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Infection in patients with burn injury: sources, pathogens, sensitivity, and role of empirical antibiotics therapy
Olayinka Adebanji Olawoye1, Chinsunum Peace Isamah2, Samuel Adesina Ademola1
1Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital, Ibadan, Nigeria; Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Background:
Infection in the patient with burn injury is a leading cause of morbidity and mortality worldwide. Clinicians in low- and middle-income countries are often left with no option other than to commence empirical antibiotics.
Objective:
To determine the magnitude of infection in patients with burn injury, the sources of these infections, the prevalent microorganisms and their sensitivity pattern, and the sensitivity of the microorganisms to empirical therapy.
Materials And Methods:
This prospective observational study was conducted in a regional burn center in western Nigeria between October 2010 and March 2020.
Results:
A total of 364 patients were included in the study, with males constituting 58.5% (213) of the patients and females 41.5% (151) of the patients. The median patient age was 22 years. Flame was the most common cause of burn injury (61.5% [n = 224]). The median total body surface area burn was 22%. The majority of the patients had a clinical diagnosis of infection (85.4% [n = 311]), with the burn wound (60.8%), respiratory tract (22.2%), and urinary tract (6.1%) constituting the clinical sources of the infection. The most prevalent causes of burn wound infection were Klebsiella pneumoniae (K pneumoniae) (30.2%), Staphylococcus aureus (S aureus) (24.3%), and Pseudomonas aeruginosa (P aeruginosa) (21.0%). All cultured bacteria with the exception of Citrobacter freundii were sensitive to amikacin, with K pneumoniae and S aureus being the most sensitive to it, and P. aeruginosa being more sensitive to ceftazidime. The most commonly prescribed empirical antibiotics were amikacin (20.3%) and levofloxacin (19.8%). The cultured organisms in burn injury patients with wound infection showed high sensitivity and specificity to empirical antibiotics therapy.
Conclusion:
The results of this study indicate that the source of infection determines the most likely organism and its sensitivity profile.
Insights
Infections in burn patients are common, with burn wounds being the most frequent source. Empirical antibiotic therapy, particularly amikacin, showed high sensitivity against prevalent bacteria like Klebsiella pneumoniae and Staphylococcus aureus.
Area of Science:
- Infectious Diseases
- Burn Care
- Microbiology
Background:
- Infection is a major cause of death in burn patients globally.
- Limited treatment options in low- and middle-income countries necessitate empirical antibiotic use.
Purpose of the Study:
- To assess infection rates, sources, and microbial patterns in burn patients.
- To evaluate the effectiveness of empirical antibiotic therapy against prevalent pathogens.
Main Methods:
- Prospective observational study in a Nigerian regional burn center (2010-2020).
- Inclusion of 364 burn patients, analyzing infection sources, causative microorganisms, and antibiotic sensitivity.
Main Results:
- 85.4% of patients had clinical infections, primarily in burn wounds (60.8%).
- Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa were the most common pathogens.
- Empirical antibiotics, especially amikacin, demonstrated high sensitivity against most cultured bacteria.
Conclusions:
- Infection source is critical for predicting causative organisms and their antibiotic sensitivity.
- Empirical antibiotic therapy can be effective, guided by local resistance patterns.
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