HOSPITAL-ACQUIRED MRSA SEPSIS IN BURN CARE UNIT OF A TERTIARY CARE CENTER IN NORTH INDIA.

Abstract

INTRODUCTION: Bloodstream infection and the subsequent development of sepsis are among the most common infection complications occurring in burn patients. Hospital-Acquired transmission of microorganisms are associated with the emergence of antimicrobial resistance among a variety of bacterial and fungal burn wound pathogens which limits the therapeutic options for the treatment of infections associated with burns. Over the last several decades, antibiotic resistant organisms have resulted in increased mortality in burns patients. MATERIAL AND METHODS: This prospective study was conducted in the Department of Microbiology, Government Medical College, over a period of 1 year The patients admitted to burn care unit with the following criteria were included in the study: No infection at the time of admission and up to 48 hrs (cultures negative); Length of stay in the hospital more than 48 hrs; Signs and symptoms suggestive of infection. Patients referred from other hospitals were excluded. Samples from patients falling under the inclusion criteria of the study and manifesting any symptoms and signs of Hospital-Acquired infection during the management of burns were included in the study H. ospital-Acquired infections were dened based on CDC criteria as described below: Blood samples for culture were collected from patients with burn wounds showing signs of infection as dened by CDC. Positive Isolates were conrmed by conventional biochemical tests. Isolates exhibiting ambiguous taxonomic classication were conrmed by Vitek-2 Compact Automated Identication System following the manufacturer's instructions. Antimicrobial susceptibility testing were performed using the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI). OBSERVATIONS AND RESULTS: A total 71 patients developed Hospital-Acquired infections out of these 20 % developed blood stream infection. Most common age group in our study was between 31-40 years (33.80%) Most frequent organisms isolated from blood culture were MRSA (20%) followed by pseudomonas aeruginosa (15%) and Acinetobacter spp (10%).Candida spp was isolated from 10% of cultures. All isolates of stayphlococcus aureus were Methicillin resistant however all ve isolates were sensitive to vancomycin, clindamycin and linezolid. All isolates of Pseudomonas were sensitive to polymyxin-b,while as 33% were sensitive to Gentamicin. All isolates of Acinetobacter were sensitive to Gentamicin and Tobramycin while as only 50% were sensitive to Ooxacin. Further burn units are CONCLUSION: ideal for outbreaks of MDR pathogens which can affect other patients, so adequate infection control measures need to be in place. Culture and antimicrobial susceptibility testing should be performed routinely, including MRSA and ESBL screening, whenever burn wound and blood stream infections are suspected. Antimicrobial sensitivity test results should be used to guide the choice of antibiotics. Also we need to conduct molecular studies on the isolates to determine their resistance genes and strains typing to determine which strains are implicated in these hospital acquired infections.