Comparative study of antibiotic resistance in bacteria isolated from the burned patients during two periods (2005-2008, 2008-2011) and in two hospitals (Hospital Aziza Othmana, trauma and burn center)

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Lamia Thabet
Ayoub Zoghlami
Jalel Boukadida
Abdelraouef Ghanem
Amen Allah Messadi

Abstract

Background: Continuous monitoring of the bacterial flora and antibiotic resistance of the main bacteria involved in nosocomial infections helps improve treatment and prevention strategies.
Aim: To compare the bacteriological profile and antibiotic susceptibility of the main bacterial isolates within the burned patients over two periods of 3 years and in two hospitals.
Methods: During two three-year periods: period 1 (P1): 1/7/2005-30/6/2008 and period 2 (P2): 1/7/2008-30/6/2011) and in two hospitals: Hospital Aziza Othmana (HAO) and the traumatology and burn center (CTGB), 2153 and 3719 non-repetitive strains were isolated from burn patients from different samples. The transfer of the intensive care unit was made on 01/07/2008 from the Hospital Aziza Othmana to CTGB. The study of antibiotic sensitivity was performed according to CA-SFM.
Results: During the period P1, Pseudomonas aeruginosa was the main bacteria isolated (18%) followed by Staphylococcus aureus (14%) and Acinetobacter baumannii (12%). After the transfer of intensive care burn unit to the traumatology center, ecology bacterial varied with S. aureus (20%) in the first place followed by P. aeruginosa (15%) and Proteus mirabilis (11%). The study of the evolution of antibiotic susceptibility showed an overall downward trend of resistance in the second half of 2008, immediately after the transfer of service in the new hospital structure. The rate of ceftazidim resistant Klebsilella pneumoniae decreased from 80.4% to 50%, Similary the resistance of P. aeruginosa to ceftazidime and imipenem decreased respectively from 61% to 39.4% and from 63.3% to 37.1%. Nevertheless, the reduction of resistance was followed by a rapid increasing during the year 2009 to reach overall rates of resistance previously observed in the hospital Aziza Othmana. Concerning S. aureus, the rate of MRSA (methicillin-resistant S. aureus) showed no significant variation throughout the study period: 60% versus 56.3% at HAO and CTGB. A. baumannii brings up the problem of mutirésistance: 92.7% of strains were resistant to ceftazidime and 63.9% to imipenem during P1 with an emphasis on resistance to imipenem during P2 increased to 89.3%.
Conclusion: Resistance is a problem in the intensive care burn unit. Preventive measures have to be taken.

Keywords:

Antibiotic resistance, bacterial ecology, burn, prevention

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References

  1. L D'Avignon , BHogan , C Murray ,F Loo , et al. Contribution of bacterial and viral infections to attributable mortality in patients with severe burns: an autopsy series. Burns 36; 2010:773-9.
  2. E Keen, B Robinson, D Hospenthal, et al. Prevalence of multidrug resistant organisms recovered at a military burn center. Burns 36; 2010:819-25.
  3. Comité de l'antibiogramme de la SFM. Bull. Soc. Fr. Microbiol. 2008.
  4. W Song, Lee Kyu Man, HJ Kang, DH Shin, DK Kim. Microbiologic aspects of predominant bacteria isolated from the burn patients in Korea. Burns 2001; 27: 136-9.
  5. M Guggenheim, R Zbinden, A Handschin, A Gohritz, A Altintas, P Giovanoli. Changes in bacterial isolates from burn wounds and their antibiograms: a 20 year study (1986-2005). Burns 35; 2009:553-60.
  6. RK Gang, SC Sanyal, RL Bang, E Mokaddas, A Lari. Stphylococcal septicaemia in burn. Burns 26; 2000:359-66.
  7. Mallaret MR. Quelle architecture concourt à la prévention des infections nosocomiales en réanimation ? Réanimation 11; 2002:260-5.
  8. J Hubner, U Frank, I Kappstein, MH Just, GE Noeeldge, K Geiger. Influence of architectural design on nosocomial infections in intensive care unit. A propspective 2 years analysis. Intensive Care Med 15; 1989:179-83.
  9. Z Khan Shirani, AT MaManus, GM Vaughan, WF McManus, B A Pruitt, AD Mason. Effects of Environnement on infection in Burn patients. Arch Surg 121; 1986:31-6.
  10. C Tremblay. Mise à jour du traitement des infections à Staphylococcus aureus résistant à la méthicilline. Phamactuel 5; 2008:284-95.
  11. G Khorasani, E Salehifar, G Eslami. Profile of microorganisms and antimicrobial resistance at a tertiary care referral burn centre in Iran: Emergence of Citrobacter freundii as a common microorganism. Burns 34; 2008:947-52.
  12. H Kallel , M Bahloul, L Hergafi, et al. Colistin as a salvage therapy for nosocomial infections caused by multidrug-resistant bacteria in the ICU. Int J Antimicrob Agents 28;2006:366-9.
  13. R Cohen. Colimycine: un vieil antibiotique qu'il faut apprendre à connaître. Arch Ped 2010 ; 17:171-6.
  14. P Nordmann, A Carrer. Les carbapénémases des entérobactéries. Arch Ped 2010 ; 17: 154-62.