Title: Prospective Study of Burn Wound for Microbial Involvement and Antimicrobial Susceptibility from a Tertiary Center of Gwalior

Authors: Dr Madan Mohan Mudgal, Dr Naveen Kushwah, Dr Raghvendra Singh, Dr Himanshu Gehlot

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i12.111

Abstract

Background: The major challenge for a burn team is nosocomial infection in burn patients, which is known to cause over 50% of burn deaths.

Aims and Objectives: To assess the pattern of bacterial colonization in a burn wound in patients admitted in Burn Unit.

Materials and Methods: Eighty two burn patients were studied in New Burn Unit of Department of Surgery, Gajra Raja Medical College and J A Group of Hospitals, Gwalior between June 2015 to May 2016. All patients were studied for nature and extent of microbial involvement in burn wounds and antimicrobial susceptibility and isolate pattern. Wound swabs were collected before change of dressing and administration of antibiotics with a swab immersed with normal saline on 0, 3rd, 7th and 14th day of hospital stay.

Results: Most common age group was 31-40 years (28.04%) with female preponderance (56.095%). Most of the patients had total body surface area (TBSA) of burn less than 30% (n=24) followed by 31-40% (n=25). Rate of bacterial growth was more on day 3 and 7 with 63.4% and 94.7% swabs yielding bacterial growth respectively. Bacterial isolates were frequently positive in cases with higher percentage of burn injury and mostly seen at day 7. Most common bacteria observed in burn wound was Staphylococcus aureus (n=96) followed by Pseudomonas species (n=80). A high level of drug resistance was seen with Pseudomonas species.

Conclusion:  Burn wound are devastating form of trauma generally affecting female population. Bacterial contamination occurs after 24 hours of initial treat and reaches maximum level at 7 days Staphylococcus aureus and Pseudomonas species are most common organism causing sepsis and wound infection. These organisms were sensitive to use of Norfloxacin, and Amikacin.

Keywords:  Nosocomial infection, total body surface area, bacterial infection, burn wound.

References

  1. Wibbenmeyer L, Danks R, Faucher L, Amelon M, Latenser B, Kealey GP et al. Prospective analysis of nosocomial infection rates, antibiotic use, and patterns of resistance in a burn population. J Burn Care Res 2006; 27(2):152-60.
  2. Koller J, Boca R and Langsadl L. Changing pattern of infection in the Bratislava Burn Center. Acta Chir Plast 1999; 41(4):112-6.
  3. Schofield CM, Murray CK, Horvath EE, Cancio L, Kim S, Wolf S et al. Correlation of culture with histopathology in fungal burn wound colonization and infection. Burns 2007; 1:15-32.
  4. Mark A, Carolyn H. Intensive care management and control of infection. BMJ 2004; 329:220-223.
  5. Church D, Elsayed S, Reid O. Burn wound infection. Clin Microbiol Rev 2006; 19(2): 403-34.
  6. Cheesbrough M. District Laboratory Practice in Tropical Countries. Part II 2nded; Elsevier 2005: 80-84.
  7. McManus AT, Mason AD Jr, McManus WF, Pruitt BA Jr. A decade of reduced gram-negative infections and mortality associated with improved isolation of burned patients. Arch Surg 1994;129:1306-9.
  8. Liwimbi OM, Komolafe IO. Epidemiology and bacterial colonization of burn injuries in Blantyre. Malawi Med J 2007;19:25-7.
  9. Mundhada SG, Waghmare PH, Rathod PG, Ingole KV. Bacterial and fungal profile of burn wound infections in Tertiary Care Center. Indian J Burns 2015;23:71-5.
  10. Macedo JLS, Santos JB. : Predictive factors of mortality in burn patients. Rev. Inst. Med. trop. S. Paulo 2007;.49(6): 65-79
  11. Erol S, Altoparlak U, Akcay MN, Celebi F, Parlak MA. Changes of microbial flora and wound colonization in burned patients. Burns 2004; 30(4): 357-61.
  12. Ibrahim NH, Amer TA. Frequency of Bacterial and Fungal Infections of Burn Wounds at Cairo University Burn Center. Egyptian Journal of Medical Microbiology 2008;17 (4):573-83.
  13. Soares de Macedo JL and Santos JB. Bacterial and fungal colonization of burn wounds. MemInstOswaldo Cruz, Rio de Janeiro 2005; 100(5): 535-9.
  14. Taylor GD, Kibsey P, Kirkland T, Burroghs E and Tredget E. Predominance of Staphylococcus organisms in infections occurring in a burns intensive care unit. Burns 1992; 18: 332-5.
  15. Vindenes H, Bjerknes R. Microbial colonization of large wounds. Burns 1995; 21: 575-579.
  16. Revathi G, Puri J and Jain BK. Bacteriology of burns. Burns 1998; 24: 347-9.
  17. Agnihotri N, Gupta V, Joshi RM. Aerobic bacterial isolates from burn wound infections and their antibiograms: a five-year study. Burns 2004; 30: 241-3.
  18. Nasser S, Mabrouk A, Maher A. Colonization of burn wounds in Ain Shams University burn unit. Burns 2003; 29: 229-233.
  19. Srinivasan S, Varma AM, Patil A, Saldanha J. Bacteriology of the burn wound at the BaiJerbaiWadia Hospital for children, Mumbai, India — A 13-year study, Part I-Bacteriological profile. Indian J PlastSurg 2009;42:213-8.
  20. Kehinde AO, Ademola SA, Okesola AO, Oluwatosin OM, Bakare RA. Pattern of bacterial pathogens in burn wound infections in Ibadan, Nigeria. Age (Omaha) 2004;10:29-34.
  21. Mohammed SW. Isolation and identification of aerobic pathogenic bacteriafrom burn wound infections. J Al NahrainUniv 2007;10:94-7.
  22. Lakshmi N, Koripella R, Manem J, Krishna PB.: Bacteriological profile of and Antibiogram of Burn wound infections in a tertiary care hospital. IOSR Journal of Dental and Medical Sciences 2015;14(10): p.1-4.
  23. Bayram Y, Parlak M , Aypak C, Bayram I. :Three-year Review of Bacteriological Profile and Antibiogram of Burn Wound Isolates in Van, Turkey. Int. J. Med. Sci. 2013; 10(1):19-28.
  24. Sewnet G, Edwards V, Greenwood. J.: What’s new in burn microbiology? James Laing Memorial Prize Essay. Burns 2010; 29(1): 15- 24.
  25. Negeri. Trends in antibiotic susceptibility patterns and epidemiology of MRSA isolates from several hospitals in Riyadh, Saudi Arabia. Annals of Clinical Microbiology and Antimicrobials 2011; 5: 30-36.

Corresponding Author

Dr Naveen Kushwah

101 Laxmi Residency, Raj Paiga Road Lashkar, Gwalior (MP)