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Aerobic Microbial Skin Flora in Jeddah City, Saudi Arabia

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Aerobic Microbial Skin Flora in Jeddah City, Saudi Arabia The Egyptian Journal of Hospital Medicine Vol., 5 : 49–77 Dce 2001 I.S.S.N: 12084 Aerobic Microbial Skin Flora in Jeddah City, Saudi Arabia Rajaa M. Milyani Department of Biological Sciences, Faculty of Science, King Abdulaziz University. Abstract The aerobic microbial skin flora of 40 healthy subjects living in Jeddah city (Saudi Arabia) was determined. Two age groups: children and adults; including males and females were investigated. Seven sites were studied: forehead, axilla, chest, groin, leg, toe web and anterior nares. The skin was sampled by rubbing the chosen site with a surfactant substance (Tween 80) moistened cotton swab which was dipped back in the surfactant container and the resulted suspension was agitated for one minute. Thirty three microbial species were isolated from the seven sites of the study group, in which Acinetobacter baumannii, Acinetobacter lwoffii, corynebacterium species and Staphylococcus (Staph.) aureus dominated among children (30% each). The most other prevalent isolates recovered were Alkaligenes species, Bacillus species, Chryseomonas luteola, Staph. epidermidis, Enterococcus faecalis and Staph. hominis (27.5% each). Organisms including Candida albicans, Enterobacter agglomerans, Escherichia coli, Flavobacterium meningosepticum, Klebsiella oxytoca, Micrococcus luteus, Micrococcus roseus, Micrococcus varians, Micrococcus species, Burkholderia cepacia, Stenotrophomonas maltophilia, Pseudomonas paucimobilis, Pseudomonas fluorescence, Pseudomonas species, Staph. capitis, Staph. cohnii, Staph. saprophyticus, Staph. simulans, Staph. warneri, Staph. xylosus, viridans-type streptococcus and yeasts were also found in different percentage. Higher isolation rates of Acinetobacter lwoffii, Staph. aureus, Alkaligenes species, Corynebacterium species, Chryseomonas luteola, Enterobacter agglomerans, Staph. epidermidis and other coagulase negative Staphylococci were noted in children from the seven sites. However, Chryseomonas luteola, and Pseudomonas species, were found only in the groin area among males. Otherwise, no significant differences were recorded in the isolation rates from each site separately in relation to age and sex. The role of the isolated microorganisms in endogenous, exogenous and nosocomial infections was emphasized. Introduction “Surprisingly little is known about receives millions of people for religious the microflora of the skin and its role in purposes, from all over the world at common skin infections such as almost all the year around namely: psoriasis and eczema and even less Saudi Arabia. The importance of such known of the flora in rare diseases”. A knowledge is certainly obvious, statement that had been written in 1974 particularly in preventing exogenous by Noble and Somerville and and or endogenous infections. Milyani regrettably, the same can be applied to et. al. (1987) stressed upon the medical our knowledge in 1990s, not only to the significance of such topic and the lack skin flora but also to the whole of information amongst Saudi subjects, microflora of man, in a country that and took a step towards that by studying 49 Aerobic Microbial Skin Flora…….. the throat microbial flora in Jeddah city Jeddah city, highlighting its medical as a start. Since then our knowledge significance and to discuss the role of have accumulated, from other parts of the isolated organisms in endogenous, the world, and the role played by the exogenous and nosocomial infections. normal microbial flora in different infections became clearly apparent Materials And Methods (Maibach and Aly 1981; Noble 1983; Subjects: 40 apparently healthy Boyce et. al. (1990). Though, this 22 females and 18 males consisted of phenomenon has gained attention as two age groups. 1 -12 years (24 children early as 1843 by Oliver Wendell before menarche and puberty); and 13 - Holmes who was known to teach at 17 years (16 early adults after puberty). Boston that puerperal fever was caused None had been receiving antibiotics for by germs on the hands of physicians nine weeks or using deodorants. and midwives which were transmitted Axillary hair was not removed. to the vaginas of women during internal Media Used: Five growth media examination. Few took these ideas were used: nutrient agar + 0.5% glucose seriously until Joseph Lister in 1865 + 0.5% Tween80, for the isolation of used carbolic acid to disinfect the skin skin lipophilic organisms; blood agar + of the operation site and the operator‟s crystal violet 1:666.666; was used to hands (Sethna, 1978). Furthermore, and select Streptococcus pyogenes. above all Prophet Mohammad peace (Milyani, 1976); Tinsdale agar base; be upon him, before more than 14 MacConkey agar and Cystine-Lactose- century, taught the world to wash their Deficient agar (Oxoid Ltd, London). bodies, faces, rinse the mouth, clear Sampling method and culture: with water the inside of the nose A modified standardized swabbing (sniffing), wash hands, forearms to the method by Selwyn and Ellis (1972) was elbows and feet to the ankles (around used. It involved rubbing thoroughly an five times a day); the wisdom behind area of 2 cm2 of the chosen site with that is obviously to rid the body of any moderate pressure, for one minute with transient pathogens, minimize the a sterile cotton-wool swab which had number of microbial flora to a balanced been moistened with a sterile solution of state and thus preventing the mischief of 0.5 % Tween 80 (Fluka) in 0.075M these organisms that may act as phosphate buffer at pH 7.9. The swab opportunistic pathogens causing was dipped back into a sterile 10ml test different diseases and infections tube containing 2ml of the sampling (Milyani, 1998). solution (Tween 80, the surfactant With the advent of antibiotics, substance) and the suspension was cytotoxic and immunosuppressive mechanically agitated for one minute on drugs, in parallel to the increase in a Rotamixer. Whereas, anterior nares compromised patients, allowed the so- were sampled by, rotating the Tween 80 called innocent normal flora to establish moistened cotton swab inside the nares itself and emerge as opportunistic for one minute. Culturing the samples pathogen if not as a true pathogen was within one to two hours of causing high rates of morbidity and collection . The following procedure mortality (Mandell et. al., 2000). was carried out for culturing: the cotton The aim of the present study was swab was removed from the tube and to determine the microbial flora of the streaked evenly all over the surface of skin among children and adults, in each growth medium (dipping it in the 50 Rajaa M. Milyani suspension each time prior to Enterococcus (E.) faecalis and Staph. inoculation of the new medium). The hominis giving an incidence of 27.5% inoculated plates were then incubated each (Table 1 and Figure 1). Organisms aerobically at 37°C for 48 – 72 hours. including Candida (C.) albicans, Samples were collected within five Enterobacter (E.) agglomerans, months when ambient temperature Escherichia (E.) coli, Flavobacterium varied between 37°C - 45°C. (F.) meningosepticum, Klebsiella (K.) oxytoca, Micrococcus luteus, Identification: Micrococcus roseus, Micrococcus Commercial identification kits were varians, Micrococcus species, used: API Staph., API 20E (Analytab Burkholderia (B.) cepacia, Product, Plainview, N.Y) and Spectrum Stenotrophomonas (S.) maltophilia, 10 System (ABL, Austin, Texas); In Pseudomonas (P.) paucimobilis, P. general, identification was carried out fluorescence, Pseudomonas species, according to Koneman et.al. ( 1997). Staph. capitis, Staph. cohnii, Staph. Statistical analysis: The data were haemolyticus, Staph. saprophyticus, analyzed using Fisher‟s exact test and Staph. simulans, Staph. warneri, Staph. Pearson chi-square (each when xylosus, viridas-type streptococcus and applicable) to determine the significant yeasts were also found in different differences between the microbial percentage among both age groups, isolation rates in relation to age, sex, males and females (Table 1 and 2). On seven sites and each site separately. the other hand, significant differences between children and adults were found Results: in the isolation rates of A. lwoffii (P= The isolation rates of different 0.004), Alkaligenes species (P= 0.027), organisms recovered from the total Corynebacterium species (P= 0.015), seven sites of the skin and from each C. luteola (P= 0.027), E. agglomerans site separately, in relation to age and (P= 0.032), Staph. aureus (P= 0.015), sex are demonstrated in Tables 1- 16 Staph. capitis (P= 0.032), Staph. cohnii and Figure 1. Figures 2-7 show the (P= 0.027), Staph. epidermidis (P= isolation rates of some of the isolates in 0.012), Staph. haemolyticus (P= 0.032), each site. Staph. hominis (P= 0.012), Staph. Thirty three microbial species simulans (P= 0.027), Staph. warneri were isolated from the seven sites of the (P= 0.027) and Staph. xylosus (P= study group including Gram positive 0.027) from the seven sites (Table 1). and Gram negative microorganisms; the However, in relation to sex, significant Gram positive comprised 20 species differences were evident only in the while the Gram negative comprised 13 isolation rates of C. luteola (P= 0.013), species. Acinetobacter (A.) baumannii, and P. species (P= 0.013) in the groin Acinetobacter (A.) lwoffii, Corynebac- area among males (Table 12). terium species and Staphylococcus Otherwise, no significant differences (Staph.) aureus dominated among were recorded in the isolation rates from children comprising 30% of each each
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