Infection is defined as invasion and multiplication of micro organisms in the body tissues, which may be clinically in apparent or result in local cellular injury because of competitive metabolism, toxins, intra-cellular replication or antigen antibody response [1]. This series of events lead to progressive tissue destruction and eventual host demise if left unchecked. The infection process begins with a disruption of the host mechanical barriers to micro organisms, the availability of microorganisms and colonization [2]. Wound infections can be caused through two major sources: exogenous and endogenous bacteria. The probability of wound infection largely depends on the patients systemic host defenses, local wound conditions and microbial burden [3,4]. Despite modern surgical techniques and the use of antibiotic prophylaxis, Surgical Site Infection (SSI) is one of the most common complications encountered in surgery [5]. SSI places a significant burden on both the patient and health system. SSI is thus a major cause of morbidity, prolonged hospital stay and increased health costs [6].

Skin and soft tissue infections (SSTIs) may also contribute to longer hospital stays increase the cost of medical care and play an important role in development of antimicrobial drug resistance. Common examples of SSIs includes cellulitis, abscesses, impetigo, folliculitis, furuncle, carbuncle, necrotizing fasciitis, diabetic foot infections and surgical site infections. Complicated SSI may prove fatal and require hospitalization, intravenous antibiotics or surgery. An SSI is classified as complicated if the infection has spread to the deeper soft tissue, if surgical intervention is necessary or if the patient has co-morbid conditions Hence, this study could play a significant role in the early recognition of the Problem and hence, there is need for early intervention for better management of wound infections.

Duration & Setting: This study was done in a tertiary care hospital for a period of one year from Jan 2016-Dec 2016.

Ethical clearance: Ethical clearance from the Institutional Ethical committee was obtained.

Sample size: Two hundred & thirty eight cases of pussamples were taken.

Table-1: Distribution pattern of bacterial isolates (n= 238).

Pus discharge was collected from 238 patients were identified, out of which 167 (70.1%) were males and 71(29.9%) were females.

Cases of pus discharge came mainly from rural areas (199/83.61%) as compared to urban areas (39/16.38%).

Bacterial isolates: Out of 238 pus samples, 209(88.6%) were culture positive for bacterial growth and no growth was observed in 29(11.4%) cases as shown in Table 1. Out of 209 bacterial culture positive cases, 201 were monobacterial and 8 were poly bacterial. Out of 209 bacterial isolates; S. aureus (56/26.6%) was the commonest followed by P. aeruginosa (47/22.4%). The prevalence of monomicrobial isolates from various wound infections is depicted in table 2, wherein Staphylococcus aureus was the predominant organism when samples were collected from post operative wounds, burns, traumatic wounds and soft tissue infections.

Antibacterial susceptibility profile: Gram positive bacteria showed maximum susceptibility to Vancomycin whereas gram negative isolates showed its maximum susceptibility to Meropenem and Amikacin. P. aeruginosa isolates showed maximum susceptibility to Doripenem and Piperacillin tazobactum. 44.2% of S.aureus isolateswere MRSA and 56% of Gram negative isolates were ESBL producers as shown in Table 3.

Table-3: Antibiotic sensitivity pattern of bacterial isolates.

In the present study an attempt was made to study the bacteriological profile of wound infections and antimicrobial susceptibility pattern of the isolates. In this study along with the identification of aerobic bacterial organisms, changing pattern of antibiotic sensitivity with special reference to Methicillin Resistant Staphylococcus aureus (MRSA) and Extended Spectrum of Beta lactams (ESBLs) were alsoidentified.

It was observed that the commonest age group affected is 21-40 years which is correlated with the studies done by Shute Malik et al [11] and Dr. Zarrin Afroz et al [12]. Males (70.1%) were affected more than females (29.9%). This study was correlated with Ramesh Rao et al [15] which found males (60%) more affected than females, N. Sowmya et al [14] 66.6% and Shruti Malik et al [11] 51.9% also showed the predominance of males over females probably because of their more exposure to life.

Monomicrobial etiology was more common 96.1%, than polymicrobial 3.8%. This study is correlated with N. Soumya et al [14] 91.7% and Mehta V.J. et al [15] 70.4% wherein the monomicrobial etiology was more common than polymicrobial which may be due to the prior use of antibiotics.

In the present study Staphylococcus aureus 26.6% was the predominant organism followed by Pseudomonas aeruginosa 22.4%, Escherichia coli 12.9%, Klebsiella pneumoniae 12.4%, Proteus mirabilis 8.4% and CONS 5.4%. Staphylococcus aureus (26.6%) was the most predominant isolate which correlated with the other studies done Shruti Malik (30.1%), Mehta V.J. (38.3%), Ramesh Rao (27.8%) and Dr. Pravin (48.4%) [13-16].

Second most predominant organism in the present study was Pseudomonas aeruginosa 22.4% which correlated with the studies of Gayathree Naik (20%), Shruti Malik (17.8%), Mehta V.J (21.3%), Ramesh Rao (18.5%) and Dr. Pravin (17.52%) [11-15]. In the present study, polymicrobial 8 cases included combination of Pseudomonas aeruginosa with Staphylococcus aureus (37.5%) which correlates with the study of Anbumani et al. Other polymicrobials included Pseudononas aeruginosa with Klebsiella pneumonia accounting for 37.5% cases, Klebsiella pneumonia with Proteus mirabilis 12.5% and Staphylococcus aureus with Proteus mirabilis 12.5% case. Out of 52 Staphylococus

Meropenem was the most sensitive drug among all gram negative isolates and Vancomycin was the most sensitive drug among gram positive isolates. This study shows that the organisms are becoming resistant to commonly used antibiotics and also developing resistance to newer antibiotics.

Nowadays automated methods of identification of the pathogen and antibiotic sensitivity are available which aids in quick results, thus reducing the time of treatment and helping the patients. More comprehensive studies are required from time to time to define the magnitude of problem & produce data for policy decision on optimal intervention modalities. Vital use for formulation of antibiotic policy and implementation of antimicrobal stewardship program-mmes is need of the hour. Hospital must have an active antibiotic stewardship programme implemented. Further based on the antibiogram of hospital, antibiotic policy should be framed and followed. Such a treatment policy if followed will lead to reduction in mortality, morbidity & health care cost associated with wound infections.

All the authors contributed equally in the study design, analysis and manuscript preparation