STUDY OF PYODERMAS AND ITS BACTERIOLOGICAL ANALYSIS AT TERTIARY CARE HOSPITAL, NAGPUR

Abhishek Goenka, Narendra Deogade and Ashok Gadhari ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 05 January 2020 Final Accepted: 07 February 2020 Published: March 2020 Copy Right, IJAR, 2020,. All rights reserved.


Discussion:-
In the present study, out of the 200 cases of pyogenic skin infections, primary pyoderma constituted 74% of the cases and the remaining 26% constituted secondary pyoderma. Thus showing that primary pyodermas are more common than secondary pyoderma. Similar findings were seen in the studies of-  Table 9:-Occurence of primary and secondary pyoderma in various studies.
In present study (Table 2), folliculitis constituted majority of the cases (25%) followed by impetigo(14.5%). It is consistent with the work of Patil et al (2006) 12 & Paudel etal (2013) 11 where folliculitis constituted 58.8% & 26.7% of the total cases respectively. Although a few studies have shown impetigo to be the commonest lesion, which might be because majority of their cases were of Paediatric age group. 9 In the present study majority of our patients were adults, which accounts for the high frequency of folliculitis . Folliculitis was the second commonest type in few other studies. 3 Tushar et al 9 demonstrated Maximum cases of Impetigo (26%) followed by boils, carbuncle, furuncle in 21% cases, folliculitis (14%), cellulitis (2%).
Most of our patients belonged to the adult age group (table 3). Maximum number of cases fell in the age group 31-40 years (29%). Similar finding has been noted by Ramana et al (2008), 13 where 64% of the cases were more than 40 years old. But many studies have found pyodermas to be more common in pediatric age group with higher incidence in < 10 years age group, 14,15 and in few studies >40% patients belonged to 1-4 years age group. 2,4 As most of the pediatric patients specifically visit the pediatric and surgical out-patient department for minor skin problems, this may be the reason for a low number of pyodermas in children in this study.
Incidence of pyoderma in the present study was found to be more ( Present study showed that majority of the patients belonged to the lower income group (70%) followed by the middle income group (27%). Only 3% of the higher income group presented with pyoderma. This has been note by other workers also. 2 Various factors like poverty, malnutrition, overcrowding, and poor hygiene have been stated to be responsible for its higher incidence in the lower socio-economic class. In the present study conducted on 200 cases the most common pathogen isolated was S.aureus (63.5%). Similar findings have been reported by other workers. 2,1315,16, However, there was no significant difference between the isolation of Staphylococcus aureus in primary and secondary pyodermas, the percentage being 61.4% and 42.3% respectively with a P >0.005 which correlates with the study of Paudel et al. 11 In one study, even in chronic wound infections, Staphylococcus aureus was isolated in 70.8% of cases, though more number of Gram-negative bacilli have been isolated from secondary pyodermas and chronic wound infections as compared to primary pyodermas. 11 Isolation of Streptococci in the present study was 4.5% which is similar to that of Patil et al, 12 where the isolation was 2.3%. However other studies 2,12,13,15,16 have shown a higher isolation rate. The reason behind this could be due to the change in the etiological agent or due to inhibition of Streptococcus pyogenes by secondary invasion of Staphylococcus aureus which is supposed to produce bacteriocins, toxic to Streptococci or due to bacterial interference.

Middle income group
In our study Enterococcus spp were isolated in 4.5% cases. In study conducted by Ramana et al 13 isolation rate of Enterococcus spp was 11.4%. As Enterococcus fecalis is a part of normal fecal flora, the isolation seen in this study may be due to contamination of the lesion or due to opportunistic infection. 11 , in our study, 9.5%were CONS, 3.4% E.coli, 2.2% C. freundii , 10.1% Klebsiella spp, 4.5% Proteus spp, and7.9% Ps.aeruginosa were found which are compared to other studies (Table 8).

Conclusion:-
As most of the cases were culture positive, pyodermas should not be ignored and should be treated. Staphylococcus aureus remains still the most common bacteria causing pyoderma.