Burn wound infection; significance of rule of nine in microbial surveillance

Burn injuries are common and major health problem throughout the world. The burn wound represents as a favorable area for opportunistic colonization of microorganisms with exogenous and endogenous origin. In burns patients infections arise from multiple sources. Burn wounds become initially colonized and infected with Gram positive bacteria, mainly Staphylococci, that are superseded during the second week by Gram Negative bacteria. it is a microbial surveillance retrospective study; that aimed to evaluate the significance of Rule of nine in diagnosis of aerobic bacterial burn wound infection and carried out in between June 2007 to September 2011 in the Department of Pharmaceutics, University of Karachi.Descriptive retrospective study. A total of 118 patient irrespective of age, sex, date and time of burn, date and time of hospital admission, interval between time of burn and hospital admission, degree and percentage [%] of burn and duration of hospital stay [when specimen collected] were registered for this study. All patients were divided into two groups [A and B]. Out of 58 patients of group A isolation rate per patient was 1.1 while in group B it becomes 3.0. According to TBSA the isolation rate in group B rises with rise in TBSA. Most prevalent organism in these patients was found S. aureus[23%] P.aeruginosa[21%]. Burn patients are incubator for variety of aerobic bacteria and rate of isolation of these organisms increase with rise in TBSA. The wounds of these patient must required continuous microbial surveillance that may reduce the rate of mortality

Resistance pattern of clinical isolates involved in surgical site infections

Wound infections due to the incursion of microbes need to be averted or to heal the wounds by antibiotics. Antibiotics are not only aid in cure of infections but also help to prevent the flourishing and production of one or more species of microorganism, resultant in purulent discharge. This current study was carried out to evaluate the resistance pattern of clinical isolates from surgical site infections by the Kirby Bauer disc diffusion method. A total of 257 clinical isolates were collected from different hospitals in Karachi and evaluated by using fifteen antibiotics belonging to different groups. Staphylococcus aureus [n=87], Escherichia coli [n=76], Pseudomonas aeruginosa [n=56], Proteus [n=21] and Klebsiella [n=17] species are the most common clinical isolates of surgical site infections. Among the semi-synthetic penicillins, ampicillin was found to be resistant to nearly all clinical isolates but amoxicillin was moderately sensitive to S. aureus. Combinations of semi-synthetic penicillins are more sensitive than the penicillin alone. Co-amoxiclave exhibits superior sensitivity to all the surgical infection isolates except Pseudomonas aeruginosa which showed 68.75% resistance. Pseudomonas aeruginosa was highly resistant to cephalosporin except ceftraixone which showed 21.88% resistance. S. aureus was slightly responsive to cefazolin, cephradine, cefaclor, ceftizoxime, cefuroxime and ceftriaxone. E. coli, Gram-negative clinical isolate was showed 25% and 31.25% resistance to ceftriaxone and cefuroxime. In the Klebsiella species, 71.42% and 64.29% resistance to cefazolin and cefuroxime respectively, was observed. Aminoglycosides such as gentamycin and tobramycin were found to be more susceptible to all the clinical isolates. Quinolones like ofloxacin and enoxacin were showed good sensitivity to nearly all the clinical isolates. On the basis of the present study, it is recommended to adopt a rational use of antibiotics in prophylaxis and the utilization of a coordinated scheme of surgical wound inspections.