Spread of Efflux Pump Overexpressing-Mediated Fluoroquinolone Resistance and Multidrug Resistance in Pseudomonas aeruginosa by using an Efflux Pump Inhibitor / 감염과화학요법

BACKGROUND: Fluoroquinolone resistance in Pseudomonas aeruginosa may be due to efflux pump overexpression and/or target mutations. We designed this study to investigate the efflux pump mediated fluoroquinolone resistance and check the increasing effectiveness of fluoroquinolones in combination with an efflux pumps inhibitor among P. aeruginosa isolates from burn wounds infections. MATERIALS AND METHODS: A total of 154 consecutive strains of P. aeruginosa were recovered from separate patients hospitalized in a burn hospital, Tehran, Iran. The isolates first were studied by disk diffusion antibiogram for 11 antibiotics and then minimum inhibitory concentration (MIC) experiments were performed to detect synergy between ciprofloxacin and the efflux pump inhibitor, carbonyl cyanide-m-chlorophenyl hydrazone (CCCP). Then to elucidate the inducing of multi drug resistance due to different efflux pumps activation in Fluoroquinolone resistant isolates, synergy experiments were also performed in random ciprofloxacin resistant isolates which have overexpressed efflux pumps phenotypically, using CCCP and selected antibiotics as markers for Beta-lactams and Aminoglycosides. The isolates were also tested by polymerase chain reaction (PCR) for the presence of the MexA, MexC and MexE, which encode the efflux pumps MexAB-OprM, MexCD-OprJ and MexEF-OprN. RESULTS: Most of the isolates were resistant to 3 or more antibiotics tested. More than half of the ciprofloxacin resistant isolates exhibited synergy between ciprofloxacin and CCCP, indicating the efflux pump activity contributed to the ciprofloxacin resistance. Also increased susceptibility of random ciprofloxacin resistant isolates of P. aeruginosa to other selected antibiotics, in presence of CCCP, implied multidrug extrusion by different active efflux pump in fluoroquinolones resistant strains. All of Ciprofloxacin resistant isolates were positive for MexA, MexC and MexE genes simultaneously. CONCLUSION: In this burn hospital, where multidrug resistant P. aeruginosa isolates were prevalent, ciprofloxacin resistance and multidrug resistance due to the overexpression of fluoroquinolones mediated efflux pumps has also now emerged. Early recognition of this resistance mechanism should allow the use of alternative antibiotics and use an efflux pumps inhibitor in combination with antibiotic therapy.

Application of whole-range fine management in infection prevention in batches of patients with extensive burns / 医学研究生学报

According to the infection characteristics of batches of patients with extensive burns in dust explosion, the article focused on the concept and mode of whole-range fine management.Based on the characteristics and rules of infection prevention in bat-ches of patients with extensive burns, the measurement and examination of infection management were refined, the infection monitoring indexes were designed scientifically, the infection prevention scheme and monitoring table were formulated.By early and whole-range intervention of infection prevention, quantitative evaluation, fine management and precise control at different times, all levels of infec-tion management teams could fully serve their purposes in order to realize effective infection prevention.

Effects of Rehabili-Medical Makeup for Patients with Burn Scar on Exposed Region

PURPOSE: Development of reconstruction plastic surgery for burn treatment and application SRNT (skin rehabilitation nursing therapy) have promoted improvement of dysmorphic feature and functional recovery. In case of deeper and extensive burn, however, treatment of burn scar after plastic surgery and SRNT may be unsatisfactory to burn patients. Especially burn patients having dysmorphic feature on exposed area like face suffer from psychological distress like depression, anxiety, guiltyfeeling, feeling of worthlessness, psychicinertia. Rehabili-Medical Makeup have performed congenital patient having hemangioma and vitiligo using covermark, and this is one of three technical effect of specialized skin rehabilitation nurses. Application of Rehabili-Medical Makeup covers burn scar afraid of exposure and resolves psychological distress, which makes burn patients gain confidence in themselves and helps their return to society. METHODS: Subjects of one's study are 10 burn patients that received SRNT from january 2007 to january 2011 and wanted Rehabili-Medical Makeup. We performed Rehabili-Medical Makeup using covermark foundation. practiced stress measuring test (MEDICORE SA-3000P, NIPRO Cocoro Stress Meter(R)) measured satisfaction (skin color, texture, duration, effectiveness and participation in education) using questionnaire. RESULTS: In stress measureing test after Rehabili-Medical Makeup patients maintained physiological balance. Satisfaction questionnaire show that patients are satisfied with every item. CONCLUSION: Rehabili-Medical Makeup resolves psychological distress and helps their return to society, which is final goal of rehabilitation. Hereafter we suggest to apply and expand education for managing patient's burn scar for themselves.

The application of nursing process to the support of early enteral nutrition in burned patients / 肠外与肠内营养

Objective: To investigate the effects of nursing process on the support of early enteral nutrition(EEN) in severely burned patients.Methods: EEN was carried out in 97 patients with severe burns by retention of naso-gastric(intestinal) feeding tube and continuous drip of nutritious fluid.97 patients were divided by different periods into two groups:group A and group B.The nursing process was used in group B.A series of parameters including the bearing to enteral nutrition,the patients′ nourishment,the occurance rate of complication,the time of wound healing and the cure rate were observed and analysed.Results: The bearing to EEN of the patients in group B was better than that in group A(P

A supplemental special burn diet for extensively burned patients.

Sixteen severely burned patients, divided into four groups according to the extent of their burns, were studied while being fed a special diet used as a supplemental nutritional support. The first group of two patients comprised those with burns covering less than 20 percent of the body surface area (BSA). The second group of six patients comprised those with burns covering 21-40 percent BSA. The third group of six patients had burns covering 41-60 percent BSA, and the fourth group of two patients had burns more than 60 percent BSA. The special diet for burn patients was given as a supplemental diet between meals or with meals to fulfil each patient’s demand for calories and protein. Enteral feeding was started as soon as the gastrointestinal function could be tolerated. We found that the special diet for burn patients raised the positive nitrogen balance in all group and kept weight loss to a minimum. For those burned extensively, particularly those with burns exceeding 40 percent BSA, some from of parenteral nutrition was needed as a secondary supplemental diet. Serum albumin gradually rose to the normal levels tended to be slightly elevated. Unfortunately, we have not been able to follow the changes in body chemistry after the patients were discharged from the hospital.