Sabeetha, T (2007) A Study on Aerobic Bacteria in Patients with 20–40% Burns in a Tertiary Care Centre. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Patients with burn injuries are highly susceptible for infection as a result of disruption of the normal skin barrier and accompanying depression of immune response. The burn surface contains a large amount of necrotic tissue and the protein rich wound exudates provides a rich growth medium. So, following the initial period of shock, infection is the major complication and about 75% of the mortality associated with burn injuries is related to infection. In addition, overcrowding in Burns Unit is an important cause of cross-infection which necessitates a periodic monitoring of bacterial species and their antibiogram. The organisms are mainly derived from the patients gastro intestinal and upper respiratory tracts as well as from the hospital environment. It is crucial for every burn institution to determine the specific pattern of burn wound microbial colonization, the time-related changes in the dominant flora, and the antimicrobial sensitivity profiles. This would enable early treatment of imminent septic episodes with proper empirical systemic antibiotics, without waiting for culture results, thus improving the overall infection-related morbidity and mortality. In India where burns usually occur in the lower socioeconomic strata and in a productive age group-rational antibiotic therapy according to the prevalent strains of organisms should help in reducing the mortality and morbidity associated with burns. The analysis of the isolates and their sensitivity patterns helps to formulate an institutional drug policy for the patients admitted in Burn Unit. AIMS AND OBJECTIVES : • To study the profile of aerobic bacteria in patients with 20-40% burns. • To identify the factors that influence the outcome in these patients. • To determine the type of dressing that contributed to better outcome. • To study the antibiogram pattern of bacteria in the burns unit. • To determine the prevalence of β lactamase producing strains. • To study the factors that contribute to prevention of infection and mortality in these patients. MATERIALS AND METHODS : This is a cross sectional study done involving 100 patients both male and female admitted to the Burn Unit, Department of Plastic and Reconstructive Surgery, Kilpauk Medical College and Hospital, Chennai. The study was carried out at the Institute of Microbiology, Madras Medical College, Chennai. PERIOD OF STUDY: July 2005 to January 2006. 100 patients both male and female of age group 1 year to 65 years with burns of total body surface area (TBSA) of 20 to 40% were included in the study. These patients had burns ranging from deep partial thickness to full thickness injury. All patients received Tetanus toxoid booster upon admission. SPECIMENS: 1. Wound swabs from burn area. 2. Swabs from intact skin in the nasal, axillary, inguinal and umbilical regions of the patients. [If the skin in the above areas was burned samples were considered as burn wounds] 3. Blood from peripheral vein. 4. Environmental sampling study. RESULTS : Young females were found to be most commonly affected.(11-40yrs) Of the 9 Paediatric patients 6 were less then 6 years old. Flame was the most common cause (81%) in this study followed by scalds. The electrical injury was the least common cause and observed in 2 cases. Scald injuries were observed more commonly in children and women. Among 100 patients 64 cases presented with 20-30% Burns. More no. of 20-30% burns have been observed in young adults. A higher mortality rate was observed in patients with III° and II°&III° mixed burns. Highest percentage of mortality occurred within the first week. Among the survivors most were discharged within the first 2 weeks of hospitalization. The mortality of females with 31-40% of Total Burn Surface Area was the highest. Heparin saline dressing was commonly applied followed by collagen dressing. In children only collagen dressing was applied. Mortality was reported more in dressings with Silver Sulpha Diazine followed by Heparin saline. Collagen dressing had the best outcome. Among 81 flame injury patients 8 patients had inhalation injury. 100% mortality occurred in burns with inhalation injury. 37 isolates were obtained from hospital environment & staffs On admission polymicrobial type of infection was less and it was more with the patients who stayed in the hospital for longer days. CONCLUSION : This suggests the need for surveillance of environmental saprophytes, monitoring for MDR strains in the environment so as to identify and block the transmission of these strains to the patients. Measures such as the following have to be implemented with appropriate supervision to evidence, that there is no break in the aseptic techniques. 1. To reduce the nosocomial infections, improved barrier nursing, personal hygiene and restriction of visitors should be strictly followed. 2. Discarded dressing materials should be properly disposed without delay. 3. Use of sterile disposable aprons or separate sets of autoclaved linen for each dressing should be provided. 4. Adequate spacing of beds is necessary. 5. Periodical fumigation of all the wards of burns unit should be under taken. 6. Necessary equipments to provide respiratory support is needed in patients with inhalation injury. 7. As the outcome of collagen dressing was good, patients may be provided with collagen dressing as per the clinical indication eventhough it is costly. 8. Routine surveillance of the environment with rotation of antibiotics, based upon the susceptibility pattern of environmental isolates can also reduce the incidence of nosocomial infection.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Aerobic Bacteria ; Patients ; Burns ; Tertiary Care Centre. |
| Subjects: | MEDICAL > Microbiology |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Aug 2017 00:36 |
| Last Modified: | 16 Aug 2017 01:46 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1776 |
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