion (Kirby Bauer) technique on 4% sodium chloride Mueller Hinton Agar (BBL\u003csup\u003eTM\u003c/sup\u003e, BD).\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc156756095\"\u003e\u003cstrong\u003eSource of Data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc156756101\"\u003eParticipants\u0026rsquo; demographic data and clinical presentation were obtained using a well-structured questionnaire as well as collection of information from laboratory cultures and susceptibility testing. The questionnaire used was used was developed for this study and has never been used in any other studies.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was entered and analyzed using STATA version 12 software. Chi-square statistics were computed to check statistically significant difference between the dependent and independent variables, univariate, bivariate and multivariate analysis were done to get the statistically significant results from the study. Presentation of data was in form of tables, pi-charts and figures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Helsinki declaration guideline and ethical approval was done by Mbarara University of Science and Technology Research Ethics Committee (MUST-2023-795). Administrative clearance was by MUST faculty research committee (FRC) and Mbale district Health Office. Written informed consent/assent were obtained from participants, enrolment was voluntary and participants could withdraw from the study at any time without consequences.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003ch2\u003e\u003cstrong\u003eSocio-demographic characteristics of study participants\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eMean age of study participants was 20 years with standard deviation of 10 years. About half 54.8% (115/210) were male and it is important to note that the highest percentage 82.4% (173/210) of the total patients had wounds resulting from a surgical procedure. Additionally, 80.5% (169/206) of the patients spent less than 5 days in admission (See table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e: Participants\u0026apos; socio-demographics\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequencies (n=210)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentages (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e1-17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e46.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e18-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e35.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e31+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e44.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e55.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWound cause\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eAccident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBurn\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eSurgical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e77.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc153355520\"\u003e\u003cstrong\u003eEtiological agents that cause wound infections among patients\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAbout 41.9% (88/210) of the tested samples had bacterial growth; of which 36.4% (32/88) had \u003cem\u003eStaphylococcus\u0026nbsp;\u003c/em\u003espp, 25.0% (22/88) had \u003cem\u003eEscherichia coli\u003c/em\u003e and 15.9% (14/88) had \u003cem\u003eKlebsiella\u0026nbsp;\u003c/em\u003espp. \u003cem\u003eAcinetobacter baumanii\u0026nbsp;\u003c/em\u003ewas the least observed in only one sample 1.1% (1/88) (table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e: Etiological agents that cause wound infections among patients\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequencies (n=210)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentages (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eObserved bacterial growth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e41.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eNo bacterial growth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e58.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIsolates (n=88)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus\u0026nbsp;\u003c/em\u003espp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e36.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003eStreptococcus pyogenes\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003eAcinetobacter baumanii\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003eEscherichia coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella\u0026nbsp;\u003c/em\u003espp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003eProteus\u0026nbsp;\u003c/em\u003espp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003eCitrobactor spp\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eCategories of bacteria observed.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf all the samples which had bacterial growth, about 60.2% had gram negative bacteria and only 39.8% had gram positive bacteria.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn\u003cem\u003e\u0026nbsp;\u003c/em\u003efigure 1 shows bacteria isolated from infected wounds in which 60.2% of bacteria isolated were gram positive and 39.8% were gram negative.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn\u003cem\u003e\u0026nbsp;\u003c/em\u003efigure 2 and figure 4, shows the sensitivity patterns were meropenem, vancomycin, and Piperacillin tazobactam were more sensitive to most of the bacteria isolates from wound swabs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn figure 3 and figure 5, these showed the resistance patterns, most antibiotics which had high resistance were Clindamycin, ampicillin, ceftriaxone, ciprofloxacin and amoxiclav\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethicillin Resistant Staphylococcus aureus (MRSA) among patients.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 32 isolates of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, more than a third 37.5% (12/32) were Methicillin Resistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (MRSA) and 62.5% (20/32) were Methicillin sensitive \u003cem\u003eStaphylococcus aureus\u003c/em\u003e as shown in the figure below.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn\u003cem\u003e\u0026nbsp;\u003c/em\u003efigure 6 shows bacteria isolated from infected wounds in which 62.5% were Methicillin sensitive \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (MSSA) and 37.5% were Methicillin Resistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (MRSA).\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003ch2\u003eSocio-demographic characteristics of study participants\u003c/h2\u003e\n\u003cp\u003eThe mean age of the study participants, which was 20 years with a standard deviation of 10 years, indicates that the population under investigation is relatively youthful. This observation aligns with the findings of a prior cross-sectional study conducted by [7], suggesting that younger individuals may be more susceptible to acquiring wounds. This susceptibility can be attributed to their potentially more active lifestyles, which can lead to a higher risk of injuries and subsequent wounds.\u003c/p\u003e\n\u003cp\u003eA substantial portion of the wounds in this study (77.7%) originated from surgical procedures. This finding underscores the significance of healthcare-related factors in the context of wound infections. Surgical wounds are known to be particularly vulnerable to infection, and comprehending the patterns of susceptibility in this context is crucial for enhancing post-operative care and preventing complications. These findings are comparable with those from another cross-sectional study led by [3] where 71.2% of the wounds were linked to surgical procedures.\u003c/p\u003e\n\u003cp\u003eAdditionally, a noteworthy majority of participants (88.9%) had hospital stays of less than 5 days. This observation implies that a significant proportion of patients experienced relatively brief hospitalizations. This trend aligns with the results of a separate study conducted by [4], indicating that shorter hospital stays may reflect early positive responses to treatment options provided by healthcare providers, leading to early discharges.\u003c/p\u003e\n\u003ch2 id=\"_Toc153355525\"\u003eEtiological agents that cause wound infections among patients\u003c/h2\u003e\n\u003cp\u003eIn this study, approximately 41.9% of the tested samples showed bacterial growth. This indicates that most of wound infections among patients in the study population are bacterial in nature. This finding highlights the importance of bacterial pathogens as a common cause of wound infections, which necessitates targeted antimicrobial therapy and infection prevention measures. The findings are however contrary to findings in a cross-sectional study carried out in Spain where only 5.1% showed bacterial growth. The latter study was however conducted in a developed setting in Europe where populations of higher socioeconomic status hence low chances of acquiring infections.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStaphylococcus\u003c/em\u003e species were the most frequently identified bacteria, accounting for 36.4% of the bacterial infections observed. This finding has as well been observed in many similar studies with similar settings [4]. \u003cem\u003eStaphylococcus\u003c/em\u003e spp are known pathogens commonly associated with skin and wound infections. The presence of \u003cem\u003eStaphylococcus\u003c/em\u003e in a significant number of cases suggests that they play a prominent role in wound infections in this healthcare setting. It\u0026apos;s important to note that \u003cem\u003eStaphylococcus\u003c/em\u003e can include both methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) strains, which may have different implications for treatment and infection control.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e and Klebsiella species were also identified in 5.7% and 15.9% of the bacterial infections, respectively. These bacteria are known for their ability to cause opportunistic infections, especially in healthcare settings. The presence of \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e is of particular concern because it is associated with multidrug resistance and can be challenging to treat. \u003cem\u003eKlebsiella spp\u003c/em\u003e can also be opportunistic pathogens, and their presence in wound infections underscores the importance of infection control practices to prevent their spread. The findings from this study are comparable to those in a cross-sectional study by [1] which showed similar research findings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcinetobacter baumannii\u003c/em\u003e was the least commonly observed bacterium, present in only 1.1% of the cases. While its occurrence was infrequent in this study, \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e is notorious for its ability to cause infections, including wound infections. Even a single case of Acinetobacter infection is noteworthy because it can indicate a potential problem with infection control practices or antibiotic resistance.\u003c/p\u003e\n\u003cp\u003eThe identification of MRSA in 37.5% of the \u003cem\u003eStaphylococcus aureus\u003c/em\u003e isolates indicates a significant prevalence of antibiotic-resistant strains in the studied population. MRSA is a concern because it is often resistant to multiple classes of antibiotics, making it challenging to treat. This finding suggests that MRSA is a substantial public health issue in the studied area. They also highlight the importance of robust infection control measures in healthcare facilities. MRSA is often associated with healthcare-associated infections, and strict adherence to infection control protocols can help prevent its spread. Findings from this study are comparable to those in a separate cross-sectional study conducted in Kenya by [6] which showed similar results. \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBacterial pathogens, including \u003cem\u003eStaphylococcus spp, Pseudomonas aeruginosa\u003c/em\u003e, and \u003cem\u003eKlebsiella spp\u003c/em\u003e, were identified as the major culprits behind these infections. The presence of these bacteria underscores the importance of effective infection control measures, appropriate antibiotic selection, and ongoing surveillance to manage and prevent wound infections among patients. The rare observation of \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e highlights the need for vigilance in monitoring and controlling potential nosocomial pathogens.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAMR: Antimicrobial Resistance, \u003c/p\u003e\n\u003cp\u003eCLSI: Clinical Laboratory Standard Institute, \u003c/p\u003e\n\u003cp\u003eMDR: Multiple Drug Resistant, \u003c/p\u003e\n\u003cp\u003eMRRH : Mbale Regional Referral Hospital, \u003c/p\u003e\n\u003cp\u003eMRSA: Methicillin-Resistant Staphylococcus Aureus, \u003c/p\u003e\n\u003cp\u003eMUST: Mbarara University of Science and Technology, \u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Helsinki declaration guideline and ethical approval was done by Mbarara University of Science and Technology Research Ethics Committee (\u003cstrong\u003eMUST-2023-795\u003c/strong\u003e). Administrative clearance was by MUST faculty research committee (FRC) and Mbale district Health Office. Written informed consent/assent were obtained from participants, enrolment was voluntary and participants could withdraw from the study at any time without consequences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data and materials utilized in this study are available, and all relevant data supporting the findings are included in this manuscript. Additionally, they can be accessed through the corresponding author. Other supplementary materials, such as raw data sets and consent forms, have been submitted to the system for access by the editorial team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no competing interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any specific funding, the research was carried out under the supervision of Mbarara University of Science of Science and Technology Faculty of Medicine, department of microbiology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHabert Mabonga. He is the Principal investigator of the research study and he participated the protocol development.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAssociate Professor Joel Bazira. He participated the protocol development and manuscript review\u003c/p\u003e\n\u003cp\u003eProfessor Fredrick Byarugaba. He participated in the development of the research protocol and research supervisor at the proposal development\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMiss Tuhamize Barbra was the Co-Principal investigator for the research study and the research supervisor.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOthers Okot Hamson, Patrick Lulu and Butali Geofrey contributed to the data collection. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI thank the Almighty God for his grace, love, and faithfulness.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt is with great pleasure and honor to take this special opportunity to thank my fantastic supervisors Miss Barbra Tuhamiza and Prof Byarugaba Fredrick for their continual advices, encouragements and generous support throughout my Masters project. I feel privileged to be with this excellent team in learning and getting guidance in world of microbiology. I extend my deepest gratitude to my colleague\u0026rsquo;s class of 2020 Mr. Robert Musisi, Mr. Francis Mumbowa, Miss. Akunda K Phiona, and Miss. Natuhwera Jemimah for the enthusiastic day-to-day guidance, attention to details and their commitment in assisting me to end this Master. I am also greatly indebted to Prof Joel Mbazira, Dr. Kabanda T, Mr. Kennedy Kasaza and entire staff of microbiology department MUST for their kind guidance and generous time in transferring knowledge and skills to me. am so grateful to the staffs Mbale Regional Referral Hospital especially in the department of microbiology Mr. Okot Hamson, Mr. Butali Geoffrey and the research nurses for their support during data collection. Special thanks to my friends Mr. Lulu Patrick D for his support from time I started studying MSc. Finally, I would like to offer my special thanks to my wife Miss Lydia Mabonga and my children Mabonga Jairus, Mabonga Jemimah, and Mabonga Joanah for their continual encouragement, prayers and support.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAhmed, A.A. (2020) \u0026lsquo;Post Caesarean Wound sepsis and associated factors among patients attending a rural regional referral hospital in Western Uganda : A cross- sectional study\u0026rsquo;. doi:https://doi.org/10.21203/rs.2.24374/v1 License:\u003c/li\u003e\n \u003cli\u003eAzene, K. (2011) \u0026lsquo;Bacteriology and antibiogram of pathogens from wound infections at Dessie Laboratory , North East Ethiopia\u0026rsquo;, 13(4), pp. 1\u0026ndash;10.\u003c/li\u003e\n \u003cli\u003eBentounsi, Z. \u003cem\u003eet al.\u003c/em\u003e (2021) \u0026lsquo;Surgical care in district hospitals in sub- \u0026shy; Saharan Africa : a scoping review\u0026rsquo;, pp. 1\u0026ndash;11. doi:10.1136/bmjopen-2020-042862.\u003c/li\u003e\n \u003cli\u003eBhatta, D.R. \u003cem\u003eet al.\u003c/em\u003e (2018) \u0026lsquo;Bacterial contamination of frequently touched objects in a tertiary care hospital of Pokhara , Nepal : how safe are our hands ?\u0026rsquo;, pp. 4\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eChen, Y. \u003cem\u003eet al.\u003c/em\u003e (2020) \u0026lsquo;Trends in microbial profile of burn patients following an event of dust explosion at a tertiary medical center\u0026rsquo;, pp. 1\u0026ndash;11.\u003c/li\u003e\n \u003cli\u003eFalcone, M. \u003cem\u003eet al.\u003c/em\u003e (2021) \u0026lsquo;Journal of Global Antimicrobial Resistance Challenges in the management of chronic wound infections\u0026rsquo;, \u003cem\u003eJournal of Global Antimicrobial Resistance\u003c/em\u003e, 26, pp. 140\u0026ndash;147. doi:10.1016/j.jgar.2021.05.010.\u003c/li\u003e\n \u003cli\u003eKateete, D.P. \u003cem\u003eet al.\u003c/em\u003e (2011) \u0026lsquo;High prevalence of methicillin resistant Staphylococcus aureus in the surgical units of Mulago hospital in Kampala , Uganda\u0026rsquo;.\u003c/li\u003e\n \u003cli\u003eLeopold, S.J. \u003cem\u003eet al.\u003c/em\u003e (2014) \u0026lsquo;Antimicrobial drug resistance among clinically relevant bacterial isolates in sub-Saharan Africa : a systematic review\u0026rsquo;, (May), pp. 2337\u0026ndash;2353. doi:10.1093/jac/dku176.\u003c/li\u003e\n \u003cli\u003eLubega, A., Joel, B. and Lucy, N.J. (2017) \u0026lsquo;Incidence and Etiology of Surgical Site Infections among Emergency Postoperative Patients in Mbarara Regional Referral Hospital , South Western Uganda\u0026rsquo;, 2017.\u003c/li\u003e\n \u003cli\u003eMama, M., Abdissa, A. and Sewunet, T. (2014) \u0026lsquo;Antimicrobial susceptibility pattern of bacterial isolates from wound infection and their sensitivity to alternative topical agents at Jimma University\u0026rsquo;.\u003c/li\u003e\n \u003cli\u003eMasifa, G. \u003cem\u003eet al.\u003c/em\u003e (2018) \u0026lsquo;HHS Public Access\u0026rsquo;, 24(2). doi:10.9734/MRJI/2018/41690.Bacterial.\u003c/li\u003e\n \u003cli\u003eMohammed, A. \u003cem\u003eet al.\u003c/em\u003e (2017) \u0026lsquo;Bacterial Isolates and Their Antimicrobial Susceptibility Patterns of Wound Infections among Inpatients and Outpatients Attending the University of Gondar Referral Hospital , Northwest Ethiopia\u0026rsquo;, 2017.\u003c/li\u003e\n \u003cli\u003eNgonzi, J. \u003cem\u003eet al.\u003c/em\u003e (2018) \u0026lsquo;Incidence of postpartum infection , outcomes and associated risk factors at Mbarara regional referral hospital in Uganda\u0026rsquo;, pp. 1\u0026ndash;11.\u003c/li\u003e\n \u003cli\u003eSandar, W. \u003cem\u003eet al.\u003c/em\u003e (2021) \u0026lsquo;Wounds , Antimicrobial Resistance and Challenges of Implementing a Surveillance System in Myanmar : A Mixed-Methods Study\u0026rsquo;.\u003c/li\u003e\n \u003cli\u003eShiferaw, W.S., Aynalem, Y.A. and Akalu, T.Y. (2020) \u0026lsquo;Surgical site infection and its associated factors in Ethiopia : a systematic review and\u0026rsquo;, pp. 1\u0026ndash;15.\u003c/li\u003e\n \u003cli\u003eSlessor, M. (2016) \u0026lsquo;Bacterial pathogens associated with wound infections in Calabar, Nigeria\u0026rsquo;, (May).\u003c/li\u003e\n \u003cli\u003eTadesse, B.T. \u003cem\u003eet al.\u003c/em\u003e (2017) \u0026lsquo;Antimicrobial resistance in Africa : a systematic review\u0026rsquo;, pp. 1\u0026ndash;17. doi:10.1186/s12879-017-2713-1.\u003c/li\u003e\n \u003cli\u003eTorpy, J.M., Burke, A. and Glass, R.M. (2015) \u0026lsquo;Wound Infections\u0026rsquo;, p. 7424. Available at: http://jama.jamanetwork.com.\u003c/li\u003e\n \u003cli\u003eWHO (2014) \u0026lsquo;Antimicrobial resistance\u0026rsquo;. Available at: http://www.who.int/drugresistance/en/ ISBN.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Antimicrobial agent, susceptibility, wound infections, isolates, bacteria","lastPublishedDoi":"10.21203/rs.3.rs-5858549/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5858549/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Approximately eight million people worldwide are estimated to have wounds, both infected and uninfected, with wound infections causing considerable illness and death. In Uganda, a notable prevalence of wound sepsis has been reported in the western region, along with a significant level of antibiotic resistance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003ea laboratory based descriptive cross-sectional study where 210 wound swab samples were collected, cultured which employed quantitative data collection method and analysis. Sample size 210 determined using Kish and Leslie formula (1965). Wound sample swaps collected, cultured, microscopic and antibiotic susceptibility testing done. Data analyzed using STATA version 12 software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e41.9% (88/210) of the tested samples had bacterial growth of which 36.4% (32/88) had \u003cem\u003eStaphylococcus \u003c/em\u003espp, 25.0% (22/88) had \u003cem\u003eEscherichia coli\u003c/em\u003e and 15.9% (14/88) had \u003cem\u003eKlebsiella \u003c/em\u003espp. \u003cem\u003eAcinetobacter baumanii \u003c/em\u003ewas the least observed in only 1.1% (1/88) samples. 16.2% (34/210) of the samples had gram positive bacteria, only 25.7% (54/210) had gram negative bacteria. There was no observed bacterial growth in 58.1% (122/210) of the analyzed samples. More than a third 37.5% (12/32) were Methicillin Resistant Staphylococcus aureus (MRSA) and 62.5% (20/32) were Methicillin sensitive Staphylococcus aureus.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Antimicrobial susceptibility patterns of isolates bacteria such as \u003cem\u003eStaphylococcus\u003c/em\u003e \u003cem\u003espp,\u003c/em\u003e \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e, and \u003cem\u003eKlebsiella spp\u003c/em\u003e, were identified as the major culprits behind wound infections.\u003c/p\u003e","manuscriptTitle":"Antimicrobial Susceptibility Patterns for Bacteria Isolated From Infected Wounds in Patients Attending Mbale Regional Referral Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-10 06:32:31","doi":"10.21203/rs.3.rs-5858549/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"715bc08b-4d2d-42cc-a14a-e0ff76fc8a97","owner":[],"postedDate":"April 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":46908381,"name":"Biological sciences/Microbiology"},{"id":46908382,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2025-06-25T11:08:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-10 06:32:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5858549","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5858549","identity":"rs-5858549","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}