ABSTRACT
Background: Burn injuries and deaths pose a major public health concern globally, especially in developing and underdevelopedcountries. As burn patients have lost their primary barrier and exposed to microorganism invasion continually and chronically,Staphylococcus aureus becomes one of the greatest causes of nosocomial infection in burn patients though it is a normalskin flora. The cases of antibiotic resistance have increased, and resistant species such as methicillin-resistant S. aureus(MRSA) provide additional challenges in the form of virulence factors. Multimodal infection control concept is required to limitthe spread of infection with multidrug-resistant organism including MRSA in a burn unit. The common pathogens isolated fromburn wounds are S. aureus, Pseudomonas aeruginosa, Streptococcus pyogenes, Acinetobacter baumannii, and various coliformbacilli. Hence, antimicrobial susceptibility pattern of bacterial isolates in burn patients plays a key role in the management ofthese patients.Materials and Methods: This prospective observational study involved the collection of wound swabs from burn patientsfrom June 2018 to May 2019. All patients with burn wounds irrespective of age and sex, admitted through surgery outpatientdepartment or casualty, during the period of study were included in the study.Results: Maximum prevalence was found for P. aeruginosa, i.e., 37.5% followed by S. aureus, for which the prevalencewas found to be 18.75%. The organism least commonly cultured was Acinetobacter; the prevalence of MRSA was found tobe 57.14% and the prevalence of methicillin resistance was found to be 42.8% in patients with Staphylococcus epidermidis.Overall, the prevalence of methicillin resistance was 51.72%. The drugs most effective against P. aeruginosa, the most commonisolate, were meropenem (97.62%) and piperacillin/tazobactam (90.48%) followed by gentamicin (64.29%). Meropenem andpiperacillin/tazobactam showed 100% efficacy against the other Gram-negative bacilli isolated as well. MRSA isolates showed100% sensitivity to vancomycin and linezolid closely followed by piperacillin-tazobactam combination. Klebsiella pneumoniaeshowed 100% sensitivity to meropenem and piperacillin/tazobactam.Conclusions: The overall isolation rate was 75%. Only solitary isolates were studied. Overall, Gram-negative organisms(66.66%) were more common than Gram-positive organisms (33.33%). P. aeruginosa (37.5%) was the most commonisolate followed by S. aureus (18.75%). The prevalence of MRSA was 57.14%, but all the MRSA isolates showed 100%sensitivity to vancomycin and linezolid. On antibiotic sensitivity testing, piperacillin/tazobactam (95.24%) was found to bethe most effective drug against all the organisms isolated. Meropenem (99.40%) was the most effective drug against theGram-negative organisms. Vancomycin (100%) and linezolid (100%) were the most effective drugs for the Gram-positiveorganisms.
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Background: Post-operative respiratory complications are a major threat following emergency abdominal surgeries. It significantlyincreases post-operative morbidity and mortality. The aim of this study was to determine the incidence and factors affectingpost-operative pulmonary complications (PPCs).Materials and Methods: This is a prospective observational study conducted in 270 patients who got admitted through SOPD,casualty or transferred from other department, and undergoing emergency laparotomy over a period of 1 year (June 1, 2018–May 31, 2019). Patients were included in the study irrespective of age, sex, and occupation. Pre- and post-operative datawere collected through interview and postoperatively patients were monitored clinically and various investigations were doneto record post-operative respiratory complications. Then, their association was analyzed.Results: Two hundred seventy patients were included in the present study and 55 (20.4%) developed PPCs. Pneumonia (20)was the most common PPC followed by atelectasis (15). Elderly patients had more risk. PPCs were more in current smokers(30.98%), patients with pre-existing respiratory diseases (47.1%), duration of surgery more than 3 h. PPCs significantly increasethe duration of hospital stay and mortality.Conclusion: Pulmonary complications are significant among patients undergoing emergency laparotomy that leads to increasedmorbidity and mortality. Predictors of PPCs are smoking, pre-existing respiratory diseases, prolonged duration of surgery, andprolonged intubation.
ABSTRACT
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a well-recognized public health problem throughout theworld. The evolution of new genetically distinct community-acquired and livestock-acquired MRSA and extended resistance toother non-β-lactams including vancomycin has only amplified the crisis. This paper presents data on the prevalence of MRSAand resistance pattern to other antibiotics on the selected specimen from burn patients.Materials and Methods: This is a prospective study conducted in the burn unit of Shyam Shah Medical College and SanjayGandhi Memorial Hospital, Rewa (M.P.), from June 2018 to May 2019, where all patients with flame and scald burns wereincluded in the study who had up to a second degree or partial-thickness burns.Results: A total of 558 patients were admitted in the burn unit throu`ghout the year, the age ranged from 2 months to 85 years.About 56.10% were females and 43.90% were males. Pseudomonas aeruginosa (37.5%) was the most common isolatefollowed by S. aureus (18.75%). The prevalence of MRSA was 57.14% but all the MRSA isolates showed 100% sensitivity tovancomycin and linezolid closely followed by piperacillin and tazobactam combination. The prevalence of methicillin resistanceoverall among S. aureus and Staphylococcus epidermidis was found to be 51.72%.Conclusion: MRSA is prevalent among the burn wounds but is 100% sensitive to vancomycin and linezolid. To ensure earlyand appropriate therapy, routine microbiological surveillance and a regular update of their antimicrobial susceptibility patterncould help in the prevention of development of multidrug resistance.
ABSTRACT
Introduction: Chest trauma is one of the most serious injuries of the chest and also a common cause of significant disabilityand mortality. Chest trauma is the leading cause of death from physical trauma after head and spinal cord injury. Thoracicinjuries are primary or a contributing cause of about one-fourth of all trauma-related deaths. Traumatic chest injuries are onthe rise mainly due to increased frequency of road traffic accidents (RTAs) and rise in community disharmony. Chest injuriesare one of the common causes of major mortality and morbidity. The management of traumatic chest injuries depends on theseverity of injury, patient accessibility to nearby hospital, and availability of resources at tertiary care center.Materials and Methods: It is a prospective study of a total of 134 patients presenting to the emergency department with chest injuriesof varying severity in Sanjay Gandhi Memorial Hospital from 1 June 2018, to 31 May 2019 had been carried out. Data collectedregarding common injury modes, age and gender distribution, pre-hospitalization practices, clinical presentations, associated injuries,severity of injuries, and management options from the hospital record section and these data were analyzed with descriptive statistics.Results: Chest trauma is most common in males in their thirties with mean age of presentation 33.47 years. The most commonmode of injury was RTA 69.4%, followed by fall from height 14.9% and assault 11.1%. Pain in chest (53%) was the most commonsymptom of blunt trauma chest in the patients of our study sample followed by dyspnea (31%) and asymptomatic (9%). Clinicalsign was tenderness over chest. About 61.2% of patients found with collection in pleural cavity, in which hemothorax (23.9%)was the most common collection followed by pneumothorax (22.4%) and hemopneumothorax (15.7%).Conclusions: Chest injury is seen commonly in RTA patients. Most of the patients of chest injury had soft tissue trauma overchest in the form of abrasions and majority of these patients can be managed by symptomatic care and simple life-savingintervention, i.e. intercostal drainage. With increased RTAs, it is needed to have public awareness regarding road safetymeasures and educating them about the first aid measures for trauma patients.