Journal of Research in Pharmacy Practice

Antimicrobial resistance pattern of bacterial isolates from burn wounds in an Iranian University Hospital

Document Type : Original Article

Authors

. Ali Mohammad Sabzghabaee 1
. Dariush Abedi 2
. Hossein Fazeli 3
. Abbasali Javadi 4
. Mohammad Jalali 5
. Mohammad Reza Maracy 6
. Rasool Soltani 1
. Mohammad Javad Karamyafti 1

1 Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Isfahan Pharmaceutical Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Microbiology, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Infectious Disease, Isfahan University of Medical Sciences, Isfahan, Iran

5 Department of Food Science and Technology, Isfahan University of Medical Sciences, Isfahan, Iran

6 Department of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract
Objective: About 73% of death cases in the first 5 days after burning are due to infection 
complications. The aim of this study was to identify the causing agents of infections in burn 
patients and the sensitivity pattern of them to the commonly used antimicrobials in an 
Iranian Burn center University Hospital.
Methods: In this cross-sectional study, patients who were admitted to one of the Iranian 
Burn center University hospitals in 2009 and had nosocomial infection due to burn wound, 
whom received antimicrobial agents for therapeutic reasons, with a hospitalization period of 
more than 48 hours were enrolled. Gram stain analyses were performed to help identifying 
growing colonies. Differential tests for identification of pathogenic bacteria species were 
performed following primary tests. E-test strips of each antimicrobial were placed on the 
culture medium plate in order to determine the minimum inhibitory concentration Studied 
antimicrobials for isolated Gram-negative bacteria were meropenem, piperacillin/tazobactam, 
ceftriaxone, cotrimoxazole, and for Staphylococcus aureus, vancomycin, piperacillin/
tazobactam, cotrimoxazole, and cephalothin.
Findings: Only 16% of Pseudomonas aeruginosa species were sensitive to meropenem, and 
13% were sensitive to piperacillin/tazobactam. Ten out of 29 Klebsiella species (34%) were 
sensitive to meropenem and piperacillin/tazobactam. All isolated strains of Staphylococcus 
aureus were sensitive to vancomycine while they were all resistant to cotrimoxazole.
Conclusion: Pseudomona, Klebsiella and Staphylococcoci are the most common species 
causing burn infection in this medical center. Results showed the importance of limiting 
irrational use of wide-spectrum antimicrobials and recommends strict management of 
infections in burn injury centers.

Keywords

Antimicrobial drug resistance
burns
wound infection
1. Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn 
wound infections. Clin Microbiol Rev 2006;19:403-34.
2. Atiyeh BS, Gunn SW, Hayek SN. State of the art in burn 
treatment. World J Surg 2005;29:131-48.
3. Baker CC, Miller CL, Trunkey DD. Predicting fatal sepsis in 
burn patients. J Trauma 1979;19:641-8.
4. Ekrami A, Kalantar E. Bacterial infections in burn patients at 
a burn hospital in Iran. Indian J Med Res 2007;126:541-4.
5. Alexander JW. Mechanism of immunologic suppression in 
burn injury. J Trauma 1990;30 (12 Suppl):S70-5.
6. Griswold JA. White blood cell response to burn injury. Semin 
Nephrol 1993;13:409-15.
7. Hansbrough JF, Field TO Jr, Gadd MA, Soderberg C. Immune 
response modulation after burn injury: T cells and antibodies. 
J Burn Care Rehabil 1987;8:509-12.
8. Erol S, Altoparlak U, Akcay MN, Celebi F, Parlak M. Changes 
of microbial flora and wound colonization in burned patients. 
Burns 2004;30:357-61.
9. Wysocki AB. Evaluating and managing open skin wounds: 
Colonization versus infection. AACN Clin Issues 2002;13:382-97.
10. Edwards R, Harding KG. Bacteria and wound healing. Curr 
Opin Infect Dis 2004;17:91-6.
11. Mason AD Jr, McManus AT, Pruitt BA Jr. Association of 
burn mortality and bacteremia. A 25-year review. Arch Surg 
1986;121:1027-31.
12. Robson MC. Burn sepsis. Crit Care Clin 1988;4:281-98.
13. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance 
definition of health care-associated infection and criteria for 
specific types of infections in the acute care setting. Am J Infect 
Control 2008;36:309-32.
14. Clinical and Laboratory Standards Institute, Performance 
standard for antimicrobial susceptibility testing. Wayne, PA: 
CLSI; 2009.
15. Askarian M, Hosseini RS, Kheirandish P, Assadian O. 
Incidence and outcome of nosocomial infections in female 
burn patients in Shiraz, Iran. Am J Infect Control 2004;32:
23-6.
16. Rastegar Lari A, Bahrami Honar H, Alaghehbandan R. 
Pseudomonas infections in Tohid Burn Center, Iran. Burns 
1998;24:637-41.
17. Singh NP, Goyal R, Manchanda V, Das S, Kaur I, Talwar V. 
Changing trends in bacteriology of burns in the burns unit, 
Delhi, India. Burns 2003;29:129-32.
18. Ozumba UC, Jiburum BC. Bacteriology of burn wounds in 
Enugu, Nigeria. Burns 2000;26:178-80.
19. Santucci SG, Gobara S, Santos CR, Fontana C, Levin AS. 
Infections in a burn intensive care unit: Experience of seven 
years. J Hosp Infect 2003;53:6-13.
20. Vindenes H, Bjerknes R. Microbial colonization of large 
wounds. Burns 1995;21:575-9.
21. Chaudhury A, Rao TV. Bacteraemia in a tertiary care urban 
hospital in south India. Indian J Pathol Microbiol 1999. 
42:317-20.
22. Monafo WW, West MA. Current treatment recommendations 
for topical burn therapy. Drugs 1990;40:364-73.
23. Murphy KD, Lee JO, Herndon DN. Current pharmacotherapy 
for treatment of severe burns. Expert Opin. Pharmacotherapy 
2003;4:369-84.
Journal of Research in Pharmacy Practice
Volume 1, Issue 1
August 2012
Pages 30-33

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