"I dressed the wound, God healed it.
—Ambroise Pare, Father of Amputation Surgery"
It was a fine Thursday morning in the surgery OPD and everyone was going through their routines. Patients of all ages and sexes were coming to the hospital with ailments requiring attention. A young girl of about 10 years old, presented to the OPD with a nodule on her left cheek, accompanied by her parents. We, as interns, examined and recorded her complaints with relevant history to present the details to our plastic surgeon. After discussing the case extensively with us, he examined her and counseled the parents about the course of treatment, suggesting to schedule a surgery in 7 days. The parents agreed after deliberating among themselves. They were asked to visit again on Tuesday for the routine laboratory workup and to get admitted on Wednesday for the pre-anaesthetic check-up, fitness approval from the pediatrician and preparing the patient for the surgery. Everything went by smoothly. Then came the day of the surgery.
Fate had me posted on OT (operation theatre) duty that week and I’m grateful that I got to assist the plastic surgeon. The surgery was successful, all aseptic precautions noted and taken care of. In the recovery room, the patient was joyous and examination of the patient was within normal limits. The next day, the dressing was changed and the surgical site was found to be normal as would be on post-op day 1. The patient was discharged in the evening with planned medications, firm instructions about the follow up and post-operative care of the surgical site. They were instructed to report to the hospital, should any emergency arise. Four days later, the 10-year-old girl entered the ward with tears dripping down her face alongside a terrified mother.
Upon enquiry, the mother explained that the girl had complained of severe pain in her left cheek since that morning and had been crying in agony. We immediately took them to the dressing room and examined the wound. Much to our dismay, the wound displayed signs of infection. “But how did it get infected after following the precautionary measures and delicate suturing techniques?”, was the question that was impounding us. The sutures were released to collect a pus sample for culture and sensitivity. After an intricate dressing, the patient felt relieved. We sent them back after counseling and reassurance. We also knew that a discussion about wound infection and the organisms involved was awaiting us.
For the next 7 days, we redid the wound dressing with due precautions. It was a relief that the infection was not spreading. Our plastic surgeon suspected the presence of antimicrobial resistance in the causative organism and unfortunately, our suspicions were confirmed in the lab reports. The causative organism was the ubiquitous, grape-bunch looking (obviously under microscope) bacteria, Staphylococcus aureus. It was the Methicillin Resistant Staphylococcus aureus (commonly called MRSA).
Antibiotic therapy was modified at once and the wound showed considerable improvement. It really made a gulf to healing when there was minimal or no pus in the wound site. We prayed for a scarless recovery, which was difficult, given the intensity of the complication that the patient went through. There was weekly follow up for the next month. The patient recovered and the last visit went by with a huge smile on her face and an immaculately tiny scar of surgery. Nonetheless, there was suffering, and we were grateful to aid the patient.
Antimicrobial resistance is a rising concern, and it should be dealt with due diligence and advancements in medical research. We all have a role to play, because we are in this together!
Share your experience in battling antimicrobial resistance. What do you think are the ways each of us can help in combating this matter at hand? Write to us on anushka@thinkroman.com.