Nosocomial Burn Wound Infections due to Non-Fermenting Gram Negative Bacteria: Our experiences from a tertiary care center in North India

  • Naz Perween Dept. of Microbiology, Superspeciality Pediatric Hospital and Postgraduate Teaching Institute Sector-30, NOIDA, UP-201301 India
  • S Krishna Prakash Department of Microbiology, Maulana Azad Medical College, BSZ Marg, New Delhi, India-110002
  • Prabhav Aggarwal Department of Microbiology, Maulana Azad Medical College, BSZ Marg, New Delhi, India-110002
  • Lalit Mohan Gupta Department of Microbiology, Maulana Azad Medical College, BSZ Marg, New Delhi, India-110002
Keywords: Pseudomonas, Acinetobacter, Antimicrobial resistance, burns

Abstract

Background: Nosocomial infections contribute to up to 50% mortality in burn patients. Non fermenting Gram negative bacteria, being ubiquitous in nature, can easily colonize the burn site and subsequently cause infections. The objective of the study was to understand the role of two of the most common non-fermenters, Pseudomonas aeruginosa and Acinetobacter baumanii in nosocomial burn wound infections and determine their antimicrobial resistance pattern.Methods: Wound swabs were collected from burn patients and cultured using standard microbiological techniques. Isolates of non-fermenters, Pseudomonas aeruginosa and Acinetobacter baumanii, were identified by conventional biochemical tests. The antibiotic susceptibility testing of these isolates were carried out by disc diffusion method. Result: A total of 248 and 70 clinical strains of Pseudomonas aeruginosa and Acinetobacter baumanii were isolated, respectively. Out of these, 67.62% and 72.05% isolates of Pseudomonas aeruginosa and Acinetobacter baumannii were MDR. Pseudomonas showed highest resistance to gentamicin (83.3%), followed by ceftazidime (80.18%), and Netilmicin (76.89%). Among Acinetobacter baumanii isolates, resistance to cephalexin (98.5%) was highest, followed by gentamicin (94.6%) and cefotaxime (94.12%). Conclusion: The increasing antibiotic resistance shown by these important pathogens leaves us with fewer option to treat severe life-threatening infections, stressing the need of a continuous antibiotic surveillance program and stringent implementation of infection control practices.    

References

1. Ekrami A, Kalantar E. Bacterial infections in burn patients at a burn hospital in Iran. Indian J Med Res 2007;126:541-4.
2. Alkaabi SAG. Bacterial Isolates and Their Antibiograms of Burn Wound Infections in Burns Specialist Hospital in Baghdad. J Baghdad Sci. 2013;10(2):331-40.
3. Srinivasan S, Vartak AM, Patil A, Saldanha J. Bacteriology of the burn wound at the Bai Jarbai Wadia Hospital for children, Mumbai, India- A 13 year study, Part-I Bacteriological profile. Indian J Plast Surg. 2009:42(2):213-218.
4. Mehta M, Dutta P, Gupta V. Bacterial isolates form burn wound infections and their antibiograms: A eight year study. Indian J Plast Surg. 2007;40(1):25-8.
5. Hussien IA, Habib KA, Jassim KA. Bacterial Colonization of Burn Wounds. J Baghdad Sci. 2012:9(4);623-31.
6. Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn Wound Infections. Clin Microbiol Rev. 2006;19(2):403-34.
7. Japoni A, Anvarinejad M, Farshad S, Giammanco GM, Rafaatpour N, Alipour E. Antibiotic Susceptibility Patterns and Molecular Epidemiology of Metallo-β- Lactamase Producing Pseudomonas Aeruginosa Strains Isolated from Burn Patients. Iran Red Crescent Med J. 2014;16(5):1-6.
8. Branski LK, Al-Mousawi A, Rivero H, Jeschke MG, Sanford AP, Herndon DN. Emerging Infections in Burns. Surg Infect. 2009;10(5):389-97.
9. Van TD, Dinh Q, Vu PD, Nguyen TV, Pham CV, Dao TT et al. Antibiotic susceptibility and molecular epidemiology of Acinetobacter calcoaceticus-baumannii complex strains isolated form a referral hospital in northern Vietnam. J Glob Antimicrob Resist. 2014;2(4):318-21.
10. Oncul O, Ulkur E, Acar A, Turhan V, Yeinz E, Karacaer Z, Yildiz F. Prospective analysis of nosocomial infections in a Burn Care Unit, Turkey. Indian J Med Res. 2009;130:758-64.
11. Liwimbi, OM, Komolafe IOO. Epidemiology and bacterial colonization of burn injuries in Blantyre. Malawi Med J. 2007;19(1):25-7.
12. Falagas ME, Karageorgopoulos DE. Pandrug Resistance (PDR), Extensive Drug Resistance (XDR), and Multidrug Resistance (MDR) among Gram-Negative Bacilli: Need for International Harmonization in Terminology. Clin Infect Dis. 2008;46(7):1121-2.
13. Manchanda V, Sanchaita S, Singh NP. Multidrug resistant Acinetobacter. J Global Infect Dis. 2010;2:291-304.
14. Bhatt P, Rathi KR, Hazra S, Sharma A, Shete V. Prevalence of multidrug resistant Pseudomonas aeruginosa infection in burn patients at a tertiary care centre. Indian J Burns 2015;23:56-9.
15. Bhat AS, Vinodkumar CS. Prevalence of burn wound infections with aerobic and anaerobic bacteria and their antimicrobial susceptibility pattern at tertiary care hospital. Int J Sci Res. 2013;2(11):410-3.
16. Valarmathi S, Pandian MR, Senthilkumar B. Incidence and screening of wound infection causing microorganisms. J Acad Indus Res. 2013;1(8):508-10.
17. Anupurba S, Bhattacharjee, A, Garg A, Sen MR. Antimicrobial susceptibility of Pseudomonas aeruginosa isolated from wound infections. Indian J Dermatol. 2006;51(4):286-8.
18. Agnihotri N, Gupta V, Joshi RM. Aerobic Bacterial Isolates from burn wound infections and their antibiograms- a five year study. Burns. 2004;30(3):241-3.
19. Sharma S, Hans C. Bacterial Infections in Burn patients: A three years study at RML Hospital, Delhi. J Commun Dis. 1996;28(2):101-6.
20. Singh NP, Goyal R, Manchanda V, Das S, Kaur I, Talwar V. Changing Trends in bacteriology of burns in burns unit, Delhi, India. Burns. 2003;29(2):129-32.
21. Revathi G, Puri J, Jain BK. Bacteriology of Burns. Burns. 1998;24(4):347-9.
22. Yolbaş I, Tekin R, Kelekçi S, Selçuk CT, Okur MH, Tan I, et al. Common pathogens isolated from burn wounds and their antibiotic resistance patterns. Dicle Med J. 2013;40(3):364-8.
23. Keen EF, Robinson BJ, Hospenthal DR, Aldous WK, Wolf SE, Chung KK, et al. Incidence and bacteriology of burn infections at a military burn center. Burns. 2010;36(6):461-8.
24. Azimi L, Motevallian A, Ebrahimzadeh Namvar A, Asghari B, Lari AR. Nosocomial Infections in Burned Patients in Motahari Hospital, Tehran, Iran. Dermatol. Res. Pract. 2011; doi: 10.1155/2011/436952.
Published
2016-11-06
Issue
Vol 3 No 5 (2016): (Suppl) November
Section
Original Article

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