Journal of Applied Sciences Research, 6(1): 70-80, 2010

© 2010, INSInet Publication

Control of Bacterial Contamination of Bed Sores by Using Some Natural Extracts

1
Ghaly, M.F., 2Shalaby, M.A., 3Shash, S.M., 3Baraka, D.M. and 3Aly, R.A.

1
Botany Department, Faculty of Science, Zagazig University;

2
Immunology & Microbiology Department, Faculty of Medicine, Zagazig University and

3
Botany Department, Faculty of Science, Benha University, Egypt.

Abstract: A total 35 pressure sores samples were collected from males and females patients in El-W afaa
& El-Amel hospital, Cairo, by sterile swabs and isolated on nutrient, MacConkey's and blood media, a
positive bacteria growth were detected on these media. Staphylococcus epidermidis was the most
predominant pathogen isolated from pressure sores (31.4%) followed by Proteus vulgaris (28.6%),
Pseudomonas aeruginosa (22.8%), E. coli (8.6%), K. pneumoniae (5.8%) and S. aureus (2.8%). Antibiotics
sensitivity test for Gram-positive and negative bacteria showed that the antibiotic ofloxacin is the most
effective against clinical bacterial isolates (68.6%) followed by norfloxacin (62.8%), chloramphenicol and
amikacin (51.4%). Six types of disinfectants were used iodine, betadine, gawy stain, cetavlon, gentian and
mercrychrome, where the most effective were iodine and betadine. The effect of plant extracts against
highly resistant bacterial isolates showed that clove, rosemary, peppermint and thyme showed strong
inhibitory action against tested isolates. The combination between ofloxacin and amikacin with clove plant
extract showed that the clearly synergistic effect was obtained against tested clinical bacterial isolates.
Antibacterial activity of honey bees showed that date honey is the most active against bacterial isolates
followed by the pond grain honey, seder honey, citrus honey, albrdqoc and clover honey. The effect of
volatile oils against resistant bacterial isolates showed that peppermint, thyme, garlic and marjoram given
strong antibacterial activity against tested bacterial isolates where in peppermint give 50, 35, 30, 25, 25,
22 and 20 mm inhibition zones.

Key words: Bacterial contamination control, bed sores, natural extracts.

INTRODUCTION dermis, and stage 4 is breakdown of the subcutaneous

skin layers including deeper tissue and even muscle
Bed sores, also called pressure sores and decubitus fascia. Once an ulcer or pressure sore has started, the
ulcers, and are caused by prolonged pressure on the sore is extremely hard to reverse without extraordinary
skin, mostly over bony areas. Small vessels become means such as specialized care. Specialized care can
compressed, nutrients and oxygen are restricted to the include, load reducing surfaces such as air beds, special
skin and underlying tissue, tissue cells begin to die and dressing such as permeable (breathable membrane)
slough off, and microorganisms can invade the dressing, and even in the event of some stage 4 ulcers
damaged tissue causing it to become infected [1 ]. packing and irrigation with fluids on a daily basis or
Pressure sores or bed sores are a common and serious more. Differentiation of bacterial infection from simple
complication of spinal cord injury. It is the most contamination is best made with a tissue biopsy; which
common sores of sepsis paraplegia [2 ]. Individuals who allows quantitative wound culture techniques. This will
are at risk of developing bedsores include those who indicate whether antibiotics should be administered [3 ].
are bedridden, are unable to change positions, those A variety of microorganisms normally live on the
who use a wheelchair, advanced age, poor nutrition s k in w i t h o u t n e c e s s a r i l y c a u s i n g i n f e c t io n
(obesity, underweight, protein deficiency, anemia), (uncomplicated skin). Infection usually caused by
dehydration, poor hygiene, and diabetes are other Gram-positive cocci of the normal microflora and
factors that increase ones risk [1 ]. An ulcer of this type wound infections in immune compromised or
is rated in stages. Stage 1 is reddening of area, stage debilitated patients which often involve Gram-negative
2 is redness with blistering of the area, stage 3 is pathogen e.g. Pseudomonas aeruginosa [4 ]. W hen this
breakdown of the uppermost layers of skin or the organism gains a foothold in a hospital or the

Corresponding Author: Ghaly, M.F., Botany Department, Faculty of Science, Zagazig University, Egypt.

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 J. Appl. Sci. Res., 6(1): 70-80, 2010

community, the potentially serious nature of the (5µg), amikacin (AK) (30µg), chloramphenicol (C)
infections they may cause and the limited options for (30µg), cephalexin (CL) (30µg) The plates were
antibiotic treatment may have important and life incubated at 37 o C for 24h. The inhibition zones were
threaten consequences [5 ]. In recent years, a great deal of measured with a millimeter ruler including the diameter
progress has been made in the management of bacterial of the disc. The end point of the reading was taken as
infection especially that caused by Pseudomonas complete inhibition of the growth to the naked eye [1 7 ].
aeruginosa and Staphylococcus epidermidis by using The antibiotics, ofloxacin and norfloxacin were
natural or chemical substances that may have selected according to sensitivity of different bacterial
antibacterial activity [6 ]. Antiseptics and disinfectants are isolates to determine the MIC and MBC against tested
used to minimize contamination; these include plain bacterial isolates namely E. coli, Klebseilla, Proteus,
liquid soap, betadine and iodine [7 ]. The treatment of Pseudomonase and Staphylococcus according to
adults and children skin and skin structure infection Lowry [1 8 ]. Betadine paint, gawy paint, gentian paint,
w a s c o n d u c te d b y d iffe r e n t a n t ib i o t ic s a s cetavlon, iodine and mercrychrome were tested for their
azithromycin [8 ]. Antibiotics and medicinal plants as well antibacterial activity against bacterial isolates. The use
as their extracts have been used for skin infection antiseptics and disinfectant were obtained from Nile
treatment[9 ]. Study reported that M entha piperita L., co., Egypt. Antimicrobial tests were determined by
Foeniculum vulgare L. have strong inhibitory effect on standardized agar disc diffusion technique in which
Staphylococcus aureus[1 0 ]. Plants and plant products as every disc loaded 20ul from each disinfectant [1 9 ].
essential oils have been used extensively throughout The medicinal plant extracts were prepared
history to treat medical problems [1 1 ]. Honey and according to Huang et al.[2 0 ]. Honey prepared to show
propolise are the most important products of bees, their antibacterial activity according to Burton and
where propolise can relieve various types of dermatitis Borisova [2 1 ]. Volatile oils were prepared according to
caused by bacteria and fungi[1 2 ]. In the twentieth Burton and Borisova [2 2 ].
century the use of honey as having antimicrobial
properties and aiding wound healing have been reported RESULTS AND DISCUSSION
(13). The Russians used it in W orld W ar I to prevent
wound infection and to accelerate wound healing. The Bacterial organisms isolated from 35 patients (21
Germans combined cod liver oil and honey to it to male and 14 female) with pressure sores occur in
treat ulcers, burns, fistulas and boils[1 3 ]. different parts of the body, as illustrated in Plate (1),
by using sterile swaps on nutrient's agar and blood agar
M ATERIALS AND M ETHODS medium. The bacteria were isolated from different age,
from 45-75 of male patient and from 35-65 of female
These samples obtained from El-W afaa & El-Amel patient and the percent of bacterial isolates were
hospital, Cairo. Sample were collected from April 2007 recorded in Fig. (1). These results illustrated that the
to December 2007, aged of patient ranged between 35 highest percentage rate obtained was 33.4% of positive
to 75 years, these samples were obtained from 21 sample found in male age from 71-75 years and the
males and 14 females. Samples were collected in sterile highest percentage rate of female sample reaches to
cotton swabs used for isolation of bacteria on nutrient, 28.6% age from 56-60 years. Pressure sores or bed
MacConkey's and blood agar media. sores are the total sum of several factors at work in a
Bacterial isolates were identified according to bed bound patient or a patient which tends to spend
Bergey's Manual of Determinative Bacteriology [1 4 ]. All long periods at rest. These factors are constant pressure
strains of bacterial isolates were tested for antimicrobial or consistent pressure, poor nutrition, poor circulation
sensitivity by standardized disk diffusion technique. and poor hygiene resulting in a skin infection or
This was done as described by Bauer [1 5 ]. Touch one ulcer [2 3 ].
colony from each isolated strain by sterile loop then The results in Fig. (2), indicated that the number
inoculated into 5 ml sterile nutrient broth and incubate of contaminated pressure ulcer samples collected from
for 24 hours at 37úC, then make turbidity equal 0.5 M c males and females were 11 of S. epidermidis,10 of
ferland standard salin (0.05 ml barium chloride + 9.95 Proteus vulgaris, 8 of Pseudomonas aeruginosa, 3 of
ml sulfuric acid) [1 6 ]. Each broth inocula were applied by E. Coli, 2 of Klebsiella pneomoniae and one of S.
sterile swabs on Muller-Hinton agar plates, one or two aureus. So the highest percentages of distribution are
plate was used for each strain in which antibiotics found in S. epidermidis (31.4%) followed by Proteus
discs were applied to the surface at constant distances. vulgaris (28.6%), Pseudomonas aeruginosa (22.8%), E.
The antibiotics used in this experiment were penicillin coli (8.6% ), Klebsiella pneumoniae (5.8%) and S.
(P) (10µg), ampicillin (AM) (10µg), erythromycin (E) aureus (2.8%). Several microorganisms were isolated
(15µg), norfloxacin (NOR) (10µg), ofloxacin (OFX) from bedsore patients, opportunistic microorganisms

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 J. Appl. Sci. Res., 6(1): 70-80, 2010

have been known to contaminate the bed sores caused 11, 62.5 µg/ml of ofloxacin against Proteus vulgaris
by prolonged resting on the beds or chairs, the most number 22 and 31.25 µg/ml of ofloxacin against S.
common bacteria in skin wounds were found to be epidermidis number 7. The results indicated that the
Pseudomonas aeruginosa, Staphylococcus epidermidis maximum MBC were obtained at norfloxacin antibiotic
and Staphylococcus aureus. In this work, different which recorded 250 µg/ml against P. aeruginosa
bacteria were isolated from 35 samples collected from number 27 and Proteus vulgaris number 14, and the
hospitals in Egypt. The most dominant isolates were lowest MBC were obtained 31.25 µg/ml at S.
found to be Staphylococcus epidermidis, Escherichia epdirmidis number10 and K. pneumoniae 21. MBC
coli, Klebsiella pneum oniae, Proteus vulgaris, equal to MIC which recorded 125 µg/ml of norfloxacin
Pseudomonas aeruginosa and Staphylococcus aureus. against P. aeruginosa number 28.
Similar results were attained in other works [2 4 ]. As illustrated in Table (2) and Plate no. 3. Six
The sensitivity test results against bacterial isolates types of disinfectants were used iodine, betadine, gawy
in Fig. (3) & Plate no. (2) the antibiotic ofloxacin is stain, gentian, cetavlon and mercrychrome, as illustrated
more effective against isolated pathogenic bacterial in where the highest effect of disinfectant were iodine,
organisms, which the percentage of sensitive organism betadine paint and gawy Stain, while cetavlon hasn't
reach to 68.6% followed by norfloxacin 62.8%, any effect. The results of this study showed the
chloramphenicol and amikacin 51.4%, erythromycin commercial iodine had an inhibitory effect against all
25.7%, ampicillin 20.0%, cephalexin 5.8% and tested bacterial isolates at dilution of 6 and 7 %
penicillin 0.0% . The antibiotic amikacin and Pseudomonas aeruginosa was the least sensitive isolate
erythromycin show intermediate effect against isolated among the tested bacterial isolates. Hence the
pathogenic bacterial organisms, where the percentage concentration of 3-5 % failed to inhibit this isolate and
reaches to 20.0% followed by ampicillin and highest concentration (6-7%) gave the least inhibitory
norfloxacin 8.6%, ofloxacin and cephalexin 2.8% and influence on it compared with another the finding of
chloramphenicol and penicillin 0.0%. On the other the present work are in accordance with that of Cole [2 7 ] .
hand, the antibiotic penicillin hasn't any effect against Mohamed [2 6 ] results illustrated that 2% concentration of
isolated pathogenic bacterial organisms, where the cetavlon give weak effect against two bacterial isolates
percentage of resistance organisms reach to 100.0% from pressure sores, this result similar with the result
followed by cephalexin 91.4%, ampicillin 71.4%, reported by Ekizoglu [2 8 ].
erythromycin 54.3%, chloramphenicol 48.6%, and An attempt was made to test the antibacterial
norfloxacin, ofloxacin and amikacin 28.6%. In this effect of different medicinal plants extracts (rosemary,
study the percentage of sensitive organisms to orange peel, garlic, lemon grass, peppermint, spearmint,
ofloxacin is 58.0%, chloramphenicol 52.0%, ampicillin marjoram, thyme, clove, fennel, cinnamon, henna and
11.0%, cefotaxim sodium 2.0% and penicillin-G chamomile), as cold water extract, boiling water extract
0.0% [2 5 ]. These results go in line with our results, and alcoholic extract against selected clinical bacterial
where it described that all isolates were poorly isolates E. coli, P. aeruginosa, K. pneumoniae, P.
susceptible to ampicillin, but exhibited good vulgaris, S. epidermidis, and S. aureus as illustrated in
susceptibility to ofloxacin and chloramphenicol. The Plate (4). Clove was the most effective incase of (cold
previous results were in disagreement with those of water, boiling water and methanol extraction), garlic
Mohamed [2 6 ] who found that the ciprofloxacin antibiotic was most effective incase cold water and methanol
is more effective one against both tested bacterial extraction and hasn't effect on boiling water. Spearmint
isolates (S. epidermidis and P. aeruginosa) and hasn't effect on cold and boiling water and weak
chloramphenical have medium inhibitory effect while effective on methanol extraction, peppermint has
ampicillin show no inhibitory action against S. moderate effect in 3 cases of extraction, ginger hasn't
epidermidis and P. aeruginosa. effect on cold water and methanol extraction but weak
Eleven bacterial isolates and The most two in boiling water. Rosemary has strong effect on boiling
effective antibiotics (ofloxacin & amikacin) were water and methanol extraction but moderate effect on
chosen to perform M IC and MBC test, where the cold water, thyme has strong effect on boiling water
results in Table (1) indicated that the maximum MBC and moderate effect in methanol and cold water, lemon
were obtained at ofloxacin antibiotic which recorded grass has moderate effect in three cases. In this study,
250 µg/ml against P. aeruginosa number 13 & 27 and four plant alcoholic extracts out the tested plant
Proteus vulgaris number 14 and the lowest MBC were extracts were Mentha piperita, Eugenia aromatica,
obtained 31.25 µg/ml at S. epidermidis number 10 & Rosmarinus officinalis and Thymus vulgaris, the most
7 and S. aureus number 35. MBC equal to M IC which active one was that of Rosmarinus officinalis. On the
recorded 250 µg/ml of ofloxacin against proteus other hand, the same extracts except that of Mentha
vulgaris number 14, 125 µg/ml of ofloxacin against piperita were active against pseudomonas aeruginosa.
Klebsiella pneumoniae number 25 and E. coli number Cymbopogon citratus extract has been used for curing

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some infections, while the antimicrobial were tested there is antagonism between the combination of garlic
against a wide range of microorganisms [2 9 ]. Mentha extract and antibiotics (ofloxacin and amikacin). This
piperita L. and Foeniculum vulgare L. have strong study illustrated that clove extract show synergism with
inhibitory effect on Staphylococcus aureus[1 0 ]. Thymus ofloxacin but garlic extract show antagonism with
vulgaris L. and Thymus serpyllum L, had inhibitory ofloxacin [3 3 ]. The previous results were in agreement
effects against four pathogenic bacteria; Staphylococcus with those of Ayad [2 5 ] who found that there is
aureus, two strain of E. coli and Yersenia synergism between the combination of clove extract
enterocolitica [3 0 ]. Different extracts of rosemary have and antibiotics (ofloxacin and amikacin), but there is
demonstrated inhibitory activity on cultures of antagonism between the combination of garlic extract
S ta p h y lo c o c c u s a u r e u s, S . a lb u s , E . c o li, and antibiotics (ofloxacin and amikacin).
Corynebacterium spp., Bacillus subtilis, Micrococcus As illustrated in Plate (7), different volatile oils
luteus, Salmonella spp., Listeria monocytogens and were used as peppermint, spearmint, lemon, thyme,
Vibrio cholerae. Two of its components, carnosol and clove, rosemary, garlic, marjoram, fennel and
ursolic acid, are responsible for this antimicrobial effect eucalyptus against selected clinical bacterial isolates E.
which also includes HIV-1 virus, fungi of Aspergillus coli, P. aeruginosa, K. pneumoniae, P. vulgaris and S.
sp., Penicillium sp., Alternaria sp. genera and other epidermidis and S. aureus. The result showed that
food fermenting microorganisms such Lactobacillus fennel, eucalyptus, lemon grass, spearmint and clove
brevis, Pseudomonas fluorescens, Rhodotorularia showed weak antibacterial effect on most of bacterial
glutinis and Kluyveromyces bulgaricus[3 1 ]. Menta isolates. In generally rosemary showed moderate
piperita were screened by disc diffusion method for antibacterial activity. Peppermint, thyme, garlic and
antibacterial activities against 56 isolates belong to 11 marjoram given strong antibacterial activity against
different species of Gram-negative bacilli and reported growth of most tested bacterial isolates, where in
an inhibitory action against Escherchia coli (19), peppermint give 50, 35, 30, 25, 25, 22 and 20 mm
Klebsiella pneumoniae (11), Pseudomonas aeruginosa inhibition zones. Essential oils and methanol extracts
(8), Salmonella typhi (3), Salmonella paratyphi A (1), obtained from aerial parts of Thymus vulgaris and
Salmonella paratyphi B (1), Proteus mirabilis (5), Pim pinella anisum seeds were evaluated for
Proteus vulgaris (1), Enterobacter aerogenes (4), antimicrobial activities, were tested single and
Shigella dysenteriae (1) and Yersinia enterocolitica (1). combined, the results indicated the different antibacteria
Leaves of Mentha piperita exhibit highest antibacterial against nine Gram-positive and G ram-negative
activities than its stem [3 2 ]. In the present study, the pathogenic bacteria: Staphylococcus aureus, Bacillus
aqueous extract of Rosmorinus officinallis was the cereus, Escherichia coli, Proteus vulgaris, Proteus
strongest active one against pseudomonas aeruginosa mirabilis, Salmonella typhi, Salmonella typhimurium,
and staphylococcus epidermidis among the tested Klebsiella pneumoniae and Pseudomonas aeruginosa [3 4 ].
extracts, while Thyme vulgaries gave the maximum The effect of volatile oils on the resistant isolated
inhibition zone against staphylococcus epidermidis bacteria to the used antibiotics showed that some
except that of Mentha piperita cuminum cyminum, volatile oils as marjoram, dianthus and cummin exhibit
Eugenia aromatica, Carum carvi and Eucalyptus inhibitory effect against the resistant bacterial isolates,
globules [2 6 ]. On other study, the results illustrated that while the remaining volatile oils (thyme, carawaya and
rosemary, lemon grass, peppermint, hibiscus, clove, eucalyptus) showed no inhibitory effect against the
marjoram, thyme, cinnamon, castor plant and resistant bacterial isolates [3 5 ]. The effect of essential
chamomile were most effective plants extracts against oils on resistant S. aureus to the used antibiotics
selected pathogens (Escherchia coli, Klebsiella showed that lemon grass has very strong effect
p n eum oniae, P roteu s m irab ilis, P seu dom onase followed by clove, cinnamon, eucalyptus and
a eruginosa and Staphyloccocus saprophyticus). peppermint but the marjoram and chamomile haven't
However in three cases (cold water, boiled water and any effect on the resistant S. aureus isolates [3 6 ].
alcohol extract), ginger was the lowest effective plant As illuistrated in Table (3) & Plate (8), date honey
extracts [2 5 ]. Orange peel and fennel were most effective the most effect on bacterial isolates followed by the
only in case of alcohol extract, low effective in case of pond grain honey, Seder honey, citrus honey, albrdqoc
boiling water extract, and not effective in case of cold honey, and clover honey. Honey bee at different
water extract. More over garlic was the most effective concentration with water was tested against tested
in case of cold water and alcohol extract, and not bacterial isolates and the obtained results clearly proved
effective in case of boiling water extract. Spearmint that there is a moderate inhibitory effect against S.
and tilia haven't any effect against bacteria. However epidermidis and the inhibitory effect increasing the
in three cases (cold water, boiling water and alcohol concentration of honey bee till reach it maximum
extract) [2 5 ]. activities at 100% concentration of honey bee. All
The results in Plates (5 and 6) illustrated that clove concentration tested of honey bee not indicate any
extract show synergism with ofloxacin and amikacin. inhibitory action against pseudomonas aeroginosa [2 6 ].
Peppermint extract show synergism with amikacin but

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 J. Appl. Sci. Res., 6(1): 70-80, 2010

Fig. 1: Bed sores percentages in males and females with different ages

Fig. 2: The distribution number of pathogenic bacteria isolated from pressure ulcer collected samples

Fig. 3: The sensitivity test of pathogenic isolates against different antibiotics drugs

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Table 1: M inim um inhibitory concentration (M ICs) (µg/m l) and m inim um bactericidal concentration (M BCs) of selected antibiotics
a)A ntibiotic ofloxacin
Bacterial isolates N o. (M IC) (M BC)
------------------------------------------------------------------------------
(µg/m l) (µg /m l)
P. vulgaris 14 250 250
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. aeruginosa 13 125 250
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
E. coli 11 125 125
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
S. epdirm idis 10 7.8125 31.25
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. aeruginosa 28 62.5 125
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
S. epdirm idis 7 31.25 31.25
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. vulgaris 22 62.5 62.5
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
S. aureus 35 7.8125 31.25
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
K. pneumoniae 25 125 125
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
K. pneumoniae 21 31.25 62.5
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. aeruginosa 27 125 250
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

+SD 84.3+62.7 181.2+90.1

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
t 5.237
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P 0.001 H S

b)A ntibiotic norfloxacin

Bacterial isolates N o. (M IC) (M BC)
------------------------------------------------------------------------------
(µg/m l) (µg /m l)
P. vulgaris 14 125 125
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. aeruginosa 13 125 125
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
E. coli 11 125 250
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
S. epdirm idis 10 15.625 31.25
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. aeruginosa 28 125 250
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
S. epdirm idis 7 31.25 31.25
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. vulgaris 22 125 250
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
S. aureus 35 15.625 62.5
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
K. pneumoniae 25 125 250
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
K. pneumoniae 21 31.25 125
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. aeruginosa 27 125 250
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

+SD 81.7+65.6 145.8+83.2

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
t 5.682
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P 0.001 H S

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Table 2: D iam eter of inhibition zone (m m ) of different disinfectant against pathogenic bacterial isolates
Bacterial isolates N o. Betadine Gawy Gentian Cetavlon M ercrychrom e Lodine
P. aeruginosa 13 20 15 12 ND 20 23
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
K. pneumoniae 21 15 15 15 ND 15 26
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. aeruginosa 27 33 30 23 ND 20 50
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
K. pneumoniae 25 30 25 20 ND 20 33
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. vulgaris 14 20 20 16 ND 10 22
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
E. coli 11 25 17 17 ND 18 25
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. aeruginosa 28 30 23 15 ND 18 33
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
S. epiderm idis 10 20 25 15 ND 15 24
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
S. aureus 35 35 21 18 ND 25 40
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. vulgaris 22 35 25 18 ND 22 40
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
S. epiderm idis 7 38 20 15 ND 17 25

Table 3: D iam eter of inhibition zone (m m ) of different Type of honey against pathogenic bacterial isolates.
Bacterial isolates N o. The pond grain honey D ate honey Citrus honey Albrdqoc honey Clover honey Seder honey
S. epiderm idis 7 15 15 13 12 10 10
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. aeruginosa 13 13 12 12 13 16 14
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
K. pneumoniae 25 12 13 13 14 12 13
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
K. pneumoniae 21 15 15 12 10 12 15
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
E. coli 11 18 21 17 15 13 16
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
S. epiderm idis 10 15 12 12 11 12 19
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. vulgaris 22 12 13 11 10 15 14
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. vulgaris 14 12 12 13 14 9 11
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
S. aureus 35 15 11 12 12 9 15
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. aeruginosa 27 9 10 11 12 11 13
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
P. aeruginosa 28 10 9 12 10 9 9

Plate. 1: Patients with bedsores on different parts of the body.

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Plate. 2: Antibiotic susceptibility of bacterial isolates by disc diffusion method

AK = amikacin; P = penicillin; AM = ampicillin; E = erythromycin; CL = cephalexin; NOR = norfloxacin; OFX
= ofloxacin & C = chloramphenicol

Plate. 3: The effect of disinfectant on bacterial isolates

1- Betadin, 2- Gawy, 3- Gentian, 4- Cetaflon. 5- Almikrokrom, 6- Iodine.

Plate. 4: Effect of (alcoholic, boiling water & cold water) plants extracts against bacterial isolates by disc diffusion
method.
1- Rosemary, 2- Orange peel, 3- Garlic, 4- Lemon grass, 5- Peppermint, 6- Spearmint, 7- Marjoram, 8- Thyme,
9- Henna, 10- Cinnamon, 11- Clove, 12- Ginger, 13- Chamomile, 14- Fennel.

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 J. Appl. Sci. Res., 6(1): 70-80, 2010

Plate. 5: Combination between plants extracts and ofloxacin antibiotic against bacterial isolates by disc diffusion
method.
1- Garlic, 2- Clove, 3- Rosemary, 4- Peppermint, 5- MIC of ofloxacin.

Plate. 6: Combination between medicinal plants extracts and amikacin antibiotic against bacterial isolates by disc
diffusion method.
1- Garlic, 2- Clove, 3- Rosemary, 4- Peppermint, 5- MIC of amikacin.

Plate. 7: Effect of Volatile oils against bacterial isolates by disc diffusion method.
1- Peppermint, 2- Spearmint, 3- Lemon, 4- Thyme, 5- Clove, 6- Rosemary, 7- Garlic, 8- Marjoram, 9-
Eucalyptus, 10- Fennel.

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