A Study on Aerobic Bacteria in Patients with 20–40% Burns in a Tertiary Care Centre.
2007
INTRODUCTION : Patients with burn injuries are highly susceptible for infection as a
result of disruption of the normal skin barrier and accompanying
depression of immune response.
The burn surface contains a large amount of necrotic tissue and
the protein rich wound exudates provides a rich growth medium. So,
following the initial period of shock, infection is the major complication
and about 75% of the mortality associated with burn injuries is related to
infection. In addition, overcrowding in Burns Unit is an important cause
of cross-infection which necessitates a periodic monitoring of bacterial
species and their antibiogram. The organisms are mainly derived from
the patients gastro intestinal and upper respiratory tracts as well as from
the hospital environment.
It is crucial for every burn institution to determine the specific
pattern of burn wound microbial colonization, the time-related changes
in the dominant flora, and the antimicrobial sensitivity profiles. This
would enable early treatment of imminent septic episodes with proper
empirical systemic antibiotics, without waiting for culture results, thus
improving the overall infection-related morbidity and mortality.
In India where burns usually occur in the lower socioeconomic
strata and in a productive age group-rational antibiotic therapy
according to the prevalent strains of organisms should help in reducing
the mortality and morbidity associated with burns. The analysis of the
isolates and their sensitivity patterns helps to formulate an institutional
drug policy for the patients admitted in Burn Unit.
AIMS AND OBJECTIVES : • To study the profile of aerobic bacteria in patients with 20-40%
burns.
• To identify the factors that influence the outcome in these patients.
• To determine the type of dressing that contributed to better outcome.
• To study the antibiogram pattern of bacteria in the burns unit.
• To determine the prevalence of β lactamase producing strains.
• To study the factors that contribute to prevention of infection and
mortality in these patients.
MATERIALS AND METHODS : This is a cross sectional study done involving 100 patients both
male and female admitted to the Burn Unit, Department of Plastic and
Reconstructive Surgery, Kilpauk Medical College and Hospital,
Chennai. The study was carried out at the Institute of Microbiology,
Madras Medical College, Chennai.
PERIOD OF STUDY:
July 2005 to January 2006.
100 patients both male and female of age group 1 year to 65
years with burns of total body surface area (TBSA) of 20 to 40% were
included in the study. These patients had burns ranging from deep
partial thickness to full thickness injury. All patients received Tetanus
toxoid booster upon admission.
SPECIMENS:
1. Wound swabs from burn area.
2. Swabs from intact skin in the nasal, axillary, inguinal and
umbilical regions of the patients. [If the skin in the above areas
was burned samples were considered as burn wounds]
3. Blood from peripheral vein.
4. Environmental sampling study.
RESULTS : Young females were found to be most commonly affected.(11-40yrs) Of
the 9 Paediatric patients 6 were less then 6 years old.
Flame was the most common cause (81%) in this study followed by
scalds. The electrical injury was the least common cause and observed
in 2 cases. Scald injuries were observed more commonly in children
and women.
Among 100 patients 64 cases presented with 20-30% Burns. More no.
of 20-30% burns have been observed in young adults.
A higher mortality rate was observed in patients with III° and II°&III°
mixed burns.
Highest percentage of mortality occurred within the first week. Among
the survivors most were discharged within the first 2 weeks of
hospitalization.
The mortality of females with 31-40% of Total Burn Surface Area was
the highest.
Heparin saline dressing was commonly applied followed by collagen
dressing. In children only collagen dressing was applied.
Mortality was reported more in dressings with Silver Sulpha Diazine
followed by Heparin saline. Collagen dressing had the best outcome.
Among 81 flame injury patients 8 patients had inhalation injury. 100%
mortality occurred in burns with inhalation injury.
37 isolates were obtained from hospital environment & staffs
On admission polymicrobial type of infection was less and it was more
with the patients who stayed in the hospital for longer days.
CONCLUSION : This suggests the need for surveillance of environmental
saprophytes, monitoring for MDR strains in the environment so as to
identify and block the transmission of these strains to the patients.
Measures such as the following have to be implemented with
appropriate supervision to evidence, that there is no break in the aseptic
techniques.
1. To reduce the nosocomial infections, improved barrier nursing,
personal hygiene and restriction of visitors should be strictly
followed.
2. Discarded dressing materials should be properly disposed without
delay.
3. Use of sterile disposable aprons or separate sets of autoclaved
linen for each dressing should be provided.
4. Adequate spacing of beds is necessary.
5. Periodical fumigation of all the wards of burns unit should be
under taken.
6. Necessary equipments to provide respiratory support is needed in
patients with inhalation injury.
7. As the outcome of collagen dressing was good, patients may be
provided with collagen dressing as per the clinical indication
eventhough it is costly.
8. Routine surveillance of the environment with rotation of
antibiotics, based upon the susceptibility pattern of environmental
isolates can also reduce the incidence of nosocomial infection.
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