Bacterial
Burn Wound Infections and Susceptibility to Antibiotics in
Al-Thaowrah General Hospital, Hodeidah
City, Yemen
Ahmed M. Al-kadassy1,
Mohamed A. Suhail1*, Abdul Rahman S. Naji2,
Mawhoob
N. O. Alkadasi2 and Abdulbaset A. Zaid3
1Department of Medical Laboratory ,Faculty
of Medical Science, Hodiada University, Yemen
2Department of Biology , Zabid Education Collage, Hodiadah
University, Yemen
3Post Graduate and Research Center, Maulana Azad College, Aurangabad (MS)
ABSTRACT:
Infection is a
major cause of mortality in hospitalized burn patients. The present study was
undertaken to determine burn infection bacterial etiological agents and their
antimicrobial sensitive pattern, the influence of environmental conditions, and
associated with burn infections. This study was conducted from March 2013 to
September 2013 at Burns' Center and Surgery in Al-Thaowrah
Hospital, Hodeidah, Yemen. A total of 85 swabs were
collected. Single isolates organisms
were present in 73 % of cases and multiple isolates were noted in 27 %
cases. The frequency of Gram negative
organisms was higher. The most common isolates were Pseudo.spp 37%, and Staph.
aureus 35.2%. (54.1%) of
patients were males and (45.9%) were females.
KEY
WORDS: Bacterial burn infections and susceptibility to
antibiotics in Hodiada city, Yemen.
INTRODUCTION:
Infection is an
important cause of morbidity and mortality in hospitalized burn patients. 75%
of all deaths following thermal injuries are related to infections. Thermal
injury destroys the physical skin barrier that normally prevents invasion of
microorganisms. During the first week following thermal trauma, the affected
sites are colonized with bacteria (1-5). Nosocomial infections is higher in burn patients due to
various factors like nature of burn injury itself, immunocompromised
status of the patient, age of the patient, extent of injury, and depth of burn
in combination with microbial factors such as type and number of organisms,
enzyme and toxin production, colonization of the burn wound site, systemic
dissemination of the colonizing organisms (3,4). Cross-infection results between different
burn patients due to overcrowding in burn wards. Burn wound infections are
largely hospital acquired and the infecting pathogens differ from one hospital
to another (6,7).
The aim of this
study was to determine the burn infection bacterial etiological agents and
their antimicrobial sensitive pattern, the influence of environmental
conditions, and associated with burn infections.
MATERIAL AND METHODS:
Study
Material and methods:
Study setting and design:
This study was
carried out during the period from March 2013 to February 2014. Samples were collected from patients
admitted to the Burn center in Al-Thowrah hospital, Hodaidah city.
Study population:
A total of 85
patients suffering from burns were included in this study.
Sample
Collection:
This study
was carried out on 85 burn wound swabs were taken from burned patients, who
presented invasive burn wound infection, from both sexes, and average age
1month -70 years, to burn unit in Al-Thawrah Hospital
located in Hodeida city from (13March
2013 to 10September 2013). These swabs were immersed in Amies transport medium. Swabs were taken and transferred
promptly to the lab to be cultured. All swabs were inoculated into blood
agar and MacConkey agar medium.
Incubation was done at 37oC for 24 to 48h for isolation of aerobic
bacteria. Patients' swabs were cultured at the Hodeidah
University Lab.
Following
incubation, the isolates bacteria from blood agar and MacConkey were identified by their colonial
morphology on media ,Gram’s staining and biochemical
tests (8-12). All isolates were subjected to antibiotics
sensitivity testing. Antimicrobial susceptibility tests were done on
Mueller-Hinton agar (Oxoid, England) using Disk
Diffusion Susceptibility Testing (Kirby-Bauer Method). After incubation,
the diameter of complete inhibition zones were measured using reflected light
and ruler(9).The antimicrobial
agents tested were
|
Gram Negative |
||
|
Antimicrobial
discs |
Potency |
Abbreviation |
|
Amikacin |
30µg |
AK |
|
Amoxacilin |
10µg |
AX |
|
Ciprofloxacin |
5 µg |
CPR |
|
Meropenem |
10 µg |
MR |
|
Cefoperazone |
75µg |
PZ |
|
Cefotaxime |
30µg |
CFT |
|
Ceftazidime |
30 µg |
CF |
|
Ceftriaxone |
30 µg |
FR |
|
Piperacillin |
100 µg |
PIP |
|
Chloramphenicol |
30 µg |
C |
|
Gentamicin |
10 µg |
GM |
|
Erythromycin |
15 µg |
ER |
|
Ofloxacin |
5µg |
OF |
|
Gram Positive |
||
|
Antimicrobial
discs |
Potency |
Abbreviation |
|
Ciprofloxacin |
5 µg |
CPR |
|
Clarithromycin |
15μg |
CL |
|
Cefolexin |
17μg |
CX |
|
Linezolid |
30 µg |
LINEZ |
|
Amoxyclav |
30µg |
AMC |
|
Netilmicin |
10µg |
NET |
|
Cephalexin |
30µg |
CP |
|
Oxacilin |
1µg |
OX |
|
Amoxacilin |
10µg |
AX |
|
Vancomycin |
30 µg |
VM |
|
Cefazolin |
30µg |
CZ |
|
Erythromycin |
15 µg |
ER |
|
Ceftazidime |
30 µg |
CF |
Statistical
analysis: Statistical analysis was done using SPSS version
14 soft ware. Chi-square test was employed
to compare the
proportion of bacterial
isolates with patients’
age and comparison of antimicrobial sensitivity.
P-value of < 0.05 was considered to indicate statistically significant
difference.
RESULTS:
A total of 85
patients suffering from burn were included in this study. 46 patients which
account for (54.1%) were males and 39 patients which account (45.9%) were
females. Both single Gram positive and single Gram negative bacteria showed the
same percentage of the total sample (36.5% each) with approximately equal
percentage in both males and females. Mixed Gram positive and Gram negative
bacteria were (27%) of the total sample predominantly in females (Table1).
In comparison of single isolates to mixed, single isolates was nearly three
times that of mixed (Table2).
Table 3:
showed the distribution of causative agents according to Gram's stain among
patients with infected burns in Al-Thawrah Hospital, Hodeidah city, Yemen. Both Gram positive bacteria and Gram
negative bacteria were isolated equally (50% each) from the total sample. The
most common isolate of Gram negative bacteria was Pseudomonas species
(74.1%) which corresponds 37% of total single isolates and the most common
isolate of Gram positive bacteria was Staphylococcus aureus
(70.4%) which corresponds 35.2% of total single isolates.
According to
tables 4-A and 4-B, different antibiotics were tested against the G-ve bacteria and G+ve
bacteria. Most of the Gram-negative isolates obtained were found to be
multidrug resistant. All Gram negative bacteria were
belong to various members of the family Enterobacteriacea.
Sensitivity of G-ve bacteria to antibiotic
(Table (4-A)) showed that Ceftriaxone,
Ciprofloxacin, and, Meropenem were the most
effective drugs against Pseudomonas species, followed by Amikacin, Chloramphincol and Cefoperazon. Also sensitivity of GPB to antibiotic (Table
(4-B)) showed that Vancomycin, CiprofloxacinI),
ErythromycinI were the most effective drugs against Staph.aereus.
Table1:
Distribution of Gram positive , Gram negative , and Mixed infections in relation to
gender among patients with infected
burns
|
Gender |
Gram
positive |
% |
Gram
negative |
% |
Mixed |
% |
Total |
% |
|
Male |
20 |
23.5% |
18 |
21.2% |
8 |
9.4% |
46 |
54.1% |
|
Female |
11 |
13.0% |
13 |
15.3% |
15 |
17.6% |
39 |
45.9% |
|
Total |
31 |
36.5% |
31 |
36.5% |
23 |
27% |
85 |
100% |
Table2:
Comparison of single isolates to mixed among patients with infected burns
|
Bacterial growth |
Number |
Percentage |
|
Single |
62 |
73 % |
|
Mixed |
23 |
27 % |
|
Total |
85 |
100 % |
Table3 :Distribution of causative agents according to Gram's stainamong
patients with infected burns
|
Gram's stain |
Name of
bacteria |
Frequency |
Percentage |
|
Gram negative |
Pseudomonas
species |
40 |
74.1 % |
|
Klebsilla species |
8 |
14.8 % |
|
|
E.coli |
1 |
1.9 % |
|
|
Proteus spp |
2 |
3.7 % |
|
|
Citrobacter |
3 |
5.5 % |
|
|
Total |
54 |
100 % |
|
|
Gram positive |
Staph. aureu |
38 |
70.4 % |
|
Staph. epidermides |
8 |
14.8 % |
|
|
Staph. saprophyticus |
8 |
14.8 % |
|
|
Total |
54 |
100 % |
Table (5)
illustrated the distribution of Gram positive and Gram negative bacteria according
to gender among patients in burn's center, in
Al-Thawrah Hospital, Hodeidah
city, Yemen. The males had higher rates of infection by Staph.aureus
(18.5%) followed by Pseudomonas species (16.7%), while the
females had higher rates of infection by Pseudomonas species (20.4%)
followed by Staph.aureus (16.7%). Generally,
the total infection in both sexes had the same percentage (50% each).
Table (6-A) it
was evident the incidence of Gram negative infection show dominance of Pseudomonas
species (74.1%) of total infection
with Gram negative bacteria while the remnant four Gram negative bacteria
organisms show neglected ratios of infection except Klebsiella
species. with 14.8%. The most infected age category with Gram negative
bacteria is (11-20) years in which 16 patients were infected (29.6%) followed
by the age category (21-30) years in which 13 patients were infected (24.1%)
and then followed by the age category (1month-10 years) in which 12 patients
were infected (22.2%). So the age from 1 month to 30 years correspond 76% of
total infected patients with Gram negative bacteria.
Table (6-B) it
was evident the incidence of Gram positive
bacteria infection show dominance of Staph.aureus, (70.4%) of the total infection
with Gram positive bacteria, while the
remnant two Gram positive bacteria
organisms show equal ratio of infection 14.8% for Staph.epidermides
and Staph.saprophyticus. The
most infected age category with Gram positive bacteria is (11-20) years in which 25
patients were infected (46.3%). The age from 1 month to 30 years correspond 76%
of total infected patients with Gram positive bacteria.
From the last
two tables (6-A and 6-B), the most prominent infections were Pseudomonas
species and Staph.aureus with Gram positive bacteria
and Gram negative bacteria respectively. The most infected age is from 1 month
to 30 years in both groups (Gram positive and Gram negative bacteria) and each correspond to 76%.
Table (7-A)
illustrates the distribution of the Gram negative ,Gram positive, and Mixed
bacteria according to the general characteristics of the patients in the burn
center, Al-Thawrah Hospital, Hodeidah
city, Yemen. The patients with age category (11-20) years were the highest in
infection by positive bacteria which account for 17.7%. Patients with age categories
(11-20) and (21-30) years were infected by negative bacteria and mixed bacteria
respectively (11.8% each). Regarding gender categories, males had higher
infection than females by gram positive and negative bacteria 20(23.5%),18 (21.2%), respectively. However, females had higher mixed
bacterial infection 15(17.6%). Married patients had higher infection with both
Gram positive and negative bacteria 16 (18.8%), 17 (20%) respectively, while
unmarried had higher mixed bacterial infection 13 (15.3%). Urbanized patients
showed higher infections with Gram negative 22 (25.9%), and Gram positive
bacteria 19 (22.4%). More than half of the sample were without work and had different types
of mentioned bacteria.
Table (4-A): Sensitivity of G-ve bacteria to antibiotic among patients
|
|
Pseudo. Spp n=40 |
k. spp n=8 |
Proteus spp n=2 |
E.coli n=1 |
Citrobacter n=3 |
|
Antibiotic |
S |
S |
S |
S |
S |
|
1-Amoxicilin2 |
1 |
6 |
0 |
0 |
0 |
|
2-Cefotaxim |
2 |
0 |
1 |
0 |
0 |
|
3-Ceftriaxone |
8 |
3 |
0 |
0 |
1 |
|
4-Amikacin |
7 |
2 |
0 |
1 |
1 |
|
5- Gentamicin |
1 |
0 |
0 |
0 |
0 |
|
6- Erythromycin |
4 |
2 |
0 |
0 |
1 |
|
7-Chloramphincol |
7 |
2 |
0 |
0 |
1 |
|
8-
Ciprofloxacin |
8 |
7 |
0 |
1 |
1 |
|
9- Cefoperazon |
7 |
1 |
0 |
0 |
0 |
|
10-Ceftazidem |
2 |
0 |
0 |
0 |
0 |
|
11-Meropenem |
8 |
0 |
1 |
0 |
0 |
|
12-Ofloxcin |
6 |
0 |
2 |
0 |
0 |
|
13-Pipracillin |
3 |
0 |
0 |
0 |
0 |
Notes: Pseudo spp= Pseudomonas species , k. spp= Klebsiella species, E.coli= Escherichia coli, n=Number , S=sensitive.
Table
(4-B): Sensitivity of G+ve bacteria to
antibiotic among patients
|
Organism |
S. aereus n=38 |
S. epidermidis n=8 |
S. saprophaticus n=8 |
|
Antibiotic |
S |
S |
S |
|
1- Amoxicilin |
3 |
2 |
3 |
|
2-Oxacillin |
0 |
0 |
0 |
|
3-Cephalexine |
0 |
1 |
3 |
|
4-
Ciprofloxacin1 |
14 |
7 |
0 |
|
5-
Erythromycin1 |
10 |
2 |
0 |
|
6- Vancomycin |
16 |
6 |
3 |
|
7-Netilmycin |
1 |
1 |
1 |
|
8-Clarythromycin |
5 |
1 |
0 |
|
9-Amoxyclave |
0 |
0 |
0 |
|
10-cefazolin |
0 |
2 |
1 |
|
11-Ceftazedime |
1 |
0 |
0 |
|
12-Cefolexin |
2 |
0 |
1 |
|
13-Linezolid |
8 |
1 |
6 |
Table (7-B)
shows the distribution of the G-ve, G+ve, and Mixed bacteria according
to the general characteristics of the patients' burns (degree of burn, cause of
burn and site of infection) in the burn center, Al-Thawrah
Hospital, Hodeidah city, Yemen. Patients with third
degree burns were the most infected ones (64%) by different types of bacteria
followed by those with second degree (35%). It was found that the most common
causes of burns were boiling water and hot objects (37.6% and 32.9%
respectively) and the most infected sites were the extremities (right leg
(23.5%), right hand (17.6%), left hand (16.5%), and left leg (12.9%).
Table (5):
Distribution of G+ve and G-ve according to gender among patients
|
|
Male |
Female |
Total |
||||
|
N=28 |
% |
N=26 |
% |
N=54 |
% |
||
|
Gram Positive Bacteria |
Staph. aureus |
20 |
18.5% |
18 |
16.7% |
38 |
35.2% |
|
Staph. epidermides |
4 |
3.7% |
4 |
3.7% |
8 |
7.4% |
|
|
Staph. saprophyticus |
4 |
3.7% |
4 |
3.7% |
8 |
7.4% |
|
|
Total |
28 |
25.9% |
26 |
24.1% |
54 |
50% |
|
|
Gram Negative Bacteria |
Pseudomonas
species |
18 |
16.7% |
22 |
20.4% |
40 |
37.1% |
|
Klebsilla species |
5 |
4.6% |
3 |
2.8% |
8 |
7.4% |
|
|
E.coli |
0 |
0% |
1 |
0.9% |
1 |
0.9% |
|
|
Proteus |
1 |
0.9% |
1 |
0.9% |
2 |
1.8% |
|
|
Citrobacter |
2 |
1.8% |
1 |
0.9% |
3 |
2.8% |
|
|
Total |
26 |
24.1% |
28 |
25.9% |
54 |
50% |
|
|
Grand total |
54 |
50% |
54 |
50% |
108 |
100% |
|
Table (6-A):
Distribution of G-ve bacteria according to
age among patients
|
Age |
Pseud.spp. N % |
Klebsiella N % |
E.coli N % |
Proteus N % |
Citrobacter N % |
Total N % |
|
1m-10y |
10 25% |
1 12.5% |
1 100% |
0 0% |
0 0% |
12 22.2% |
|
-20y |
11 27.5% |
2 25% |
0 0% |
1 50% |
2 66.7% |
16 29.63% |
|
-30y |
11 27.5% |
2 25% |
0 0% |
0 0% |
0 0% |
13 24.07% |
|
-40y |
5 12.5% |
2 25% |
0 0% |
0 0% |
0 0% |
7 12.97% |
|
-50y |
1 2.5% |
1 12.5% |
0 0% |
0 0% |
0 0% |
2 3.7% |
|
-60y |
1 2.5% |
0 0% |
0 0% |
1 50% |
0 0% |
2 3.7% |
|
-70y |
1 2.5% |
0 0% |
0 0% |
0 0% |
1 33.3% |
2 3.7% |
|
Total |
40 100% |
8 100% |
1 100% |
2 100% |
3 100% |
54 100% |
Table (6-B): Distribution of G+ve bacteria according to age among patients
|
Age |
Staph.aureus N % |
Staph.epidermides N % |
Staph.saprophyticus N % |
Total N % |
|
1m-10y |
6 15.8% |
1 12.5% |
1 12.5% |
8 14.8 % |
|
-20y |
18 47.3% |
2 25% |
5 62.5% |
25 46.3 % |
|
-30y |
6 15.8% |
1 12.5% |
1 12.5% |
8 14.8 % |
|
-40y |
3 7.9% |
4 50% |
1 12.5% |
8 14.8 % |
|
-50y |
2 5.3% |
0 0% |
0 0% |
2 3.7% |
|
-60y |
3 7.9% |
0 0% |
0 0% |
3 5.6% |
|
-70y |
0 0% |
0 0% |
0 0% |
0 0% |
|
Total |
38 100% |
8 100% |
8 100% |
54 100% |
Table(7-A): Distribution of the G-ve, G+ve, and Mixed bacteria according to the general characteristics
of the patients
|
|
Gram Positive |
Gram Negative |
Mixed |
Total |
X2 |
P-value |
|||||||
|
N =31 |
% |
N =31 |
% |
N=23 |
% |
N =85 |
% |
X2 |
p-value |
||||
|
Age |
|
|
|
|
|
|
|
|
14.58 |
0.265 |
|||
|
1m-10y |
3 |
3.5 |
7 |
8.2 |
5 |
5.9 |
15 |
18 |
1.7616 |
0.4145 |
|||
|
-20y |
15 |
17.7 |
6 |
7.1 |
10 |
11.8 |
31 |
36 |
4.0068 |
0.0559 |
|||
|
-30y |
5 |
5.9 |
10 |
11.8 |
3 |
3.5 |
18 |
21 |
2.8890 |
0.0318 |
|||
|
-40y |
4 |
4.7 |
3 |
3.5 |
4 |
4.7 |
11 |
13 |
0.6072 |
0.1741 |
|||
|
-50y |
2 |
2.4 |
2 |
2.4 |
0 |
0.0 |
4 |
5 |
1.4839 |
0.3515 |
|||
|
-60y |
2 |
2.4 |
1 |
1.2 |
1 |
1.2 |
4 |
5 |
0.3513 |
0.3995 |
|||
|
-70y |
0 |
0.0 |
2 |
2.4 |
0 |
0.0 |
2 |
2 |
3.4839 |
0.1470 |
|||
|
Gender |
|
|
|
|
|
|
|
|
5.01 |
0.082 |
|||
|
Male |
20 |
23.5 |
18 |
21.2 |
8 |
9.4 |
46 |
54 |
2.2975 |
0.3170 |
|||
|
Female |
11 |
12.9 |
13 |
15.3 |
15 |
17.6 |
39 |
46 |
2.7098 |
0.0818 |
|||
|
Martial statues |
|
|
|
|
|
|
|
|
0.70 |
0.704 |
|||
|
Unmarried |
15 |
17.6 |
14 |
16.5 |
13 |
15.3 |
42 |
49 |
0.3552 |
0.8373 |
|||
|
Married |
16 |
18.8 |
17 |
20.0 |
10 |
11.8 |
43 |
51 |
0.3470 |
0.7039 |
|||
|
Residence |
|
|
|
|
|
|
|
|
5.65 |
0.059 |
|||
|
Urban |
19 |
22.4 |
22 |
25.9 |
9 |
10.6 |
50 |
59 |
2.3257 |
0.3126 |
|||
|
Rural |
12 |
14.1 |
9 |
10.6 |
14 |
16.5 |
35 |
41 |
3.3224 |
0.0594 |
|||
|
Work history |
|
|
|
|
|
|
|
|
10.16 |
0.118 |
|||
|
Manual work |
4 |
4.7 |
4 |
4.7 |
3 |
3.5 |
11 |
13 |
0.0003 |
0.9999 |
|||
|
Student |
11 |
12.9 |
6 |
7.1 |
8 |
9.4 |
25 |
29 |
1.6802 |
0.4316 |
|||
|
Employee |
5 |
5.9 |
1 |
1.2 |
0 |
0.0 |
6 |
7 |
5.8817 |
0.0228 |
|||
|
No work |
11 |
12.9 |
20 |
23.5 |
12 |
14.1 |
43 |
51 |
2.5982 |
0.0144 |
|||
Table(7-B): Distribution of the G-ve, G+ve, and Mixed bacteria
according to the general characteristics of the patients' burns
|
|
Gram Positive |
Gram Negative |
Mixed |
Total |
X2 |
P-value |
||||
|
|
No =31 |
% |
No =31 |
% |
No=23 |
% |
No =85 |
% |
|
|
|
Degree
of burn |
|
|
|
|
|
|
|
|
3.2426 |
0.5181 |
|
First degree |
1 |
1.2 |
0 |
0 |
0 |
0 |
1 |
1 |
1.7419 |
0.4185 |
|
Second degree |
11 |
12.9 |
13 |
15.3 |
6 |
7.1 |
30 |
35 |
0.9402 |
0.2616 |
|
Third degree |
19 |
22.4 |
18 |
21.2 |
17 |
20.0 |
54 |
64 |
0.5605 |
0.4722 |
|
Causes of burn |
|
|
|
|
|
|
|
|
14.4485 |
0.4169 |
|
Hot Objects |
13 |
15.3 |
9 |
10.6 |
6 |
7.1 |
28 |
32.9 |
1.2331 |
0.5398 |
|
Electrical |
3 |
3.5 |
5 |
5.9 |
1 |
1.2 |
9 |
10.6 |
1.7691 |
0.2229 |
|
Chemical |
0 |
0 |
2 |
2.4 |
2 |
2.4 |
4 |
4.7 |
2.4376 |
0.1221 |
|
Boiling water |
10 |
11.8 |
12 |
14.1 |
10 |
11.8 |
32 |
37.6 |
0.4562 |
0.2353 |
|
Coolness |
0 |
0 |
1 |
1.2 |
0 |
0 |
1 |
1.2 |
1.7419 |
0.3332 |
|
Kerosene |
3 |
3.5 |
1 |
1.2 |
1 |
1.2 |
5 |
5.9 |
1.2230 |
0.2271 |
|
Petrol |
2 |
2.4 |
0 |
0 |
3 |
3.5 |
5 |
5.9 |
3.8457 |
0.0793 |
|
Gas |
0 |
0 |
1 |
1.2 |
0 |
0 |
1 |
1.2 |
1.7419 |
0.0612 |
|
Lightning |
0 |
0 |
1 |
1.2 |
0 |
0 |
1 |
1.2 |
1.2331 |
0.5398 |
|
Site of infection |
|
|
|
|
|
|
|
|
30.6416 |
0.0601 |
|
Head |
1 |
1.18 |
2 |
2.35 |
1 |
1.18 |
4 |
4.7 |
0.3513 |
0.8389 |
|
Face |
0 |
0 |
0 |
0 |
4 |
4.71 |
4 |
4.7 |
10.7826 |
0.0038 |
|
Neck |
0 |
0 |
1 |
1.18 |
2 |
2.35 |
3 |
3.5 |
2.8415 |
0.0011 |
|
Right hand |
5 |
5.88 |
4 |
4.71 |
6 |
7.06 |
15 |
17.6 |
1.3642 |
0.1221 |
|
Left hand |
7 |
8.24 |
5 |
5.88 |
2 |
2.35 |
14 |
16.5 |
1.5490 |
0.2330 |
|
Chest |
0 |
0 |
2 |
2.35 |
0 |
0 |
2 |
2.4 |
3.4839 |
0.0807 |
|
Abdominal |
2 |
2.35 |
2 |
2.35 |
2 |
2.35 |
6 |
7.1 |
0.1197 |
0.1650 |
|
Back |
4 |
4.71 |
1 |
1.18 |
0 |
0 |
5 |
5.9 |
4.3226 |
0.1085 |
|
Pubic |
0 |
0 |
1 |
1.18 |
0 |
0 |
1 |
1.2 |
1.7419 |
0.0482 |
|
Right leg |
10 |
11.7 |
7 |
8.24 |
3 |
3.53 |
20 |
23.5 |
2.0905 |
0.1472 |
|
Left leg |
2 |
2.35 |
6 |
7.06 |
3 |
3.53 |
11 |
12.9 |
1.9944 |
0.1297 |
DISCUSSION:
In the current
study, males (54.1%) were infected more than females (45.9%) which is nearly
similar to the findings reported in Teiba Center for
Burns Surgery in Al-Jumhory Hospital located in
Sana'a city, Yemen,(7) which was found that burn wound infection in males (58%)
higher than that in females (42%) as well as to another study done in Sana'a in
which infected males were 76% and infected females were 24%.(17) This may be
due to that males are exposed more to burns and wear loose fitting clothes like
dhoti,
which catch fire easily also mostly restaurant
workers are males engaged in cooking. However, in other study in India showed
that burn infection in females (60%) was more than male (40%).(8).
In this study as well as a study was done by Luterman,
A., Dasco, C.C. and Curreri,
P.W, 1986, it was found that the highest distribution of burn wound infection
found within the age group 11-20 years.(5,9) On the other hand a study was done
in Sana'a city showed that the highest distribution of burn wound infection
found within the age group <10 years 84 (42%).(7) Murray, C., Hospenthal, D.R. (2008)(10) and the present study had
similarity in the susceptibility to burns, degree of burns that infected,
causes of the burns, and the most infected sites of burns. Burn wound surfaces
are become colonized with microorganisms, gram-positive bacteria that survive
the thermal insult, such as S. aureus located deep
within sweat glands and hair follicles, heavily colonize the burn wound surface
within first 48 hr.(18). In North America and Europe, acid burns are generally
regarded as uncommon industrial accidents and they are rarely associated with
assault.(19)Iran, found that 77 (64.2%) out of 120
burn infection patients were males while 43 (35.8%) were females. In Kuwait out
of 1415 burn patients, 102 of them had developed clinically and
microbiologically proven septicemia.(20). In this
study and a study was done by Murray, C., Hospenthal,
D.R. (2008)(10) showed that Pseuodmonas species (37.1%) was the most commonly isolated
bacteria among burn patients with burn wound infection followed by Staph.aeureus (35.2%), while some other studies showed Staph.aeureus was the most prevalent bacteria among burn
patients.(7,11,12).
CONCLUSION:
A total of 85
patients suffering from burn were included in this study. 54.1% were males and
45.9% were females. Both single Gram
positive and single Gram negative bacteria showed the same percentage of the
total sample (36.5% each) with approximately equal percentage in both males and
females. Mixed Gram positive and Gram negative bacteria were (27%) of the total
sample predominantly in females. The
most common causative agents of burn wound infection in burned patients treated
at Burns Center Surgery in Al-Thaowrah Hospital
during 13-3-2013 to 10-9-2013 were Pseudomonas species and Staphylococcus aureus. Pseudomonas species had higher sensitivity to Ceftriaxon, Ciprofloxacin and Meropenem.
Staphylococcus aureus had higher sensitivity to Vancomycin, Ciprofloxacin and Erythromycin.
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Received on 31.05.2014 Accepted on 18.06.2014
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Asian J. Pharm.
Res. 4(2): April-June 2014;
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