Bacteria causing wound infection and
their antibiotic sensitivity pattern in burn patients
Dr. Prashant Borde
Department Of Microbiology,
Shri. Bhausaheb Hire Govt Medical College, Dhule
Introduction
Bacterial infection
of he wounds
in burn patients has been a prime
prime concern of surgeons world over. As
skin acts as a protective barrier against pathogen, thermal burns renders the
person susceptible for many infections bacterial
infection of of such wounds can penetrate deep inside and may lead to
septicaemia and could endanger life of the patients. Antibiotics were the prime
medications used for he treat men of such infections, in burn patients. But
soon resistant strains emerged in many hospital setup.
Bacterias
that are resistant o multiple antibiotics, are major cause of morbidity and
mortality among bur patents. Medical community is constant search to combat
these organisms. The search for the newer and newer antibiotic has been of no
use sine most of the antibiotics meet with
ability of the organisms to produce resistance. Gram negative bacterias
like pseudomonas and gram positive cocci like staphylococcus are the principal
pathogens having resistance , found in burn patients.
Numerous
studies has demonstrated that mortality risk is significantly increased when
the initial antibiotic regimen does not adequately cover the infecting pathogens
selecting such s regimen is complicated by the increasing prevalence of
resistance to commonly used antibiotics. Thus, for every case a detailed lab
investigation is necessary to find the sensitivity and resistance pattern of
thee infection organisms. This gives us an overlook of the antibiotics which could be used against a particular
organism.
Most of the
antibiotics till date has not proved to e efficient against many bacterias like
pseudomonas, staphylococcus and E. colli. However newer drugs are still being
invented and remain efficient ill they meet with the resistance of the
organisms. For the same combinations of the antibiotics could prove of some
help. It is necessary to find the resistance pattern of the organisms In a
particular hospital so that there is a even use of antibiotics and prescious antibiotics are not wasted.
This will stop the irrational use of the antibiotics which is responsible for
the emergence of multi drug resistance in the pathogens this project has a view
of finding the newer antibiotics single or in combinations which can be used to combat the organisms in
the hospital setup.
 |
| Bacterias planning for invasion |
Aims And objectives
1.To identify
the organisms causing wound infection in burn patients.
2. To know the
percentage of different organisms causing infections in burn patients
3. To study the resistance pattern of the organisms
.
4. To find out
the available antibiotics to which the organisms are sensitive.
METHODOLOGY
¨ Case control study
¨ No. of patients
screened – 50
¨ Patient selection-
More than 10% burn
¨ Pus swabs were collected for each case with sterile cotton swab sticks from the wounds
Details were recorded in case and transported immediately to Microbiology laboratory.
¨ Each
swabs was inoculated on blood and MacConkeys medium and the colony
morphology was studied.
¨ Organisms
were identified by Gram stain, various biochemical tests as per standard
microbiological methods.
Antibiotic sensitivity.
1. The
colonies were picked up and mixed with the peptone water in the test tube.2. The turbidity was compared with of Mc ferland’s standard.
¨ 3. The inoculated broth was used for antibiotic susceptibility test.
¨ 4. Test
was done by Kirby Baur disk diffusion
method.
¨ 5. Anitibiotic disks were selected as per NCCLS guidelines.
Antibiotic
sensitivity pattern of PSEUDOMONA AERUGINOSA
Antibiotic sensitivity pattern of STAPHYLOCOCCUS AUREUS
Antibiotic
sensitivity pattern of ESCHERICHIA COLI
OBSERVATION.
No.
|
Isolates.
|
No. of isolates
|
Percentage.
|
1.
|
Pseudomonas. aureginosa
|
17
|
34%
|
2.
|
Staphylococcus aureus
|
14
|
28%
|
3.
|
Escherichia coli
|
19
|
38%
|
4.
|
Klebsiella species
|
4
|
8%
|
5.
|
Proteus
|
1
|
2%
|
Discussion
Bacterial infection in the burn
patient has been a very grave problem in the whole world
planned detailed
study is necessary to find the resistance pattern of such bacteria. In this
project 50 samples were collected from which 84% were single isolate and 16
were multiple
isolates. The organisms found in our hospital setup are
pseudomonas aureginosa,
staphylococcus aureus, Escherichia coli, klebsiella
species, proteus species. contaminant
like gram positive cocci and
streptococcus was found in 2 patients. 2 swabs were reported
as sterile.
There was no study conducted like
this before.
From about 50 samples 34 were found
to be positive for
pseudomonas. From those, nearly all
were resistant to the antibiotics present
in our hospital.
Even the drugs like meropene and amikacin were not fond
to be sensitive for pseudomonas. As sinle drugs from the
groups like penicillin and cephalosporins were of no use
combinations of the drugs were used. The drugs
used
were Cefoprrazone+sulbacam and Piperacillin+
tazobactam. From about 17
isolates of pseudomonas
76.4% were found o be sensitive for
piperacillin+tazobactam and intermediate sensitive for
17.6%. sensitivity for
cfoperazone+ sulbctam was seen
for 70.5% isolates and intermediate sensitive for
23.5%.still 100% sensitivity was not
obtained as 5.8
of isolates were resistant for both combinations.
Staphylococcus strains were nearly
resistant all the
antibiotics in our hospital setup. Resistance was found even
for oxacillin. Vancomycn and
teicoplanin were the only antibiotics for which
the sensitivity was seen. However only 78.8%
isolates were found sensitive and 7.14% were intermediate for both the antibiotics. It was
strange that 14.28% of isolates were resistant to these antibiotics. The study was limited to
vancomycin and teicoplanin as they were considered to be standard drugs.
Maximum isolates about 38% were
found of Escherichia coli. They were identified
as lactose fermenting smooth
moist colonies over macConkeys agar. Tha sensitivity pattern
was variable.
About 5.26% isolates were found completely sensitive to ceftazidime, while
63.15% were intermediate. About 10.52% samples were intermediately sensitive to
cefoperazone, cefuorxime and ceftriaxone. All others antibiotics were found to
meet with
resistance.
75% Klebsiella isolates were
sensitive intermediately for
ciprofloxacin. 25% isolates
were completely sensitive to ciprofloxacin and none
other. Proteus were 100% sensitive
to gentamicin and ceftazidime.
Many organisms causes infections in
burn patients and they ae potentially harmful.
Thus, selection of a perfect
regimen of antibiotics is very essential. Furher, multidrug
resistant organisms
cause a great obstruction for selecting a good antibiotics. Thus a
planned study to find out newer and newer
available antibiotics to which he
organisms are
sensitive is very important. This will reduce the irrational use
of antibiotics and also will
reduce the morbidity and mortality rate in burn
patients causing reduction in hospital stay
and reduction I medical
expenditure.
CONCLUSION
¢In this study
conducted on the burn patients in burn ward of
Shri Bhausaheb
Hire Govt
Medical College, Dhule –
34% isolates of Pseudomonas
28% isolates of Staphylococcus
48% isolates of Gram negative bacteria
were found.
¢The combination of cefoperazone+sulbactum and piperacllin+tazobactam was
effective
for pseudomonas aeruginosa
¢ Vancomycin and Teicoplanin was found to be
sensitive for Staphylococcus aureus
¢Ceftazidime, Cefotaxime,
Ciprofloxacin and
Gentamicin were found sensitive for
Gram negative bacteria.
