Burn wound septicemia–A pilot study from a tertiary care hospital

How to cite this article:
Sarma S, Nair D, Rawat D, Nanda D, Hasan A, Diwan S, Deb M, Aggarwal P. Burn wound septicemia–A pilot study from a tertiary care hospital. Ann Trop Med Public Health 2011;4:146-8

 

How to cite this URL:
Sarma S, Nair D, Rawat D, Nanda D, Hasan A, Diwan S, Deb M, Aggarwal P. Burn wound septicemia–A pilot study from a tertiary care hospital. Ann Trop Med Public Health [serial online] 2011 [cited 2020 Aug 9];4:146-8. Available from: https://www.atmph.org/text.asp?2011/4/2/146/85776

Sir,

Burn wound infections are a serious complication of thermal injury. Delay in isolating the pathogen and reporting of antibiotic sensitivity in these cases can lead to loss of critical time in patient management. This study was undertaken to study the microbiology of burn-associated infections and emphasize the role of automation (BacT alert 3D, Biomerieux France) in rapid detection of sepsis in these patients.

A total of 36 patients having burn wounds with clinical and histopathological evidence of septicemia were included in this study and evaluated according to a predetermined protocol. The samples included tissue biopsies, wound swabs, and paired blood samples. Tissue biopsy specimens were cultured by a semiquantitative technique. Wound swabs and conventional blood culture were done manually according to standard procedures. [1]

Blood culture (automation) was done in the BacT Alert 3D system strictly following the manufacturers instruction. Antibiotic sensitivity was done by Kirby-Bauer disk diffusion method. [1]

The most common age group involved was between 21 and 40 years, 29 (80.5%) and maximum (53%) burns were attributed to flame. Second-degree burns were the most frequent and majority (66%) of the patients had 20 to 40% total body surface area involvement. The range of hospital stay was 5 to 45 days with a mean duration of 10 days. Culture detection rates were 36.11%, 44%, and 45.4%, respectively, for blood, wound swab, and biopsies, respectively. Eighty percent of the blood cultures were positive by automation (within 24 hours) and 10% were positive by conventional blood cultures (within 48 hours). The spectrum of organisms isolated from blood was Staphylococcus aureus, 11 (87%) and Enterococcus spp, 2 (13%). Organisms isolated from wounds (swabs and biopsy) included Pseudomonas, 9 (42.8%); S. aureus, 5 (23.5%); Klebsiella spp, 3 (14.3%);  Escherichia More Details coli, 2 (9.6%); Citrobacter, 1 (4.7%); and coagulase-negative Staphylococcus, 1 (4.7%). Multiple pathogens (S. aureus and Pseudomonas in two cases and Klebsiella and Pseudomonas in one of the cases) were recovered from wound culture of 3 (8.3%) patients. Only in 3 (8.3%) patients were the same isolates (S. aureus) recovered in both blood (automation) and wound cultures.

Antibiotic sensitivity revealed most of the strains to be multidrug resistant (MDR). Among S. aureus, 73.3% were methicillin-resistant S. aureus (MRSA). The most effective drug was found to be vancomycin and clindamycin. No vancomycin-resistant Enterococcus was seen in this study. 84.5% of the Pseudomonads were MDR and 11.1% of the strains showed resistance to meropenem/imipenem and piperacillin and tazobactam combinations. Other Gram-negative bacteria isolated showed complete resistance to most of the drugs. Extended spectrum beta lactamase (ESBL) screening was performed on all isolates of Klebsiella, E. coli, and Citrobacter spp. and 66.2% was found to be ESBL positive [Table 1].

Table 1: Antimicrobial resistance in Gram-negative bacteria

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In the current study, culture positivity was maximum with tissue biopsy specimens. In a study, the results of cultures agreed with all histologically diagnosed bacterial infections. [2] Eighty percent of the isolates were detected by automation. In several recent studies, automation has been found to be a better and faster diagnostic tool for the detection of septicemias as compared with conventional blood culture. [3],[4] Thus, it can be inferred from our study that automation has definite advantages over conventional blood culture.

S. aureus was the predominant isolate from blood in our study which coincides with previous reports from both India and abroad. [5],[6] Pseudomonas followed by S. aureusKlebsiella spp, and E. coli were the common pathogens isolated from burn wounds. Similar reports have been published by various other workers in India, which corroborates with our findings but contrasts with others who have reported S. aureus as the commonest isolate. [7] Among S. aureus, 73.3% were MRSA. In a study of bacterial flora of burn wounds in India, the incidence of MRSA was found to be 94%. [7] MDR in burn isolates was found to be very common in Gram-negative isolates and the incidence of ESBL was found to range from 37 to 61%, which matches well with our observation of 60%. [7] The high percentage of MDR isolates is probably due to empirical use of broad-spectrum antibiotics. Strict restrictions on antibiotic usage and internal environmental control within burn units will help to decrease the incidence of nosocomial resistant strains and cross infection. Regular monitoring of burn wound flora and formulation of a protocol for wound care in treating these patients will prove to be effective in improving the overall infection-related morbidity and mortality.

References

 

1. Forbes B, Sahm D, Weissfeld A. Bailey and Scotts Diagnostic Microbiology. 10 th ed. Mosby; 2007.
2. McManus AT, Kim SH, McManus WF, Mason AD Jr, Pruitt BA Jr. Comparison of quantitative microbiology and histopathology in divided burn wound biopsy specimens. Arch Surg 1987;122:74-6.
3. Thorpe TC, Wilson ML, Turner JE, DiGuiseppi JL, Willeret M, Mirrett S, et al. BacT/Alert: An automated colorimetric microbial detection system. J Clin Microbiol 1990;28:1608-12.
4. Frank U, Malkotsis D, Mlangeni D, Daschner FD. Controlled clinical comparison of three commercial blood culture systems. Eur J Clin Microbiol Infect Dis 1999;18:136-41.
5. Bang RL, Sharma PN, Sanyal SC, Bang S, Ebrahim MK. Burn septicemia in Kuwait: Associated demographic and clinical factors. Med Princ Pract 2004;26:136-41.
6. Serour F, Stein M, Gorenstein A, Somekh F. Early burn related gram positive septicemic infection in children admitted to a pediatric surgical ward. Burns 2006;32:352-6.
7. Singh NP, Goyal R, Manchanda V, Das S, Kaur I, Talwar V. Changing trends in bacteriology of burns in the burns unit, Delhi, India. Burns 2003;29:129-32.

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1755-6783.85776

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