FREQUENCY AND TREATMENT OF METHHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS IN OBSTETRIC AND GYNECOLOGICAL SEPSIS AT TERTIARY CARE HOSPITAL

ABSTRACT 

Aims: To perform culture and sensitivity for pathogens causing puerperal and postoperative wound sepsis, and see the frequency of Methicillin Resistant Staphylococcus Aureus in such infections. 

Setting: Obstetric & Gynecology ward in Jinnah Postgraduate Medical Center from Dec 2008 to May 2010. 

Methods: All patients presenting with puerperal sepsis or post operative infected wounds were enrolled in the study. Pus was collected for culture and sensitivity using standard technique one before starting the treatment and was sent to the laboratory in Ames transport medium. Empirical treatment with triple regimen (Ampicillin, Metronidazole, and Gentamicin) was started immediately to cover gram positive as well as negative bacteria in addition to anaerobic infection. After receiving the sensitivity report, antimicrobial agent were changed accordingly. Samples from ward and theater staff and environment were also taken to look for possible mode of transmission. Data was recorded on a proforma. Discrete variables are expressed as percentages; two by two table method was used to calculate drug sensitivity. A p- value < 0.05 was considered as statistically significant. Calculations were performed with statistical software package SPSS. 

Results: One hundred and fifty cases were enrolled. Staphylococcus aureus was the most frequent organism isolated in, 34.6 % cases. Methicillin Sensitive Staphylococcus aureus was seen in 20% cases and Methicillin Resistant Staphylococcus Aureus was seen in 14.6%.  Out of these 14.6% Methicillin Resistant Staphylococcus aureus, 77% were associated with puerperal sepsis and rest 23% were associated with post operative wound infection. Second commonest organism was E.coli, seen in 34% cases and it showed best sensitivity to amikacin. 

Conclusions: Staphylococcus aureus and E.coli were the common causative agents of post operative infections and puerperal sepsis.