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.

                               THANK YOU..............!!!