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ORIGINAL ARTICLE
Year : 2015  |  Volume : 23  |  Issue : 1  |  Page : 65-70

Bacterial etiology and their antibiogram in burn wound infections at Kalaburgi region (India)


1 Department of Post Graduate Studies and Research in Microbiology, Gulbarga University, Gulbarga, Karnataka, India
2 Department of Surgery, District Hospital, Gulbarga, Karnataka, India

Date of Web Publication11-Dec-2015

Correspondence Address:
Dr. Y M Jayaraj
Department of Post Graduate Studies and Research in Microbiology, Gulbarga University, Gulbarga - 585 106, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-653X.171660

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  Abstract 

Purpose: To investigate the common aetiological agents and their antibiotic resistivity pattern in burn wound infections in this geographical area. Methods : Swabs from the burn wounds were collected on random basis using sterile cotton swabs from the patients admitted to Burn ward of Government Hospital, Gulbarga, Karnataka (South India) during 2012-13. Antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method according to M02-A11 and M100 -S22 Clinical Laboratory Standards Institute (CLSI) January 2012 guidelines and procedures on Mueller-Hinton agar. Results: A total 91 swabs from burns wound infection were collected from the patients of Burn Ward, out of which 83 were positive. Pseudomonas sps (33.73%) and S. aureus (27.71%) accounted for 61.44% of the positive cases as single aetiological agents. Klebsiella sps and E. coli accounted for 22.88% of the cases. The remaining 15.65% of cases had mixed aetiological agents. The results revealed the dominance of Gram negative organisms. It is significant to note that 64.52% and 24.19% of Gram negative bacterial isolates (62) were ESBL and MBL producers respectively indicating the base for the emergence of drug resistance. S. aureus was isolated from 23 positive cases as a single aetiological agent (27.71%) while it accounted for 11 (13.24%) cases with other co-pathogens. In the present study 67.65% (23 out of 34) Staphylococcus aureus isolates were Methicillin-resistant. Conclusions: The present study has revealed the emergence of MDR strains of Gram negative bacilli especially Pseudomonas sps and S. aureus as the predominant aetiological agents in burn wound infections in the hospital environment.

Keywords: Burn wound, extended spectrum β-lactamase, infection, metallo-β-lactamases, methicillin-resistant Staphylococcus aureus


How to cite this article:
Kulkarni V, Arali SM, Jayaraj Y M, Shivannavar CT, Joshi M R. Bacterial etiology and their antibiogram in burn wound infections at Kalaburgi region (India). Indian J Burns 2015;23:65-70

How to cite this URL:
Kulkarni V, Arali SM, Jayaraj Y M, Shivannavar CT, Joshi M R. Bacterial etiology and their antibiogram in burn wound infections at Kalaburgi region (India). Indian J Burns [serial online] 2015 [cited 2021 Oct 24];23:65-70. Available from: https://www.ijburns.com/text.asp?2015/23/1/65/171660


  Introduction Top


The burn wound represents the susceptible site for nosocomial and opportunistic pathogenic infections and is the leading cause of morbidity and mortality. [1],[2],[3],[4] Among the pathogens, β-hemolytic streptococci (Group A), Pseudomonas aeruginosa and Staphylococcus aureus are the leading pathogens in burn wound infection. [1],[3],[4],[5] Emergences of antibiotic resistance among them have changed the prospective of chemotherapy and prognosis. Methicillin-resistant S. aureus (MRSA), [4],[6],[7],[8] extended spectrum β-lactamase (ESBL) and metallo-β-lactamases (MBL) producing Gram-negative bacteria [9],[10],[11],[12],[13] are emerging as major pathogens in burn wound infections. In view of the nosocomial mode of infection and emergence of multiple antibiotic resistance organisms, there is a need for periodic evaluation of their prevalence and antibiogram in patients of burn wards. Hence, the present work has been undertaken.


  Materials and Methods Top


Bacterial isolates

In all 91 swabs from the burn wounds were collected on a random basis from the patients admitted to burn ward of Government Hospital, Gulbarga, Karnataka (South India) during 2012-2013. The samples were collected from the patients admitted to burn ward during the 3 rd to 5 th day. And the patients were on the antibiotic treatment as per the directions of the physician. The swab samples in transport medium (brain-heart infusion broth) were taken to the laboratory within 2 h of collection under aseptic conditions. The swabs were further inoculated on Nutrient Agar, Mannitol Salt Agar, Cetrimide Agar, Mac Conkey Agar and Blood Agar and were incubated aerobically at 37°C for 24 h. The bacterial isolates were identified by conventional diagnostic procedures (cultural, morphological, and biochemical characters). [14]

Antimicrobial susceptibility testing

The isolates were subjected for Antimicrobial susceptibility testing by Kirby-Bauer disc diffusion method according to M02-A11 and M100-S22 Clinical Laboratory Standards Institute January 2012 guidelines and procedures on Mueller-Hinton agar. [15],[16] The antimicrobial agents tested included penicillin-G (10 units), ampicillin (10 μg), amikacin (30 μg), clindamycin (2 μg), erythromycin (15 μg), tetracycline (30 μg), ceftazidime (30 μg), ceftriaxone (30 μg), cefepime (30 μg), methicillin (5 μg), oxacillin (1 μg), cefoxitin (30 μg), vancomycin (30 μg), linezolid (30 μg), co-trimoxazole (trimethoprim/sulphamethoxazole-1.25/23.75 μg), ciprofloxacin (5 μg), levofloxacin (5 μg), nalidixic acid (30 μg), carbenicillin (100 μg), piperacillin + tazobactam (100/10 μg μg), cefoperazone + sulbactam (50/50 μg μg), cefotaxime (30 μg), cefotaxime + clavulanic acid (30/10 μg), imipenem (10 μg), imipenem + ethylenediaminetetraacetic acid (EDTA) (10/750 μg).

Methicillin-resistant Staphylococcus aureus, extended spectrum β-lactamase and metallo-β-lactamases confirmation test

The MRSA isolates were further confirmed by oxacillin-cefoxitin disc diffusion method and the ESBL and MBL among the Gram-negative isolates were detected by using ESBL Detection Kit-SD238 (cefotaxime, cefotaxime + clavulanic acid) and MBL Detection Kit-SD282 (Imipenem + EDTA) obtained from Hi-Media Laboratories Pvt., Ltd, Mumbai (India) as per standard guidelines. [15],[16]


  Results Top


Age wise distribution of the samples

Out of 91 cases, maximum numbers of cases were in the age group of 21-40 and less number of cases in extreme age groups. Similarly, a maximum number of cases amongst male and female were in the same age groups. Number of female cases was recorded among children as well as in an old group. The details are given in [Table 1].
Table 1: Age and sex wise distribution of the patients (n = 91)


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Prevalence of bacterial isolates

Of 91 cases, 83 (86.46%) were positive for bacterial culture and sensitivity testing. Of the 83 positive cases, 70 (84.34%) had single etiology and 13 (15.66%) had mixed etiology. The results are given in [Table 2].
Table 2: Bacteria isolated from burn wound swabs (83)


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It is evident that Pseudomonas spp. (33.73%) and S. aureus (27.71%) accounted 61.44% of the positive cases as single etiological agents. Klebsiella spp. (13.25%) and  Escherichia More Details coli (9.63%) accounted 19 cases (22.88%). The remaining 15.65% of the cases were with mixed etiological agents. The results revealed the dominance of Gram-negative organisms as well as S. aureus.

Antibiotic resistance pattern

The antibiotic resistance patterns of isolate pathogens are given in [Table 3]. It is evident that all the Gram-negative isolates are highly resistant to β-lactam antibiotics (penicillins and cephalosporins). However, a good number of Gram-negative isolates were sensitive to combinational drugs. It is interesting to note that S. aureus also exhibited resistant to penicillin-G, ampicillin and cephalosporins while being sensitive to imipenem, vancomycin, linezolid, and clindamycin and were moderately sensitive to erythromycin. In the present study, 67.65% (23) S. aureus isolates were methicillin-resistant which were further confirmed by oxacillin-cefoxitin confirmation test [Figure 1].
Figure 1: Extended spectrum b-lactamase and metallo-b-lactamases producing Escherichia coli and Pseudomonas spp. and oxacillin-cefoxitin confirmation test of methicillin-resistant Staphylococcus aureus


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Table 3: Antibiotic resistant pattern of isolated pathogens


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Extended spectrum β-lactamase and metallo-β-lactamases producing isolates

The 62 isolates of Gram-negative bacilli, when tested for ESBL and MBL production, gave interesting results [Table 4]. Out of 62 isolates, 40 (64.52%) were ESBL producers and 15 (24.19%) were MBL producers. Maximum isolates of E. coli and Klebsiella spp. were ESBL producers when composed to Pseudomonas spp. (55.56%). It is alarming to note that is 40% of isolates of E. coli were MBL producers [Table 4] and [Figure 1].
Table 4: Distribution of ESBL and MBL among isolated Gram-negative bacteria


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  Discussion Top


This study was confined to bacterial etiology and its antibiogram of burn wound samples. Thus, the samples were collected from the patients admitted to burn ward during the 3 rd to 5 th day. The patients were on the antibiotic treatment as per the directions of the physician and the antibiotics were stopped after the week of admission. In present study has revealed the importance and emergence of multidrug-resistance (MDR) ESBL/MBL producing pathogens in case of burn wound infections. This situation calls for rigorous and correct treatment and management of burn cases. The studies revealed a higher number of cases among the age group 21-40 (57 out of 91 cases). Earlier reports also substantiate the present findings. [17]

A number of reports from foreign groups indicated the predominance of S. aureus in burn wound infection. [4],[7] On other hand, the reports from Indian subcontinent indicate the predominant of Gram-negative bacilli, especially Pseudomonas spp., E. coli and Klebsiella spp. [Table 5]. However, it is to be noted that even in the present study, the presence of S. aureus was quite significant and next only to Pseudomonas spp. The difference in the major etiology of burn wounds could be attributed to the socioeconomical status of the individuals, society and hospital environment.
Table 5: Comparative evaluation of different bacteria isolates and their antibiotic resistant pattern in various previous Indian studies


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The antibiogram studies indicate the emergence of multiple drug resistance strains. The organisms have exhibited resistance to the commonly used antibiotics as well as new generation antibiotics (cephalosporins). This may be due to the overuse of the said drugs in other infections leading to the development of multiple drug resistance pathogens. [3] The presence of MDR strains in the nosocomial environment and immunocompromised as well as physiologically compromised burn cases may facilitate the infection in burn patients and the failure of antibiotic therapy and a higher rate of mortality and morbidity.

It is significant to note that 64.52% and 24.19% of (62) Gram-negative bacterial isolates were ESBL and MBL producers respectively, indicating the base for the emergence of drug resistance. Singh et al. 2003 have also recorded similar trend among the isolates. [13] However Bandekar et al. recorded only 39.8% of isolates having ESBL producing ability. [11] In the present study 55.56% of isolates of Pseudomonas spp. were ESBL producers which is comparable to the observations of Altoparlak et al. [10] and is in contrast to the observations of Singh et al. 2003 and Bandekar et al. 2011, who reported the prevalence rate 20-22% of ESBL producing P. aeruginosa. [11],[13] Similarly the observations on Klebsiella spp. are comparable to that of Singh et al. 2003 and are in contrast with the observations of Bandekar et al. who reported only 7.2% of the same. [11],[13]

Altoparlak et al. 2005 recorded that MBL producing Gram-negative bacteria accounted for 56.8% while Bandekar et al. 2011 recorded a low percent (4.8%). [9],[11] The present work recorded a moderate number of the same (24.19%; 15 out of 62).


  Conclusion Top


The present study has revealed the emergence of MDR strains of Gram-negative bacilli, especially Pseudomonas spp. and S. aureus as the predominant etiological agents in burn wound infections in the hospital environment. The observations on the antibiogram and resistance pattern calls for the review of antibiotic policy and usage of combinational drugs in the management of burn wound infections. The observations on the emergence of ESBL and MBL strains are also significant and point toward the basis for antibiotic resistance pattern. The results have been compared with the available reports.

Acknowledgments

The authors are grateful to District Surgeon and Medical Superintendent, District Government Hospital Gulbarga for their kind support for performing this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.[19]

 
  References Top

1.
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2.
Gupta M, Gupta OK, Yaduvanshi RK, Upadhyaya J. Burn epidemiology: The Pink City scene. Burns 1993;19:47-51.  Back to cited text no. 2
    
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Ozumba UC, Jiburum BC. Bacteriology of burn wounds in Enugu, Nigeria. Burns 2000;26:178-80.  Back to cited text no. 4
    
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Pruitt BA Jr, McManus AT, Kim SH, Goodwin CW. Burn wound infections: Current status. World J Surg 1998;22:135-45.  Back to cited text no. 5
    
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Kaushik R, Kumar S, Sharma R, Lal P. Bacteriology of burn wounds - The first three years in a new burn unit at the Medical College Chandigarh. Burns 2001;27:595-7.  Back to cited text no. 8
    
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Altoparlak U, Aktas F, Celebi D, Ozkurt Z, Akcay MN. Prevalence of metallo-beta-lactamase among Pseudomonas aeruginosa and Acinetobacter baumannii isolated from burn wounds and in vitro activities of antibiotic combinations against these isolates. Burns 2005;31:707-10.  Back to cited text no. 9
    
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Altoparlak U, Erol S, Akcay MN, Celebi F, Kadanali A. The time-related changes of antimicrobial resistance patterns and predominant bacterial profiles of burn wounds and body flora of burned patients. Burns 2004;30:660-4.  Back to cited text no. 10
    
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Bandekar N, Vinodkumar CS, Basavarajappa KG, Prabhakar PJ, Nagaraj P. Beta lactamases mediated resistance amongst Gram-negative bacilli in burn infection. Int J Biol Med Res 2011;2:766-70.  Back to cited text no. 11
    
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Rezaei E, Safari H, Naderinasab M, Aliakbarian H. Common pathogens in burn wound and changes in their drug sensitivity. Burns 2011;37:805-7.  Back to cited text no. 12
    
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Singh NP, Goyal R, Manchanda V, Das S, Kaur I, Talwar V. Changing trends in bacteriology of burns in the burns unit, Delhi, India. Mol Biol Rep 2003;29:129-33.  Back to cited text no. 13
    
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Collins CH, Lyne PM, Grange JM. Collins and Lyne′s Microbiological Methods. 7 th ed. Publisher: Butterworth Heinemann; 1995. p. 163-205.  Back to cited text no. 14
    
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Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard M02-A11. 11 th ed., Vol. 32. 950, West Valley Road, Suite 2500, Wyane, PA 19087 USA: Clinical and Laboratory Standards Institute; 2012.  Back to cited text no. 15
    
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Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard M100-S22. 11 th ed., Vol. 31. 950, West Valley Road, Suite 2500, Wyane, PA 19087 USA: Clinical and Laboratory Standards Institute; 2012.  Back to cited text no. 16
    
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Ganesamoni S, Kate V, Sadasivan J. Epidemiology of hospitalized burn patients in a tertiary care hospital in South India. Burns 2010;36:422-9.  Back to cited text no. 17
    
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Mehta M, Dutta P, Gupta V. Bacterial isolates from burn wound infections and their antibiograms: A eight-year study. Indian J Plast Surg 2007;40:25-8.  Back to cited text no. 18
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Rajput A, Singh KP, Kumar V, Sexena R, Singh RK. Antibacterial resistance pattern of aerobic bacteria isolates from burn patients in tertiary care hospital. Biomed Res 2008;19:1998-2001.  Back to cited text no. 19
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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