Microbiological analysis and anti-microbial selection in a Burn centre of a Tertiary Care

Background: Burn wound is often complicated by infection resulting in significant patient morbidity and mortality. This study aimed to analyse various micro-organisms encountered and their antimicrobial susceptibility in a tertiary care centre to guide the empirical therapy. Materials and Methods: This prospective study of 62 patients with > 1st degree burns, > 5% Body surface area on zero post-burn day. Patients were evaluated for various infections using surface swabs and wound biopsy. Blood, urine and sputum culture were done if infection suspected and were sent for microbiological assessment. Results: Majority of patients enrolled were young males (77%). Mostly (92%) patients were managed conservatively. Mean duration of hospital-stay was 11 days. 29(46.8% patients had ≤ 25% burns. Majority (49%) patients were discharged, 33.9% left against medical advice. Flame burns were commonest (58.1%). Majority (51.6%) patients had third degree burns. Around 75.8% patients received topical Silver Sulfadiazine. Pseudomonas aeruginosa and Acinetobacter baumannii and species were most commonly encountered in wound swab and tissue biopsy. Urine culture revealed mainly Escherichia coli (8%). Polymyxin –B, Piperacillin/Tazobactam, Colistin, Cefoperazone/sulbactam and Teicoplanin were most sensitive anti-microbials. Eleven (18%) patients succumbed to their burns revealing infections mainly due to Pseudomonas aeruginosa, Enterobacter cloacae, MRSA and Escherichia coli. Conclusion: Pseudomonas aeruginosa and Acinetobacter baumannii were insensitive to common anti-microbials and sensitive to higher ones. The surging antimicrobial- susceptibility tide displayed by the microbial pathogens pose a major threat and hinderance in burn wound management. Therefore, implementation of antimicrobial stewardship and knowledge of the evolving pattern of sensitivity is crucial. Keywords: Burn, Infection, Culture, Microorganisms, Anti-Microbial Susceptibility.