The Bacteriological Profile of Burn Wound Infections at a Tertiary Burns Center in Nepal

2019 ◽  
Vol 40 (6) ◽  
pp. 838-845 ◽  
Author(s):  
Ojas Jyoti Singh Pujji ◽  
Kiran Kishor Nakarmi ◽  
Basudha Shrestha ◽  
Shankar Man Rai ◽  
Steven Leonard Alexander Jeffery
Keyword(s):  
Traffic Accidents ◽  
Burn Injury ◽  
Road Traffic ◽  
Average Distance ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Wound Infections ◽  
Burn Wound ◽  
Gram Negative

AbstractIn Nepal, burn is the third most common injury after falls and road traffic accidents. Infection is the leading cause of mortality in burn injury. A profile exploring predominant flora and antimicrobial sensitivity is important to facilitate treatment ahead of microbiology results and to aid prevention of multidrug-resistant organisms. The aim of this study was to document epidemiological and bacteriological data of burn wound infections at a tertiary level burns center in Nepal. Samples were collected from January 2017 to May 2017, over a period of 5 months. Patient notes were referred to and information regarding baseline characteristics and burn wound infection data was collected. A total of 76 patients were included in the study during the 5-month period, which resulted in 113 samples being included for review. Females were injured most with burns 70% (n = 53) compared with males 30% (n = 23). Only 6 (8%) of 77 patients lived locally in Kathmandu. The average distance traveled by patients was 233 km (median 208, range 0–765, SD 181). Average TBSA% of burn was 22% (median 20, range 3–50, SD 12). Gram-negative organisms predominated, with Acinetobacter spp. in 42 cases (55%), Pseudomonas aeruginosa in 26 cases (34%), and Enterobacter spp. in 16 cases (21%). Colistin, polymyxin B, and tigecycline were found to be most sensitive covering 108, 98, and 94 organisms. Gram-negative bacteria colonized the majority of burn wounds. Colistin, polymyxin B, and tigecycline were the most sensitive to gram-negative bacteria. Gram-positive Staphylococcus aureus was sensitive most to vancomycin and tigecycline.

scholarly journals A Proof-of-Concept Study of the Efficacy of Systemically Administered Polymyxins in Mouse Burn Wound Infection Caused by Multidrug-Resistant Gram-Negative Pathogens

2018 ◽  
Vol 62 (5) ◽  
Author(s):  
Yu-Wei Lin ◽  
Ke Chen ◽  
Jiping Wang ◽  
Tony Velkov ◽  
Qi Tony Zhou ◽  
...  
Keyword(s):  
Bacterial Load ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Infection Model ◽  
Wound Infections ◽  
Proof Of Concept ◽  
Burn Wound ◽  
Gram Negative ◽  
Content Type ◽  
Therapeutic Benefits

ABSTRACTThe efficacy of subcutaneously administered polymyxins against burn wound infections caused byPseudomonas aeruginosa,Acinetobacter baumannii, andKlebsiella pneumoniaewas examined in a murine infection model. Subcutaneously administered colistin and polymyxin B (30 mg/kg thrice daily) achieved a ≥2-log10reduction in the bacterial load forP. aeruginosaandA. baumanniiinfections, whereas wound infections byK. pneumoniaewere less responsive (<1-log10reduction). This study highlights the potential therapeutic benefits of parenteral polymyxins for treating burn wound infections.

scholarly journals BACTERIOLOGICAL CHANGES OF BURN WOUNDS WITH TIME AND THEIR ANTIBIOGRAM

2015 ◽  
Vol 12 (12) ◽  
pp. 70-76 ◽  
Author(s):  
S Rajbahak ◽  
C Shrestha ◽  
A Singh
Keyword(s):  
Burn Injury ◽  
Bacterial Colonization ◽  
Bacterial Species ◽  
Lower Sensitivity ◽  
Microbiological Analysis ◽  
Gram Negative Bacteria ◽  
Burn Patients ◽  
Burn Wound ◽  
Female Ratio ◽  
Gram Negative

A prospective study was carried out in 42 burn patients admitted in burn unit of Bir Hospital over a period of six months from September 2011 to February 2012 to evaluate time-related changes in aerobic bacterial colonization and their susceptibility pattern. Periodic swabs were taken from the burn wound on 1st, 2nd, 3rd and 4th weeks to see the changing pattern of organisms during hospital stay of patients. Wound swabs obtained from the burn patients were subjected to microbiological analysis. The isolates were identified by standard microbiological techniques and their antibiotic susceptibility was determined by using Kirby-Bauer disk diffusion techniques. In the present study burn injury was highest in the age group 25-34 years (28.6%). Male to female ratio was 1:1.5. Fire was the major cause of burn (78.6%) followed by scald burn (7.1%). Among the 168 samples, single organism was isolated in 47.6% samples and mixed organisms in 39.9% and no growth in 12.5%. A total of 215 bacterial species were isolated from 168 samples in which Pseudomonas aeruginosa accounted for the highest percentage 45.6% followed by Staphylococcus aureus (19.1%), Acinetobacter spp. (17.7%) and coagulase negative Staphylococci (CONS) (5.6%). Gram negative bacteria were the dominating bacteria all over the study period and exhibited lower sensitivity to most of the antibiotic used. Furthermore, P. aeruginosa was least sensitive to most antibiotics used. Amikacin was the drug of choice for most Gram negative bacteria and vancomycin was found to be susceptible drug for Gram positive organisms (S. aureus and CONS). Continuous survey and analysis of changing microbial flora and their antibiogram in burn patients help in timely detection and control of spread of infection and also help to review effective antibiotic policies.Scientific World, Vol. 12, No. 12, September 2014, page 70-76      

scholarly journals Antimicrobial Activity and Toxicity of the Major Lipopeptide Components of Polymyxin B and Colistin: Last-Line Antibiotics against Multidrug-Resistant Gram-Negative Bacteria

2015 ◽  
Vol 1 (11) ◽  
pp. 568-575 ◽  
Author(s):  
Kade D. Roberts ◽  
Mohammad A. K. Azad ◽  
Jiping Wang ◽  
Andrew S. Horne ◽  
Philip E. Thompson ◽  
...  
Keyword(s):  
Antimicrobial Activity ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Gram Negative

scholarly journals Comparison of four phenotypic methods for detection of metallo-β-lactamase-producing Gram-negative bacteria in rural teaching hospital

2017 ◽  
Vol 9 (02) ◽  
pp. 081-083 ◽  
Author(s):  
Chinjal A. Panchal ◽  
Sweta Sunil Oza ◽  
Sanjay J. Mehta
Keyword(s):  
Antibiotic Sensitivity ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Beta Lactamases ◽  
Extended Spectrum Beta Lactamases ◽  
Synergy Test ◽  
Phenotypic Methods

Abstract CONTEXT: Metallo-β-lactamase (MBL)-producing bacteria lead to resistance to carbapenem an antibiotic that used as the last resort for treatment of multidrug-resistant bacteria, extended spectrum beta-lactamases, and AmpC β-lactamase-producing Gram-negative bacteria (GNB). The emergence of MBL-producing GNB is challenge to microbiology laboratories because there are no standardized guidelines available to detect them. The aim of this study was to compare four phenotypic methods to detect MBL production in GNB and to determine antibiotic sensitivity of MBL-producing isolates. MATERIALS AND METHODS: A total of 107 clinical isolates of GNB were tested for MBL production. Imipenem (IPM)-resistant GNB were taken as positive for MBL screening. MBL detection was done using ethylene diamine tetra acetic acid (EDTA) as MBL inhibitor. Four phenotypic methods were evaluated: (1) Combined disk synergy test (CDST) with 0.5M EDTA (CDST-0.5 M EDTA), (2) CDST with 0.1 M EDTA (CDST-0.1 M EDTA), (3) double-disk synergy test (DDST) with 0.5M EDTA (DDST-0.5 M EDTA), and (4) DDST with 0.1 M EDTA (DDST-0.1 M EDTA). RESULTS: Out of 107 GNB, 30 were resistant to IPM considered as screening positive. Out of 30, 21 (70%) isolates were MBL positive by CDST-0.1 M EDTA, 19 (63.33%) by CDST-0.5M EDTA, 17 (56.67%) by DDST-0.1 M EDTA, and 16 (53.33%) by DDST-0.5M EDTA. All MBL-producing Gram-negative Bacilli were resistant to ampicillin/sulbactam. Polymyxin B was found to be the most sensitive drug. CONCLUSION: CDST-0.1 M EDTA is the most sensitive method MBL detection. The detection of MBL-producing GNB is very important to control spread of the resistance.

scholarly journals High Level of Multidrug-Resistant Gram-Negative Pathogens Causing Burn Wound Infections in Hospitalized Children in Dar es Salaam, Tanzania

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Fatima Kabanangi ◽  
Agricola Joachim ◽  
Emmanuel James Nkuwi ◽  
Joel Manyahi ◽  
Sabrina Moyo ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Pediatric Patients ◽  
Multidrug Resistant ◽  
Dar Es Salaam ◽  
Wound Infections ◽  
Burn Wound ◽  
Gram Negative ◽  
E Coli ◽  
Acinetobacter Spp ◽  
Klebsiella Spp

Background. Bacterial infection remains the most common cause of morbidity and mortality in pediatric patients with burn wounds. The increase in infection and multidrug-resistant (MDR) pathogens necessitates a periodic review of antimicrobial susceptibility patterns in the burn units. The study aimed to determine the magnitude of multidrug-resistant Gram-negative (MDRGN) bacteria in children with burn wound infections and describe the resistance patterns in the tertiary and regional hospitals in Dar es Salaam, Tanzania. Materials and Methods. The study was a hospital-based cross-sectional study design conducted between May 2017 and February 2018. Bacterial isolates from 103 wound swabs of pediatric patients with burn wounds were identified using conventional methods and API 20E. The antimicrobial susceptibility pattern was determined by the Kirby–Bauer disc diffusion method. Data were analyzed using Statistical Package for Social Science (SPSS) version 23.0. Results. A total of 136 pathogenic Gram-negative organisms were isolated from burn wound infections in pediatric patients. The most isolated Gram-negative bacterium was Pseudomonas aeruginosa (39.0%), followed by Acinetobacter spp. (28.7%) and Klebsiella spp. (16.2%). MDRGN strains made up 80.1% of all Gram-negative isolates. All (100%) Klebsiella spp. and E. coli were MDR, while 69.2% and 79.2% of Acinetobacter spp. and P. aeruginosa, respectively, displayed MDR strains. We observed high levels of resistance to commonly prescribed antibiotics. Among P. aeruginosa isolates, highest resistance (81.8%) was seen toward meropenem and piperacillin, 79.5% of Acinetobacter spp. showed resistance to aztreonam, while 93–100% of Klebsiella spp and E. coli displayed resistance to amoxyclavulanic acid, ceftriaxone, and ceftazidime. The proportion of extended-spectrum beta-lactamase producers among Enterobacteriaceae was 78.6%. There was a significant higher rate of infection with MDRGN organisms in pediatric patients with a higher percentage of total burn surface area (TBSA) than patients with lower TBSA ( p  = 0.016). Conclusions. P. aeruginosa, Acinetobacter spp., and Klebsiella spp. are the common Gram-negative pathogens causing burn wound infections in hospitalized pediatric patients in our setting. A high proportion of these organisms were multidrug resistant. The findings appeal for regular antimicrobial resistance surveillance in burn wound infection to inform empirical therapy.

The prompt demonstration without culturing of gram-negative bacteria in burn wound infections

1991 ◽  
Vol 49 ◽  
pp. 120-121 ◽  
Author(s):  
J.S. Hanker ◽  
B.L. Giarnmara ◽  
R.L. Hopfer ◽  
H.D. Peterson
Keyword(s):  
False Negative ◽  
Gram Negative Bacteria ◽  
Wound Infections ◽  
Burn Wound ◽  
Wound Sepsis ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Negative Results ◽  
False Negative Results ◽  
Gram Negative Organisms

Burn wound sepsis is the most important factor in the morbidity and mortality associated with major burns. Blood cultures often give false negative results and wound biopsy is a much more accurate and reliable means of assessing the burn's microbial status. From 1950 to 1965, due to the introduction of antibiotics, gram-negative organisms became predominant among those recovered from burn wound infections. Although few grampositive organisms are now seen in Gram-stained burn wound biopsies, the light pink or red staining of gram-negative organisms can occasionally go unnoticed (Fig. 1). This is not the case when the biopsy sections are stained with the new positive PATS stain developed in our laboratories for gram-negative bacteria. This reaction deposits silver on the lipopolysaccharides of the outer walls of gram-negative, but not gram-positive, bacteria. The assessment of the microbial content of the specimen site as colonized, infected, or having mixed or unmixed gram-negative microbes is facilitated by this stain (Figs. 2-4).

scholarly journals Battacin (Octapeptin B5), a New Cyclic Lipopeptide Antibiotic from Paenibacillus tianmuensis Active against Multidrug-Resistant Gram-Negative Bacteria

2011 ◽  
Vol 56 (3) ◽  
pp. 1458-1465 ◽  
Author(s):  
Chao-Dong Qian ◽  
Xue-Chang Wu ◽  
Yi Teng ◽  
Wen-Peng Zhao ◽  
Ou Li ◽  
...  
Keyword(s):  
Polymyxin B ◽  
Multidrug Resistant ◽  
Clinical Isolates ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Drug Resistant ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Content Type ◽  
Lipopeptide Antibiotic

ABSTRACTHospital-acquired infections caused by drug-resistant bacteria are a significant challenge to patient safety. Numerous clinical isolates resistant to almost all commercially available antibiotics have emerged. Thus, novel antimicrobial agents, specifically those for multidrug-resistant Gram-negative bacteria, are urgently needed. In the current study, we report the isolation, structure elucidation, and preliminary biological characterization of a new cationic lipopeptide antibiotic, battacin or octapeptin B5, produced from aPaenibacillus tianmuensissoil isolate. Battacin kills bacteriain vitroand has potent activity against Gram-negative bacteria, including multidrug-resistant and extremely drug-resistant clinical isolates. Hospital strains ofEscherichia coliandPseudomonas aeruginosaare the pathogens most sensitive to battacin, with MICs of 2 to 4 μg/ml. The ability of battacin to disrupt the outer membrane of Gram-negative bacteria is comparable to that of polymyxin B, the last-line therapy for infections caused by antibiotic-resistant Gram-negative bacteria. However, the capacity of battacin to permeate bacterial plasma membranes is less extensive than that of polymyxin B. The bactericidal kinetics of battacin correlate with the depolarization of the cell membrane, suggesting that battacin kills bacteria by disrupting the cytoplasmic membrane. Other studies indicate that battacin is less acutely toxic than polymyxin B and has potentin vivobiological activity againstE. coli. Based on the findings of the current study, battacin may be considered a potential therapeutic agent for the treatment of infections caused by antibiotic-resistant Gram-negative bacteria.

scholarly journals POLYMIXIN IN ONCOLOGY CLINICAL PRACTICE

2018 ◽  
Vol 17 (3) ◽  
pp. 88-93 ◽  
Author(s):  
N. V. Dmitrieva ◽  
I. N. Petukhova ◽  
Z. V. Grigorievskaya ◽  
N. S. Bagirova ◽  
I. V. Тereshchenko ◽  
...  
Keyword(s):  
Polymyxin B ◽  
Multidrug Resistant ◽  
Infectious Complications ◽  
Cochrane Library ◽  
Clinical Response Rate ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

The purpose of the study was to present data on polymixin-based antibiotics with activity against infections caused by multidrug- resistant Gram-negative bacteria, such as Acinetobacter baumannii,  Klebsiella pneumoniae, and Pseudomonas aeruginosa.Material and methods. The review includes data from clinical as well as in vitro studies for the period 1998–2017. The search for  relevant sources was carried out in the Medline, Cochrane Library, Elibrary and other databases.Results. The analysis of the data showed the presence of synergism and additive activity of polymyxin in combination with  carbapenems, rifampicin and azithromycin. However, experimental  data showed no direct positive correlation between combination of  polymyxim and azithromycin/ rifampicin. In clinical studies, in  hospital-acquired pneumonia, including ventilator-associated  pneumonia, the clinical response rate of polymyxin B combined with  other antibiotics ranged from 38 % to 88 %. High nephro-and  neurotoxicity of polymyxin observed in previous studies can be  explained by a lack of understanding of its toxicodynamics or the use of an incorrect dose.Conclusion. Polymyxin B in combination with other antibiotics is a promising treatment against infectious complications caused by multidrug resistant Gram-negative bacteria.

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