Microbiological profile and antibiograms of bacterial isolates from burn wounds: a scientific approach towards preventing and managing bacteremia.

The major frustration for the burns team is for the patient to survive the critical care period, only to succumb to infection, which is known to cause over 50% of burn deaths. Studying the microbiological profile of the causative microorganisms and knowing their susceptibility to antibiotics shall help us picking up the colonization of the burn wound and preventing the systemic invasion by the microorganisms by initiating a targeted antimicrobial therapy. The microbiologic profile of 100 patients admitted at General surgery department of Era's Lucknow Medical College and hospital and department of plastic surgery CSSMU Lucknow between August 2008 and August 2009 was analysed retrospectively. Samples were collected from the burn wounds on admission and thereafter routinely twice weekly. Antibiotic sensitivity was tested for all the commonly used penicillins, cephalosporins, aminoglycosides and carbapenemes. Pseudomonas species was the commonest pathogen isolated (52.14%) followed by Staphylococcus aureus (15.26%), Acinetobacter species (14.21%), Escherichia coli (14.21%), Klebsiella species (11.08%) and Proteus species (1.54%). Gram negative bacilli especially Pseudomonas was found to be highly sensitive to carbapenams followed by aminoglycosides and quinolones. Pseudomonas species was moderately resistant to piperacillin (R-42.27%) whereas resistance was more marked with other antimicrobials like amikacin (81.18%), gentamicin (89.92%), carbenicillin (84.26%), tobramycin (88.52%) and ceftazidmine (78.09%). Other antimicrobials tested also showed high percentage resistance. However, newer drugs like vancomycin and linezolid were shown to be highly effective. High antimicrobial resistance is probably promoted due to selective pressure exerted on bacteria due to numerous reasons like non adherence to hospital antibiotic policy, and excessive and indiscriminate use of broad-spectrum antibiotics. Routine microbiological surveillance and careful in vitro testing prior to antibiotic use and strict adherence to hospital antibiotic policy may help in the prevention and treatment of multi-drug resistant pathogens in burn infection.