Phenotypic and genotypic characterization of metallo-ß-lactamase producing Pseudomonas aeruginosa isolated from burn patients.

Pseudomonas aeruginosa is an opportunistic pathogen associated with many nosocomial infections. This study aimed to detect blaIMP and blaVIM genes and their common subtypes, including bla IMP-1, bla IMP-2, bla VIM-1, and bla VIM-2, among imipenem-resistant Pseudomonas aeruginosa strains. In this study, 117 P. aeruginosa strains were isolated from clinical samples of burn wound patients in Velayat hospital, Rasht, Iran, between 2018 and 2019. These isolates were tested for antimicrobial susceptibilities by disk diffusion and Metallo-ß-Lactamase (MßL) activity. The polymerase chain reaction (PCR) test was applied to detect MßLs encoding genes in MßL-producing strains. The resistance rates were as follows: Tobramycin (59%), Gentamicin (57%), Piperacillin (52%), Ciprofloxacin (51%), Ceftazidime (32%), and Amikacin (26%). Among 27 (23%) imipenem-resistant isolates, 13 (48%) produced the MßL enzyme. PCR results of imipenem-resistant isolates showed that five and four isolates contained the blaVIM (4 blaVIM1, 2 blaVIM2) and blaIMP (4 blaIMP1, 2 blaIMP2) genes, respectively. In addition some of isolates had more than one gene. In this study, 48% of imipenem-resistant strains produced the MßL enzyme. Therefore, systematic surveillance to detect MßL-producing bacteria and rational prescription and use of carbapenems could be helpful to prevent the spread of carbapenem resistance.

Evaluation of patterns, cause and risk factors of burns in patients with seizure.

BACKGROUND: Burns following convulsion could be an important problem for patients with epilepsy. In the present study we aimed to identify the pattern and the cause of burns in these patients. METHODS: This is a cross-sectional study that was performed in 2017-2019 in Guilan on 40 patients with burns following seizure. The information in the records of patients were reviewed. We collected data including age, sex, marital status, occupation, place of residence, length of hospital stay, anatomy of the burn site, percentage of burn, degree of burns, cause of burns and disease outcome. RESULTS: The mean age of the patients was 42.2±2.99 years. Seven cases (17.5%) had burns due to fire, 5 cases (12.5%) due to gas explosion, 3 cases (7.5%) due to electrocution, 15 cases (37.5%) with hot water, 1 case (2.5%) with hot liquids, 5 cases (12.5%) with hot surface, 1 case (2.5%) with hot bath, 2 cases (5%) with hot food and 1 case (2.5%) with hot glue. The mean burning percentage of patients was 19.3±3.18%. The most common patterns of burns were observed as 7 (17.5%) upper limbs and 7 (17.5%) lower limbs. The mean duration of hospitalization was 5.05±0.69 days ranging from 1 to 18 days. 37 patients (92.5%) recovered partially and 3 patients (7.5%) died. CONCLUSION: Hot water, fire and hot surface are most common causes of burns and there were significant direct correlations between age with percentage of burns and duration of hospitalization. We believe further studies should evaluate the preventive strategies in this regard.

High incidence of type III secretion system associated virulence factors (exoenzymes) in Pseudomonas aeruginosa isolated from Iranian burn patients.

OBJECTIVE: The present study aimed to determine the prevalence of virulence factors and antimicrobial resistance profile of Pseudomonas aeruginosa strains isolated from Iranian burn patients. RESULTS: This cross-sectional study performed on 100 P. aeruginosa isolates which were recovered from burn wound specimens in 2014-2015. All presumptive isolates were identified by standard microbiologic tests. Antimicrobial susceptibility test was carried out by disk diffusion method. The presence of virulence genes was determined by PCR method. Antibiotic susceptibility results revealed that the isolates were mostly susceptible to amikacin (61%), ceftazidime (60%), and imipenem (55%). Moreover, 59% of the isolates were multi-drug resistance (MDR). The most prevalent MDR pattern was aminoglycosides-penicillins-fluoroquinolones-carbapenems (15%). The presence of exoT, exoY, exoS and exoU genes was detected in 100%, 100%, 59%, and 41% of the tested isolates, respectively. Results points out the pattern of MDR and genetic diversity of type III secretion system among P. aeruginosa strains isolated from the burn population. Overall, the association of MDR and the presence of the specific virulence genes can be a predictive marker for the persistence of these isolates in the hospitals and subsequently a worse clinical condition for the affected patients.

Serial Clinical Examinations of 100 Patients Treated for Anterior Abdominal Wall Stab Wounds: A Cross Sectional Study.

BACKGROUND: The current approach in stab wounds of the anterior abdominal wall is still unclear. OBJECTIVES: The goal of this study was to evaluate serial clinical examinations of patients with abdominal wall stab wounds referred to Poursina Hospital in Rasht. PATIENTS AND METHODS: In a cross sectional study, 100 cases with stab wounds to the anterior abdominal wall were examined serially (admission time, 4, 8, 12, and 24 hours) after wound exploration. Serial hemoglobin test was performed every 8 hours. Laparotomy was performed in cases who were not hemodynamically stable or who showed symptoms of peritonitis. The results were analyzed with SPSS software version 21. RESULTS: Ninety-one men (91%) and 9 women (9%) with mean age of 27 ± 10.7 years were included. Coexisting injuries were prevalent in 12 cases. The duration of hospitalization was 1 day in 31%, 2 days in 30%, 3 - 4 days in 32% and more than 5 days in 7%. Late laparotomy was performed 12 hours after admission in 8% of patients due to peritonitis. There was visceral damage in these cases. No mortality occurred. The cost and duration of hospitalization was significantly higher in cases with coexisting injuries and those who underwent laparotomy. CONCLUSIONS: It seems serial clinical examinations are safe and decrease the cost and duration of hospitalization in stable patients with anterior abdominal wall stab wounds.

Electrical burn injury: a five-year survey of 682 patients.

BACKGROUND: Electrical burn is less prevalent in comparison to other forms of burn injuries, however this type of injury is considered as one of the most devastating due to high morbidity and mortality. Understanding the epidemiologic pattern of electrical burns helps determine the contributing factors leading to this type of injury. OBJECTIVES: Epidemiologic studies on electrical burn are scarce in Iran. This study was conducted to evaluate electrical burn injury at our center. MATERIALS AND METHODS: Demographic data, etiology, burn percentage and other measures related to electrical burn injury of 682 electrical burn patients treated from 2007 to 2011 were collected and analyzed. RESULTS: We assessed 682 electrical burn patients (~10.8% of all burn patients); the mean age was 29.4 years and 97.8% were males. The mean hospital stay was 18.5 days and the mean burn extent was 14.43%. Severe morbidities caused 17 (2.5%) deaths. Amputation was performed in 162 cases. The most common amputation site was the fingers (35%). Most victims were workers and employees and 68.5% of electrical burns occurred at their workplace; 72% of electrical burns were due to high voltage electrical current (more than 1000 V). There was a correlation between voltage and amputation (P = 0.001) and also between voltage and fasciotomy (P = 0.033), but there was no correlation between voltage and mortality (P = 0.131). CONCLUSIONS: Electrical burn injuries are still amongst the highest accident-related morbidities and mortalities. Educating the population about the dangers and hazards associated with improper use of electrical devices and instruments is imperative.

Mortality and morbidity of fireworks-related burns on the annual last wednesday of the year festival (charshanbeh soori) in iran: an 11-year study.

BACKGROUND: Management of firework-related injuries is costly for the patient, society, and government. OBJECTIVES: Evaluating effective factors yielding to such injuries may lead to better management of patients and decreased costs and morbidities. PATIENTS AND MATERIALS: This retrospective cross-sectional study was performed on burn patients referred to Shahid Motahari Burns Hospital on Charshanbeh Soori day festival during the period extending from March 2000 to March 2011 (11 days in an 11-year period). Demographic data, causes of burn injury, severity, and affected body parts were recorded. Data were analyzed using SPSS version 16. RESULTS: There were164 patients in the study with a mean age of 18.34 ± 9.31 years; 87% (145/164) were male. Homemade grenades were the most frequent cause of injury. Hand injury was reported in 56% (92/164) of the cases. Amputation was executed in 7 (4.3%) cases, and 6 (3.7%) patients died due to severe burn injuries and facial damage. CONCLUSIONS: Fireworks- related injuries during Charshanbeh Soori ceremony causes significant morbidities and damage to different body parts (especially upper limbs and face), and some of these injuries will lead to life time disabilities, amputations, and even death. As most of the injured patients are young teenagers and children, special consideration must be taken into account to prevent long term morbidities.