Co esponding au ho : Ma k-Ogu, C.S
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
An imic obial esis ance in clinical wound in ec ions: A s udy on Esche ichia coli and
Pseudomonas ae uginosa isola es om pa ien s in Imo s a e, Nige ia
Chioma S. Ma k-Ogu *, Enuma E. Mike-Anosike, and Chinwe I. Chikwendu
Depa men o Mic obiology, Fede al Uni e si y o Technology, Owe i, Nige ia.
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 216-222
Publica ion his o y: Recei ed on 09 Sep embe 2025; e ised on 19 Oc obe 2025; accep ed on 22 Oc obe 2025
A icle DOI: h ps://doi.o g/10.30574/gscbps.2025.33.1.0401
Abs ac
Backg ound: The g owing esis ance o Esche ichia coli and Pseudomonas ae uginosa o an imic obial ea men s poses
a majo public heal h conce n, pa icula ly in he ea men o hospi al-acqui ed wound in ec ions.
Aim: This s udy in es iga ed he an imic obial esis ance p o ile o Esche ichia coli and Pseudomonas ae uginosa
isola ed om pa ien s wi h wound in ec ions in Imo S a e, Nige ia.
S udy Design: A o al o 76 bac e ial isola es, comp ising Esche ichia coli and Pseudomonas ae uginosa, we e eco e ed
om pa ien s wi h clinically in ec ed wounds and subjec ed o an imic obial suscep ibili y es ing agains a panel o
an ibio ics ep esen ing mul iple an ibio ic classes, o de e mine hei an imic obial esis ance p o iles.
Me hodology: An imic obial suscep ibili y es ing was pe o med using he disc di usion me hod, as ou lined in he
Clinical and Labo a o y S anda ds Ins i u e CLSI (2017) guidelines. The isola es we e es ed agains cephalospo ins,
ca bapenems, polymyxins, and quinolones, which include ce azidime (10μg), ce iaxone (30μg), ce epime (30μg),
imipenem (10μg), me openem (10μg), colis in (10μg), polymyxin B (30μg), cip o loxacin (5μg), and le o loxacin (5μg),
o de e mine suscep ibili y p o iles.
Resul s: Findings e ealed a high p e alence o mul id ug esis ance (MDR) among he g am-nega i e bac e ial isola es,
wi h a subs an ial p opo ion o isola es exhibi ing esis ance o h ee o mo e an ibio ic classes. Speci ically, 43.9%
(18) o Pseudomonas ae uginosa and 45.71% (16) o Esche ichia coli isola es we e iden i ied as MDR.
No ably, a signi ican numbe o Esche ichia coli and Pseudomonas ae uginosa isola es exhibi ed esis ance o a ious
an ibio ic classes, including cephalospo ins, ca bapenems, polymyxins, and quinolones. Howe e , ca bapenems
demons a ed ema kable e icacy, wi h a signi ican majo i y o isola es showing suscep ibili y — 92.68% o
Pseudomonas ae uginosa and 90% o Esche ichia coli isola es.
Conclusion: The s udy highligh s he u gen need o obus an imic obial s ewa dship and in ec ion con ol p ac ices
o p ese e he e icacy o a ailable an ibio ics in he ea men o clinical wound in ec ions.
Keywo ds: Pseudomonas ae uginosa; Esche ichia coli; Wound in ec ion; Mul id ug esis ance; An imic obial
esis ance; Ca bapenems
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1. In oduc ion
An ibio ic esis ance has eme ged as a signi ican challenge in heal hca e, pa icula ly in he managemen o wound
in ec ions. The o e use and misuse o an ibio ics ha e con ibu ed o he p oli e a ion o mul id ug- esis an bac e ia,
complica ing he ea men o wounds and comp omising pa ien ou comes (Magio akos e al., 2012). Among he mos
conce ning a e mul id ug- esis an g am-nega i e bac e ia, such as Pseudomonas ae uginosa and Esche ichia coli, which
a e no o ious o hei abili y o cause se e e and di icul - o- ea in ec ions (Gajdács & U bán, 2021).
These mul id ug- esis an pa hogens pose unique challenges in wound managemen due o hei esis ance o mul iple
classes o an ibio ics. T adi ional ea men app oaches o en ail o e adica e hese bac e ia, leading o p olonged
healing imes, ecu en in ec ions, and inc eased mo bidi y and mo ali y a es (Gajdács & U bán, 2021). Fu he mo e,
he p esence o mul id ug- esis an g am-nega i e bac e ia in wounds complica es su gical p ocedu es and inc eases
he isk o sys emic in ec ions, u he exace ba ing he clinical bu den (Magio akos e al., 2012).
These pa hogens equen ly o m bio ilms, which educe an ibio ic pene a ion and inc ease ole ance (Oli ei a e al.,
2018). Bo h species a e on he WHO p io i y lis and a e pa o he ESKAPE g oup— (En e ococcus aecium,
S aphylococcus au eus, Klebsiella pneumoniae, Acine obac e baumannii, Pseudomonas ae uginosa, and En e obac e
spp.—so named o hei abili y o “escape” many an ibio ics (Zhen e al., 2019; An onelli e al., 2021).
Pseudomonas ae uginosa and Esche ichia coli a e also among he mos common colonize s o in ec ed wounds and a e
p oli ic bio ilm o me s. Bio ilms a e a majo p oblem in in ec ions due o hei inc easingly di icul con ol and
e adica ion, and ole ance o mul iple p esc ibed d ugs. (Oli ei a e . al., 2018).
In Nige ia, whe e wound in ec ions a e p e alen , unde s anding he an imic obial esis ance o hese bac e ia is c ucial
o e ec i e wound managemen . The e o e, his s udy aims o in es iga e he an imic obial esis ance o Esche ichia
coli and Pseudomonas ae uginosa isola es om pa ien s wi h wound in ec ions in Imo S a e.
2. Me hodology
2.1. S udy a ea
The esea ch was conduc ed in Imo S a e, Nige ia, ac oss he Owe i, O lu, and Okigwe zones. Hospi als and heal h
cen e s in hese zones se ed as collec ion cen e s; analyses we e pe o med a he Fede al Uni e si y Teaching
Hospi al, Owe i (FUTHO).
Inclusion c i e ia we e wounded pa ien s who p o ided in o med consen . The s udy pu pose was explained o
pa icipan s o gua dians; con iden iali y was assu ed.
2.2. Sample Collec ion
A o al o 210 wound specimens we e collec ed om acciden , o hopedic, and su gical wa ds ac oss h ee hospi als:
Fede al Uni e si y Teaching Hospi al, Owe i (FUTHO; n = 159), Imo S a e Uni e si y Teaching Hospi al, O lu (n = 28),
and Gene al Hospi al, Okigwe (n = 23). Wound swabs we e asep ically collec ed and anspo ed o he FUTHO
Mic obiology Labo a o y in 0.5 mL s e ile no mal saline.
2.3. Isola ion o O ganisms
The Ce imide aga and MacConkey Aga (Ti an Bio ech L d, India) we e p epa ed acco ding o he manu ac u e ’s
ins uc ions o he p ima y isola ion o Pseudomonas ae uginosa and Esche ichia coli, espec i ely, by s eaking he
wound swabs on o he su ace o he p epa ed media (Cheesb ough, 2006). Colonies we e sub-cul u ed on o nu ien
aga ; pu e cul u es we e ob ained by epea ed s eaking and incuba ed a 37°C o 24 hou s.
2.4. Iden i ica ion o Isola es:
Iden i ica ion and con i ma ion we e based on mo phology, cul u al cha ac e is ics, and biochemical es s
(Cheesb ough, 2006).
Pseudomonas ae uginosa colonies we e la ge, la , and blue-g een; G am-nega i e and oxidase-posi i e. Esche ichia coli
colonies on MacConkey aga we e lac ose- e men ing ( eddish-pink); G am-nega i e, ca alase-posi i e, oxidase-
nega i e.
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 216-222
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2.5. An imic obial Resis ance Tes ing:
Ki by–Baue disc di usion was pe o med on Muelle –Hin on aga . Inocula we e s anda dized o 1.5 × 108 CFU/mL
using 0.5 McFa land s anda ds; 0.1 mL was sp ead pe pla e. An ibio ic discs included ce azidime (30 µg), ce iaxone
(30 µg), ce epime (30 µg), imipenem (10 µg), me openem (10 µg), cip o loxacin (5 µg), le o loxacin (5 µg), colis in (10
µg), and polymyxin B (300 µg). Zones we e in e p e ed pe CLSI (2017).
2.6. Da a Analysis and In e p e a ion
Means we e analyzed using SPSS 23.0 and Mic oso Excel. ANOVA was applied o mul i-g oup compa isons, ollowed
by Duncan’s es o de e mine signi ican g oup di e ences.
3. Resul s
3.1. Occu ence (%) o bac e ial isola es eco e ed om wound specimens
Ou o 210 wound specimens, 76 (36.2%) we e posi i e o ei he Pseudomonas ae uginosa (n = 41) o Esche ichia coli
(n = 35). Owe i eco ded he highes occu ence (20.48%), ollowed by O lu (10.48%) and Okigwe (5.24%).
By o ganism: Owe i showed he highes occu ence o Pseudomonas ae uginosa (11.43%), while Okigwe had he lowes
(2.86%). Fo Esche ichia coli, Owe i eco ded 9.53% and O lu 2.38%. No signi ican di e ences we e obse ed ac oss
zones. These a e shown in Table 1.
3.2. An imic obial suscep ibili y p o ile o P. ae uginosa isola es
Among Pseudomonas ae uginosa isola es, esis ance was highes o ce iaxone (95.12%; P = 0.0122), ollowed by
ce epime (90.24%) and ce azidime (87.80%). Suscep ibili y was highes o me openem (95.12%) and imipenem
(90.24%). ANOVA indica ed esis an isola es we e signi ican ly mo e equen (P = 0.0160). These a e shown in Table
2.
3.3. An imic obial suscep ibili y p o ile o E. coli isola es
Esche ichia coli isola es showed high esis ance o colis in and polymyxin B (94.29% each). Ce iaxone esis ance was
51.43%. Imipenem showed he highes suscep ibili y (91.43%; P = 0.0092). See Table 3 o de ails.
3.4. Mul i-d ug esis ance p o iles o he G am-nega i e bac e ial isola es
Among G am-nega i e isola es, 89.61% we e MDR; 10.39% we e suscep ible o all ou an ibio ic classes. O MDR
isola es, 43.9% we e Pseudomonas ae uginosa (n = 18) and 45.71% we e Esche ichia coli (n = 16). (Figu e 1).
Table 1 To al dis ibu ion (%) o wound in ec ions among zones s udied
ZONES
No. o
Samples
(n=210)
No. o pe sons in ec ed
(n=76)
No. In ec ed wi h P. ae uginosa
(n=41)
No. In ec ed wi h
E. coli
(n=35)
Okigwe
23 (11.0)
11 (5.24)
6 (2.86)
5 (2.38)
O lu
28 (13.3)
22 (10.48)
11 (5.24)
10 (4.76)
Owe i
159 (75.7)
43 (20.48)
24 (11.43)
20 (9.53)
To al
210 (100)
76 (36.20)
41 (19.53)
35 (16.67)
Table 2 An ibio ic suscep ibili y p o ile (%) o Pseudomonas ae uginosa
ANTIBIOTICS
PSEUDOMONAS AERUGINOSA
(n=41)
Sensi i e
Resis an
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 216-222
219
CRO
2 (4.88)
39 (95.12)
FEP
4 (9.76)
37 (90.24)
CAZ
5 (12.2)
36 (87.80)
LVX
24 (58.54)
17 (41.46)
CPX
25 (60.98)
16 (39.02)
CST
36 (87.80)
5(12.2)
POL
36 (87.80)
5 (12.2)
MEM
37 (90.24)
4 (9.76)
IPM
39 (95.12)
2 (4.88)
Key: MEM: Me openem; POL: Polymyxin B; CPX: Cip o loxacin; CAZ: Ce azidime; CRO: Ce iaxone; IPM: Imipenem; CST: Colis in; FEP: Ce epime;
LVX: Le o loxacin
Table 3 An ibio ic suscep ibili y p o ile (%) o Esche ichia coli
An ibio ics
Esche ichia coli n=35
Sensi i e
Resis an
POL
2 (5.71)
33 (94.29)
CST
2 (5.71)
33 (94.29)
CRO
17 (48.57)
18 (51.43)
FEP
20 (57.14)
15 (42.86)
CAZ
21 (60.00)
14 (40.00)
LVX
26 (74.29)
9 (25.71)
CPX
28 (80.00)
7(20.00)
MEM
32 (91.43)
3 (8.57)
IPM
32 (91.43)
3 (8.57)
Key: MEM: Me openem; POL: Polymyxin B; CPX: Cip o loxacin; CAZ: Ce azidime; CRO: Ce iaxone; IPM: Imipenem; CST: Colis in; FEP: Ce epime;
Key: R0: Sensi i e agains all selec ed an imic obial classes; R1-2: Resis an o one o wo an imic obial classes; R3-9: Resis an o h ee o ou
an imic obial classes. MDR: Resis an o mo e han h ee an imic obial classes.
Figu e 1 Mul i-D ug Resis ance (MDR) P o iles o G am-Nega i e Pseudomonas ae uginosa and Esche ichia coli
Isola ed om Wound In ec ions
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 216-222
220
4. Discussion
This s udy ound ha Pseudomonas ae uginosa and Esche ichia coli wound in ec ions a e widesp ead in Imo S a e, wi h
an o e all p e alence o 36.2% (76/210). P. ae uginosa and E. coli had in ec ion a es o 19.53% and 16.67%,
espec i ely. Howe e , he ype and le el o in ec ion a ied ac oss zones, wi h Owe i showing he highes p e alence
(75.7%), ollowed by O lu (28%) and Okigwe (23%). These indings a e consis en wi h a p e ious s udy by Ohale e e
al. (2019) in Owe i, which epo ed in ec ion a es o 22.3% o P. ae uginosa and 13.1% o E. coli, wi h p e alence
a es o 78.7% in Owe i, 14% in O lu, and 7.3% in Okigwe. The highe p e alence in Owe i may be a ibu ed o ac o s
such as u baniza ion, mig a ion, and g ea e access o heal hca e, bu he di e ence was no s a is ically signi ican (P
> 0.05). The obse ed p e alence o hese in ec ions may also be in luenced by ac o s such as poo hygiene,
o e c owding, an ibio ic misuse, and inadequa e public heal h awa eness.
The p esen s udy obse ed a sligh ly lowe p e alence o E. coli (16.67%) compa ed o P. ae uginosa (19.53%), which
con as s wi h indings om Tom e al. (2019) in Bauchi, Nige ia, whe e E. coli p e alence (23.64%) exceeded ha o P.
ae uginosa (19.12%). Simila ly, his di e s om he esul s o Ohale e e al. (2019) in Imo S a e, who epo ed a
p e alence o 13.1% o E. coli and 22.3% o P. ae uginosa. Such disc epancies highligh he a iabili y o mic obial
p e alence ac oss egions and emphasize he need o heal hca e acili ies o iden i y hei p edominan pa hogens and
associa ed esis ance pa e ns (Pondei e al., 2013). Despi e hese a ia ions, ou indings con i m he in ol emen o
bo h P. ae uginosa and E. coli in wound in ec ions, consis en wi h he epo by De Oli ei a e al. (2020).
Pseudomonas spp. a e equen ly implica ed in nosocomial in ec ions, including pneumonia, u ina y ac in ec ions,
su gical si e in ec ions, bu ns, and in ec ions among pa ien s unde going chemo he apy o p olonged an ibio ic he apy
(Spagnolo e al., 2021). P. ae uginosa exhibi s in insic esis ance o mul iple an ibio ics due o i s low ou e memb ane
pe meabili y, inducible cephalospo inase p oduc ion, ac i e e lux mechanisms, and educed a ini y o DNA gy ase
(Umo u e al., 2018). The p esen s udy e ealed high esis ance o cephalospo ins, wi h 95.12% esis ance o
ce iaxone and 87.80% o ce azidime, aligning wi h p e ious epo s (Ya ollahi e al., 2018). This esis ance pa e n is
likely associa ed wi h he p oduc ion o ex ended-spec um be a-lac amases (ESBLs). Con e sely, P. ae uginosa
demons a ed high sensi i i y o ca bapenems, wi h 95.12% suscep ibili y o imipenem and 90.24% o me openem,
consis en wi h ea lie indings (Ja iya e al., 2008). This sensi i i y may be a ibu ed o he abili y o imipenem o
pene a e he ou e memb ane and inhibi cell wall syn hesis, esul ing in bac e ial dea h (Ja iya e al., 2008).
E. coli was also isola ed in signi ican numbe s alongside Pseudomonas ae uginosa. As a no mal gas oin es inal
inhabi an , E. coli can cause skin and wound in ec ions, pa icula ly in indi iduals wi h poo hygiene o ecal
con amina ion, as well as in pos ope a i e pa ien s (Sahu e al., 2011). An imic obial suscep ibili y es ing showed high
esis ance o colis in and polymyxin B (94.29%), ollowed by ce iaxone (51.43%). This esis ance is consis en wi h
p e ious s udies (Olai an e al., 2014), which demons a ed ha E. coli employs se e al mechanisms o e ade polymyxin
ac ion, including lipopolysaccha ide modi ica ion, e lux pump ac i a ion, capsule o ma ion, and ou e memb ane
p o ein al e a ion. Howe e , imipenem demons a ed s ong ac i i y (91.43% sensi i i y), consis en wi h epo s by
Joly-Guillou e al. (2010), whe e imipenem and me openem achie ed 100% suscep ibili y agains E. coli. This may be
due o hei s ong a ini y o penicillin-binding p o eins ha dis up bac e ial cell wall syn hesis (Nicolau, 2008).
Mul id ug esis ance (MDR) among G am-nega i e bac e ia p esen s a majo public heal h challenge, limi ing ea men
op ions and inc easing he isk o clinical ailu e. In his s udy, 34 (89.61%) isola es exhibi ed MDR, unde sco ing he
u gen need o enhanced an imic obial s ewa dship and in ec ion con ol. Among he MDR isola es, P. ae uginosa and
E. coli accoun ed o 43.9% (18) and 45.71% (16), espec i ely, con i ming hei signi ican con ibu ion o he bu den
o an imic obial esis ance in wound in ec ions. The eme gence o MDR s ains highligh s he impo ance o con inuous
su eillance o esis ance ends o guide empi ical he apy and in ec ion p e en ion s a egies. The inding ha only
10.39% o isola es we e suscep ible o all an ibio ic classes emphasizes he need o judicious an ibio ic use and
de elopmen o no el he apeu ic al e na i es.
4.1. Cephalospo in Resis ance
Cephalospo ins a e β-lac am an ibio ics commonly used agains G am-nega i e in ec ions. Howe e , his s udy
eco ded high esis ance le els, especially among P. ae uginosa isola es—95.12% esis an o ce iaxone, 90.24% o
ce epime, and 87.80% o ce azidime. E. coli isola es exhibi ed mode a e esis ance—51.43% o ce iaxone, 42.86% o
ce epime, and 40% o ce azidime. The highe esis ance in P. ae uginosa sugges s ha cephalospo ins may be less
e ec i e agains his pa hogen, highligh ing he need o ca e ul an ibio ic selec ion and imp o ed s ewa dship
p ac ices.
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221
4.2. Polymyxin Resis ance
Polymyxins (colis in and polymyxin B) a e o en ese ed o MDR in ec ions, ye ou s udy obse ed signi ican
esis ance among E. coli isola es (94.29%). In con as , P. ae uginosa showed ela i ely low esis ance (12.2%).
Al hough polymyxins emain ac i e agains P. ae uginosa, hei neph o oxic and neu o oxic e ec s limi hei
he apeu ic use (Falagas & Kasiakou, 2006). The high esis ance a e in E. coli unde sco es he u gen need o no el
an imic obials and ein o ced s ewa dship p og ams o slow esis ance sp ead.
4.3. Quinolone Resis ance
Quinolones a e syn he ic an ibio ics widely used agains G am-nega i e bac e ia. In his s udy, 40.24% o P. ae uginosa
and 22.86% o E. coli isola es we e esis an o quinolones. While hese a es a e mode a e, hey s ill pose a ea men
challenge. Ne e heless, quinolones could be conside ed seconda y op ions a e ca bapenems due o hei
compa a i ely lowe esis ance le els. Con inuous moni o ing o quinolone e icacy is necessa y o guide a ional
an ibio ic use.
4.4. Ca bapenem Resis ance
Ca bapenems a e conside ed he las line o de ense agains MDR G am-nega i e in ec ions due o hei s abili y agains
mos β-lac amases. Ou indings showed low esis ance le els—7.32% in P. ae uginosa and 10% in E. coli—consis en
wi h Ma inez e al. (2018), who epo ed 8% and 12% esis ance, espec i ely. These indings ea i m he con inued
clinical ele ance o ca bapenems bu also wa n agains complacency, as ca bapenem- esis an s ains a e eme ging
globally.
5. Conclusion
In conclusion, he indings o his s udy, consis en wi h p e ious esea ch, emphasize he con inued e ec i eness o
ca bapenems as a ea men op ion o g am-nega i e bac e ial wound in ec ions, pa icula ly in he con ex o
mul id ug esis ance. These an ibio ics play a c ucial ole as a las line o de ense agains MDR s ains and emain
essen ial in p ese ing pa ien ou comes in clinical se ings. Ne e heless, conce ed e o s a e equi ed o add ess he
unde lying ac o s con ibu ing o he eme gence and sp ead o MDR, including an ibio ic misuse, weak in ec ion con ol
p ac ices, and limi ed de elopmen o al e na i e an imic obial op ions.
Compliance wi h e hical s anda ds
Acknowledgmen s:
The au ho s would like o hank he Depa men o Mic obiology, Fede al Uni e si y Teaching Hospi al, Owe i, o
p o iding he echnical acili ies ha made his esea ch possible. The eam did no ecei e any inancial suppo o he
esea ch and w i ing o his a icle.
Disclosu e o con lic o in e es :
The au ho s ha e decla ed ha no compe ing in e es s exis .
S a emen o e hical app o al:
In acco dance wi h in e na ional s anda ds, w i en e hical app o al was ob ained and p ese ed by he au ho (s).
S a emen o in o med consen :
As pe in e na ional s anda ds and uni e si y s anda ds, pa ien (s) w i en consen was collec ed and p ese ed by he
au ho (s).
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