Staphylococcus aureus is responsible for wide range of community and hospital acquired infections; these infections involve both local suppurative conditions such as skin and skin structures infections and systemic life-threatening sepsis [1] [2] [3].

According to Silverberg [4] and Taylor and Unkal [5], skin invasion by microorganism result from weakening of the skin’s defenses against microbial invasion. Notice that, skin is most commonly breach by traumas and intentional medical procures. Traumatic wounds in community usually acquire bacteria either from normal microbiota of humans or from exogenous sources, however, it is still possible to gain bacteria from hospital sources during prolonged staying. In hospital settings Staphylococcus aureus could be transmitted from one patient to other through contact with contaminated objects, from air, during wounds dressing and invasive procedures. Additionally, SSIs have serious consequences for surgeons, patients, and institutions that double the risk of patient death [6] [7] [8].

Staphylococcus that associated with SSI infection is frequently reported to develop multidrug-resistant against a wide spectrum of commonly used antibiotics [9] [10]. The increase in incidence rates of MRSA and its spread in hospitals and the community as studied by Mohammed et al., [11] and Abdalhay et al., [12] it is highly prevalent among populations of Staphylococcus aureus isolated from different clinical specimens in different hospitals in Sudan, had posed a major challenge for infections treatment.

Understanding the prevalence of Staphylococcus aureus, antibiotic resistance patterns, and accurate and reliable detection methods are necessary for proper antibiotic treatment and effective control measures. In Sudan, scattered data concerning multi-drug resistant (MDR) Staphylococcus aureus is available, the only documented research for development of MDR was reported by Onyeka et al., [13], Hassan et al., [14] and Azab et al., [15]. Therefore, the current study aimed to evaluate the Staphylococcus aureus as a cause of wound infections and the effectiveness of used drugs.

Male participants, age group from 41 to 60 years, rural residence and diabetes mellitus were reported in 71% (177/250), 49% (122/250), 69% (173/250) and 8.4% (21/250) of enrolled patients respectively (Table 1). Positive bacterial growth was showed in 95% (238/250). Staphylococcus aureus isolates predominated with percentage of 76% (181/238) followed by gram negative bacteria 15% (35/238) and coagulase negative staphylococcus 4% (9/238), polymicrobial growth revealed in 5% (13/238) (Figure 1). With SSIs, 68% (115/170) of samples gave positive growth for Staphylococcus aureus and 81% (65/80) from traumatic wounds (Table 2). The antibiotics susceptibility of isolated Staphylococcus aureus against different antimicrobial candidates for SSIs and traumatic wounds were depicted in (Table 3) and (Table 4). All tested isolates of Staphylococcus aureus were fully susceptible to vancomycin. The effective drug against SSIs isolates with sensitivity of 88% was meropeneme followed by gentamycin (38%). While isolates from traumatic wounds expressed full susceptibility to meropeneme and 71% to gentamicin. The high resistance of both SSIs and traumatic wounds isolates was recorded against cefepeme followed by cefatoxime and ceftriaxone.

Without a doubt, Staphylococcus aureus is the most important species agent of wound infections at the hospital and community level, this can be explained by the fact that it is wide-spread in nature and the environment, in addition to being a normal microbiota in noses and skin of a significant proportion of people [17] [18]. From the current study, Staphylococcus aureus was identified in 76% of wounds samples; this high rate of the spread of Staphylococcus aureus as a causative agent of wound infections in hospitals and the community is attributable to what was previously mentioned, in addition to the poor level of personal hygiene and susceptibility to infection in elderly people and those with immunocompromised diseases such as diabetes, and this within the community [19]. Many documents refer to the predominance of Staphylococcus aureus as unique agent of wounds infection [20] [21].

At hospital setting other factors have a role in the prevalence; at the level of causative agent the virulence, ability to resist antimicrobial and disinfectants, and biofilm formation are major factors distinguish hospital Staphylococcus aureus [3]. Absence of infection control program in hospitals in Sudan and most developing countries has a great effect on the effectiveness of transmission of bacteria between patients and hospital environment. Also there is no solid systematic guidelines for wound infections medication involves proper care and application of drug sensitivity testing for infected patients.

Males in the current study accounted for 71% of total cases, from our knowledge, male gender was considered to be a risk factor for infection following trauma [22] and for SSIs [23] [24]. In line, Zhang and his group emphasized that differences in infection rate between male and female can occur due to anatomical sites, health behaviors, environmental experiences, stress and exposure to risk [25]. From the results, cases came that from rural residence were higher than urban; this may be attributed to the hard works in rural such as agriculture, lack of care for personal hygiene, and the absence of surgical unites in rural hospitals [26].

Investigating the prevalence rates of antimicrobial resistance among wound infections pathogens is critical for establishing treatment strategies and evaluating current guidelines [15] [27] [28]. Our result showed marked variability in antimicrobial sensitivity of Staphylococcus aureus strains that isolated from SSIs and traumatic wounds, with the exception of vancomycin which revealed susceptibility of 100% at all as a drug of choice [29]. With less degree meropeneme gave sensitivity of 88% in SSIs and 100% in traumatic wounds isolates, luckily, two genes encoding for carbapenems resistance were identified (data not shown).

The high sensitivity to gentamycin among traumatic wounds Staphylococcus aureus isolates is due to the restriction use of this injection in the hospitals and it is limitations, and thus only 9% of traumatic wounds isolated strains appeared as resistant. Resistance to gentamycin of relatively higher percentage was recorded in hospitals in north Ethiopia [30].

Importantly, the study findings expressed high resistance to third and fourth-generation cephalosporines; ceftriaxone and cefepeme. Cephalosporines prophylaxis is commonly used in surgery practices in most hospitals in Sudan. In addition to the usage for treatment of sepsis, acute pneumonia and post-operative situations. So, continuous exposure of bacteria such as Staphylococcus aureus to cephalosporines and hospital over-prescription may be enrolled as prediction for failure of treatment [31] [32] [33].

In conclusion, the study highlights the antimicrobials prescribed mainly for wound infections, as well as the dominance of Staphylococcus aureus as etiologic agents. In Sudan cephalosporines remain the main option in antibiotic therapy of wounds, and the most commonly prescribed one; ceftriaxone resulted in low susceptibility.

This study did not determined the percentage of methicillin-resistant Staphylococcus aureus due to the sufficient previous studies, and it also did not classified the infections of surgical-sites based on the type of operation. However, this work is comprehensive analysis of the use of the most important antibiotics for the treatment of infected wounds and corresponding antimicrobial resistance.

The authors declare no conflicts of interest regarding the publication of this paper.

Yousif, S.M., Abakar, A.D., Nour, B.Y.M., Ibrahim, S.O., Elhasan, O.M.A., Yousif, M.A., Yassin, S., Hussien, H.M., Taj-Eldin, M. and Ahmed, E.A. (2021) Frequency and Antimicrobials Susceptibility Pattern of Staphylococcus aureus Associated with Wound Infections in Surgery Department, Wad Madani Teaching Hospital, Sudan. Pharmacology & Pharmacy, 12, 334-343. https://doi.org/10.4236/pp.2021.1212028