Antimicrobial susceptibility of bacterial isolates from burn units in Gaza

doi:10.1016/j.burns.2013.04.011

Burns

Volume 39, Issue 8, December 2013, Pages 1612-1618

https://doi.org/10.1016/j.burns.2013.04.011 Get rights and content

Abstract

Background

Bacterial infections continue to be a leading cause of morbidity and mortality among burn patients despite intensive prophylaxis and treatment. Often treatment is complicated by the emergence of antimicrobial resistance pathogens. There are no reports or published data on the susceptibility profiles of bacteria isolated from burn patients in the Gaza strip.

Patients and methods

A cross sectional study was performed in the two burn units of Al-Shifa and Naser hospitals for 6 months from October 2010 to March 2011. A total of 118 wound samples from burn patients, 97 environmental samples and 28 samples from health care workers (HCWs) were collected and cultured according to the standard microbiological procedures. The bacterial isolates were identified by conventional methods and the antibiotic susceptibility profiles were determined by the standard disc diffusion method according to CLSI guidelines.

Results

The overall percentage of positive cultures from both hospitals was 45.8%, where Nasser burn unit revealed higher positive cultures than Al-Shifa burn unit. Pseudomonas aeruginosa was the most common pathogen isolated (50%) followed by Enterobacter cloacae (28.3%). Meanwhile, fingers and nasal samples that collected from HCWs showed 78.6% and 32.3% positive cultures respectively, where P. aeruginosa was the highest pathogen isolated (32.3%), followed by Coagulase Negative Staphylococci (CoNS) (29%). Environmental samples also showed higher isolation rate of Pseudomonas and CoNS. Pseudomonas isolates from patients samples were found to be resistant to most of antimicrobials used except for piperacillin–tazobactam. The family Enterobacteriaceae isolated from patients and environmental samples were resistant to most of the tested antimicrobials. However, the Enterobacteriaceae isolates from HCWs samples were sensitive to the most of the tested antimicrobials. The incidence of methicillin-resistant Staphylococci according to oxacillin sensitivity test was 60% in patient's samples, 77.8% in HCWs samples and 90% in environmental samples.

Conclusion

High percentage of resistance was found among clinical isolates in general to the commonly used antibiotics with a notable increase in MRSA incidence among both patients and environmental samples as well as HCWs.

Introduction

Burns infection remains the leading cause of morbidity and death among burn patients [1], [2]. As a result of significant improvements of surgical treatments and intensive care in burn wards, it seems that infection is the direct cause of nearly 75% of deaths following burn [3], [4], [5]. Most of the infections are thought to be of nosocomial origin [6]. Infection in the wound prolongs the healing process; treatment includes rational antibiotic administration, removal of necrotic tissues, sufficient blood and oxygen supply to the wound and good nutritional support. All these measures are very important in the care of burn victims [7]. The spectrum of pathogenic bacteria on burn wounds varies in the course of burn treatment [8]. Health care workers (HCWs) move from patient to patient thus providing a means for pathogens to spread perhaps related to sanitation protocols regarding uniforms, equipment sterilization, washing and other preventive measures. Lastly, the routine use of antimicrobial agents in hospitals creates selection pressure for the emergence of the resistant strains of microorganisms [9].

The increase of multi-drug resistant (MDR) strains among the clinical isolates has further limited the therapeutic options [10]. It is therefore necessary to carry out periodic monitoring of patterns of isolation and susceptibility profiles of microorganisms in burn wounds in order to modify the preventive and therapeutic strategies. This especially is of utmost importance because regional variation in the type and susceptibility profiles exists. Colonization rates in burn patients from Gaza strip have been rarely reported and according to our best knowledge there is no documented reports or published scientific work. Furthermore, there is no data concerning the antimicrobial drug resistance of burn infections pathogens.

Therefore, the aim of this study was to determine the antimicrobial resistance among pathogens isolated from burn patients and burn unit environment from the two burn units in Gaza strip, Palestine. It is worth mentioning that burn wound colonization does not necessarily mean disease, however, burn wound colonization is a risk factor for clinical disease. Positive cultures in this study indicate colonization.

Section snippets

Setting and patients

This prospective cross-sectional study involved 118 patients who were admitted to the burn units of Al-Shifa (94) and Nasser (24) hospital during the period from October 2010 to March 2011. Any repeat sample or isolate obtained on more than one occasion from the same patient was excluded. The study design was approved by Helsinki committee and an informed consent was obtained from participating patients and HCWs.

Sample collection

The total number of burn wound swabs was 118 (Al-Shifa 94 and Nasser 24). The

Results

The overall percentage of positive cultures from both hospitals was 45.8%. In Al-Shifa burn unit the negative cultures account for 60.6% in comparison to 39.4% positive cultures while, Nasser burn unit showed higher percentage of positive cultures (70.8%). From the 97 different environmental samples that have been investigated, there were 23 (23.7%) positive samples from both burn units.

A total of 138 bacterial isolates were recovered from various sources in burn units including patients. The

Discussion

The present study is the first that attempts to isolate and characterize the possible etiological bacterial pathogens from burn patients and their environment in the two main burn units in Gaza strip. In this study we aimed not only to present the type and frequencies of the bacterial genera present in burn patients and that present in their environment, but also we tested its antimicrobial resistance profile against most used antibiotics at our burn units in order to modify the preventive and

Conclusion

P. aeruginosa (50%), was the most common isolated bacteria in this study and patients isolates were all considered as MDR and suspected to be clonal identical according to its antimicrobial resistant profiles. Higher rates were demonstrated in the Nasser hospital burn unit. Periodic monitoring of patterns of isolation and susceptibility profiles of pathogens in our burn units should be performed regularly in order to find out the best preventive and therapeutic strategies.

Conflict of interest

The authors declare no conflict of interest

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Antimicrobial susceptibility of bacterial isolates from burn units in Gaza

Abstract

Background

Patients and methods

Results

Conclusion

Introduction

Section snippets

Setting and patients

Sample collection

Results

Discussion

Conclusion

Conflict of interest

J Hospital Infect

Burns

Clin Plast Surg

Mol Biol Rep

Burns

Burns

Burns

J Microbiol Methods

Burns

J Hosp Infect

Burns

Burns

Burns

Burns

Intensive care management and control of infection

Mol Biol Rep