Epidemiology of infections in a Burn Unit,Albania

Background

Many types of nosocomial infections (NIs) can be present in the burned patient. The purpose of this study is to calculate the rates for NI in the Intensive Care Unit of the Service of Burns and Plastic Surgery in University Hospital Centre (UHC) in Tirana, Albania.

Method

The study is prospective, clinical and analytical. The study is continued/longitudinal because monitors all patients with severe burns during a specified time period (1 year). For data analysis was used SPSS 19.0.

Results

The infection prevalence rate was 12 infected patients per 100 patients. The colonisation prevalence rate was 43 colonised patients for 100 patients. The most frequent infection microorganisms were Pseudomonas aeruginosa and Staphylococcus aureus (67% and 24%). Incidence of BSI was 3 BSI for 1000 hospitalization days. Incidence of catheter-related bloodstream infection (CRBSI) was 11.7 BSI for 1000 catheter days. Colonisation of the tip of the central catheter (CTC) was 15.6 for 1000 catheter days.

Conclusions

The epidemiology of burn wound infections as well as the definitions have changed due to important changes in burn wound treatment but further studies should be done documented the factors that can reduce the burn wound infection rates.     

Central nervous system infections in patients with severe burns

Background

Central nervous system (CNS) infections develop in 3–9% of neurosurgical ICU patients and 0.4–2% of all patients hospitalized with head trauma. CNS infection incidence in burn patients is unknown and this study sets out to identify the incidence and risk factors associated with CNS infections.

Methods

A retrospective electronic chart review was performed from 1 July 2003 to 30 June 2008 evaluating inpatient medical records along with cerebrospinal fluid (CSF) microbiological results for the presence of CNS infection. The presence of facial and head injuries and burns, along with intracranial interventions were reviewed for association with CNS infections.

Results

There were 1964 admissions with 2 patients (0.1%) found to have CNS infection; 1 each with MRSA and Acinetobacter baumannii. Both patients had facial burns and trauma to their head that required intracranial surgery. Of note, both patients had bacteremia with the same microorganisms isolated from their CSF and both survived. Of all patients, 29% had head or neck trauma and burns; 0.35% of those had a CNS infection. Scalp harvest for grafts or debridement of burned scalp was performed on 125 patients of which 9 had an invasive surgical procedure that involved penetration of the skull. The 2 infected patients were from these 9 intracranial surgical patients revealing a 22% infection rate.

Conclusion

The incidence of CNS infections in patients with severe burns is extremely low at 0.1%. This rate was low even with head and face burns with trauma unless the patient underwent an intracranial procedure.     

Phenotypic detection of Klebsiella pneumoniae carbapenemase among burns patients: First report from Iran

Background

Resistance to antimicrobial agents such as carbapenems among enterobacteriacea has been increasing, especially in Klebsiella pneumonia that produces variety of enzymes including Klebsiella pneumoniae carbapenemase (KPC). This study is the first report of its kind investigating the resistance to carbapenems among burns patients in Iran.

Method

During a 6-month period, 28 hospitalized burn patients who required to be placed on broad spectrum antibiotics were studied. Isolated species identified by routine biochemical test. Susceptibility testing for these species was performed by recommended the CLSI guidelines method. The tested antibiotics included cefotaxime, cefepime, aztreonam, imipenem, amoxicillin + clavulonic acid, gentamicin, amikacin, tobramycin, tetracycline, and trimethoprim-sulfamethoxazole, and chloramphenicol. For determination of KPC in phenotypical forms, Modified Hodge Test was utilized as per CLSI recommendation.

Results

Thirty-five Klebsiella spp. were isolated from 28 hospitalized patients. Nineteen out of 35 Klebsiella isolates were resistant to imipenem and that all of them had positive KPC. Nine of imipenem resistant isolates were also resistant to all tested antibiotics. Mortality rate among patients with positive KPC was 33%.

Conclusion

High rate of multi-drug resistant (MDR) strains in isolates with positive KPC is a major challenge in Iran and that it could cause an increase in both mortality and morbidity among burn patients. Thus, appropriate infection control measures and guidelines are needed to prevent such infections among burn patients.     

Nosocomial infection characteristics in a burn intensive care unit: Analysis of an eleven-year active surveillance

Aims

The objective of this study was to describe nosocomial infection (NI) rates, risk factors, etiologic agents, antibiotic susceptibility, invasive device utilization and invasive device associated infection rates in a burn intensive care unit (ICU) in Turkey.

Methods

Prospective surveillance of nosocomial infections was performed according to Centers for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) criteria between 2001 and 2012. The data was analyzed retrospectively.

Results

During the study period 658 burn patients were admitted to our burn ICU. 469 cases acquired 602 NI for an overall NI rate of 23.1 per 1000 patient days. 109 of all the cases (16.5%) died. Pseudomonas aeruginosa (241), Acinetobacter baumannii (186) and Staphylococcus aureus (69) were the most common identified bacteria in 547 strains.

Conclusion

Total burn surface area, full thickness burn, older age, presence of inhalation injury were determined to be the significant risk factors for acquisition of NI. Determining the NI profile at a certain burn ICU can lead the medical staff apply the appropriate treatment regimen and limit the drug resistance. Eleven years surveillance report presented here provides a recent data about the risk factors of NI in a Turkish burn ICU.     

Burns to the head and neck: Epidemiology and predictors of surgery

Background

The face is a frequent site of burn, but prevalence rates vary and reports are often limited to one healthcare setting. We examined the incidence of facial burns in the Netherlands in Emergency Departments (ED), hospitals and burn centres. Additionally, we identified which patient, injury and burn-related characteristics were predictors of facial burns, facial surgery and facial reconstruction in burn centres.

Methods

A retrospective, observational study was conducted including data from the Dutch Injury Surveillance System, the National Hospital Discharge Register and burn centres in a 5-year period (2003–2007).

Results

Facial burn incidences per 100,000 were 15.1 for ED visits, 1.3 for hospital admissions and 1.4 for burn centre admissions. A total of 2691 patients were admitted to Dutch burn centres; 47.5% (n = 1277) had facial burns of which 20.5% received primary facial surgery and 5.3% received facial reconstruction in follow-up. Predictors of facial burns and facial surgery were identified. Predictors of facial reconstructive surgery were burns to the neck (ventral), fire/flame burns and number of facial surgeries in the acute phase of the burn.

Conclusions

One in five patients with facial burns admitted to a Dutch burn centre received primary facial surgery and 1 in 20 received facial reconstructive surgery within a follow-up of minimum 2 years.     

Genotyping of Pseudomonas aeruginosa strains isolated from burn patients by RAPD-PCR

Background

Pseudomonas aeruginosa is one of the important causes of nosocomial infections that easily gains resistance to many antibiotics. This opportunistic pathogen is a major health hazard particularly in immunodeficient patients, patients in intensive care units (ICU) and burn units with life threatening outcome. The bacterium may be originated from different or common sources, and comprises a high colonization and transmission capacity.

Objective

The aim of present study was to investigate the genotypic variation of Pseudomonas aeroginosa strains isolated from burn patients by using Random Amplified Polymorphic DNA (RAPD) method.

Methods

Totally 70 clinical samples were collected from burn patients in Taleghani Burn Hospital of Ahvaz. Fifty out of total samples were positive for P. aeruginosa by application of conventional culture and biochemical identification tests. DNA was extracted from the isolates and the RAPD-PCR method was applied to the DNA extracts according to standard method using a short single primer of 272. The technique created repetitive electrophoresis patterns which was used for genotypic differentiation.

Results

RAPD-PCR, created 9 genotypic profiles designated as I–IX with base pair length ranging from 180 to 2700. Each genotype showed between 3 and 6 different weight DNA bands. Genotype I was the most prevalent, identified in 10 bacterial isolates (20%). Genotypes I, II and VI were mostly common in patients with more severe burn, and were mainly isolated from wound and blood samples obtained from the same patients.

Conclusion

In present study, we found RAPD-PCR technique as a useful tool for investigation of the genetic variation among P. aeruginosa strains. This is a rapid, low cost, genotypic method with high discriminatory power. The results could assist to screen for the original of infection caused by this organism with subsequent control of colonization and transmission.     

Bacteriology of infected burn wounds in the burn wards of a teaching hospital in Southwest Nigeria

Background

Burns are characterized by the loss of varying proportions of the protective layers of the skin, depression of immune responses, and increased wound susceptibility to infection. Wound infection is a major cause of morbidity and mortality in burn cases. This study characterizes those factors that predispose burn wounds to infection and the bacteriology of the microorganisms in our environment.

Patients and methods

Prospective study of burns patients that were admitted and treated at the Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria between January 1 and May 31, 2010 was carried out. Information about the demographics, aetiology/mechanism of burns, interval between the time of injury and admission, microbial studies, and antibiotic therapy were collected and analyzed.

Results

A total of 74 patients consisting of 43 males and 31 females were seen. The ages range between one week and 95 ± 22.42 years. Wound infections were confirmed in 28 patients (infection rate of 37.84 per 100 patients). Delayed presentation at LASUTH and length of hospital stay were significantly related to the development of wound infection. Pseudomonas aeruginosa and Proteus mirabilis were the most common infective organisms occurring in 53.6 and 10.7 percentages respectively. The isolated organisms were resistant to the beta-lactam antibiotics and mostly sensitive to carbapenem and aztreonam preparations.

Conclusion

Factors predisposing to invasive wound infections in our environment were highlighted and suggestions made on methods that could reduce the infections and thus reduce morbidity and mortality in burns.     

Improving burn care and preventing burns by establishing a burn database in Ukraine

Background

Burns are a challenge for trauma care and a contribution to the surgical burden. The former Soviet republic of Ukraine has a foundation for burn care; however data concerning burns in Ukraine has historically been scant. The objective of this paper was to compare a new burn database to identify problems and implement improvements in burn care and prevention in this country.

Methods

Retrospective analyses of demographic and clinical data of burn patients including Tukey's post hoc test, analysis of variance, and chi square analyses, and Fisher's exact test were used. Data were compared to the American Burn Association (ABA) burn repository.

Results

This study included 1752 thermally injured patients treated in 20 hospitals including Specialized Burn Unit in Municipal Hospital #8 Lviv, Lviv province in Ukraine. Scald burns were the primary etiology of burns injuries (70%) and burns were more common among children less than five years of age (34%). Length of stay, mechanical ventilation use, infection rates, and morbidity increased with greater burn size. Mortality was significantly related to burn size, inhalation injury, age, and length of stay. Wound infections were associated with burn size and older age. Compared to ABA data, Ukrainian patients had double the length of stay and a higher rate of wound infections (16% vs. 2.4%).

Conclusion

We created one of the first burn databases from a region of the former Soviet Union in an effort to bring attention to burn injury and improve burn care.     

Comparison of pathogens and antibiotic resistance of burn patients in the burn ICU or in the common burn ward

Background

This study aims to compare pathogens and their antibiotic resistances of burn patients from burn intensive care unit (ICU) or common burn ward. Of 2395 clinical samples from 63 patients in burn ICU, pathogens were detected in 1621 samples, in which 1203 strains (74.2%) were Gram negative bacteria, 248 strains (15.3%) were Gram positive bacteria, 170 strains (10.5%) were fungi. Top-4 microorganisms isolated from patients in burn ICU were Bauman's Acinetobacter (557, 34.4%), Pseudomonas aeruginosa (287.17.7%), Staphylococcus aureus (199, 12.3%) and Klebsiella pneumoniae (171, 10.5%). Of 512 clinical samples from 235 patients in common burn units, pathogens were detected in 373 samples, in which 189 (50.6%) strains were Gram negative bacteria, 150 strains (40.2%) were Gram positive bacteria, 34 strains (9.2%) were fungi. Top-4 microorganisms isolated from patients in common burn units were S. aureus (103, 27.6%), P. aeruginosa (46, 12.3%), K. pneumoniae (38, 10.2%) and Escherichia coli (32, 8.6%). Antibiotic resistance rates of pathogens isolated from clinical samples of burn patients from ICU was significantly higher than those from common units.

Conclusions

Pathogens and their antibiotic resistances are significantly different between burn ICU and common burn units. This finding has great implication for infection control in burn patients.     

Methylated spirit burns: an ongoing problem

Objective

Despite many educational campaigns we still see burns caused by methylated spirit every year. We undertook a retrospective study to analyse the impact of this problem.

Methods

We retrospectively collected data of all patients with burns caused by methylated spirit over twelve years from 1996 to 2008. Our main endpoints were: incidence, age, mechanism of injury, total body surface area (TBSA) burned, burn depth, need for surgery and length of hospital stay.

Results

Ninety-seven patients with methylated spirit burns were included. During the study period there was no decrease in the number of patients annually admitted to the burn unit with methylated spirit burns. 28% of the patients (n = 27) were younger than eighteen years old, 15% (n = 15) were ten years old or younger. The most common cause of burns was carelessness in activities involving barbecues, campfires and fondues. Mean TBSA burned was 16% (SD 12.4). 70% (n = 68) had full thickness burns. 66% (n = 64) needed grafting. Mean length of hospital stay was 23 days (SD 24.7).

Conclusions

The use of methylated spirit is an ongoing problem, which continues to cause severe burns in adults and children. Therefore methylated spirit should be banned in households. We suggest sale only in specialised shops, clear labelling and mandatory warnings.     

Dried irradiated human amniotic membrane as a biological dressing for facial burns—A 7-year case series

Background

Facial burns are common and have a significant impact on patient function and psychosocial well being. Human amnion has been used for many years as a temporary biological wound dressing in the management of partial thickness burns. The observed advantages of human amnion treatment include pain relief, ease of use, prevention of infection and acceleration of wound healing.

Objective

This study evaluated our 7 years of working with dried irradiated human amnion in the treatment of facial burns.

Method

A review of patients, treated with dried human amnion for facial burns between 2001 and 2008. Demographic details collected included age, gender, total facial surface area burned, type of burn and cause of injury. The effectiveness of the treatment was determined by wound infection rate, frequency of dressing reapplication, healing time and resulting scarring.

Results

Thirty-three patients with superficial partial thickness burn were identified (25 males, 8 females). The average age of the patients was 16.5 years (range: 8 months to 64 years). The causes included scalding (n = 15), contact burning (n = 13) and flash burning (n = 5). The mean percent total facial surface area burned was 2.7% (range: 0.5–8.5%). None of the patients developed facial wound infections. Eighty-five percent (n = 28) of the patients needed a single application of the dried amnion. The average healing time was 5.4 days (range: 2–14 days). Thirteen patients (39%) had burns confined to the facial area, of which three were discharged and treated as outpatients. Long-term follow up showed two hypopigmented scars, one hyperpigmented scar and one hypertrophic scar.

Conclusion

Superficial partial thickness facial burns can be effectively treated with dried irradiated human amnion membrane.     

The increasing trend in alcohol-related burns: It's impact on a tertiary burn centre

Introduction

The incidence of alcohol-related hospital admissions is a worldwide problem and currently costs the UK National Health Service approximately 4% of its annual budget. 40% of men and 22% of women drink over the recommended UK weekly allowance. The purpose of our study was to examine the trend in alcohol-related admissions to a tertiary burns unit over a 5-year period.

Methodology

All patients admitted were documented for alcohol-related burn, and history of alcohol dependence.

Results

1293 patients admitted between 2003 and 2008 were included in the study. The number of alcohol-related burns were as follows: 2003: 6%; 2004: 10%; 2005: 16%; 2006: 9%; 2007: 19%; 2008: 19%. This increasing trend was highly significant (p < 0.0001). Alcohol-related burns had a higher incidence of flame injury (60%) and a subsequent longer length of stay (12.5 vs. 7.9, p = 0.04). Alcohol dependence was noted in 54% of all alcohol-related burns and in 5% of the non-alcohol-related burns.

Discussion

The number of alcohol-related burns admitted to a tertiary burn unit is increasing and now comprises of nearly 20% of all admissions. This highlights the growing burden of alcohol on health and the need to address it at both a national and regional level.     

Ethnic differences in burn mechanism and severity in a UK paediatric population

Background

Burns in children are a major public health problem with long-lasting physical and psychological sequelae. Previous studies have identified that children from ethnic minorities have higher rates of burns.

Objective

The purpose of this study was to analyse the differences in paediatric burn mechanism and severity within different ethnic groups.

Methods

Demographic and burn data from all paediatric patients presenting with burn at the Burns Service, Alder Hey Children's NHS Foundation Trust, Liverpool, UK were collected over a 5 year period.

Results

766 paediatric patients (age range: 7 days to 16 years old, mean: 4.5 years) were included in the study. Ethnic minority children had higher total body surface area of burn (p < 0.001) and length of stay (p < 0.001) compared with non-ethnic minority children. Chinese children had most burns from hot food (60%), whereas non-ethnic minority children had most burns from hot beverages (35.8%). Ethnic minority children were more deprived compared with non-ethnic minority children (Index of Multiple Deprivation 48.7 vs. 40.9; p = 0.02).

Conclusion

These results show that there are significant differences in the patterns of burns in ethnic minority groups. This data should guide targeted public health prevention and educational strategies.     

Enhancing the clinical utility of the Burn Specific Health Scale-Brief: Not just for major burns

Introduction

Like many other Western burn services, the proportion of major to minor burns managed at Royal Perth Hospital (RPH) is in the order of 1:10. The Burn Specific Health Scale-Brief (BSHS-B) is an established measure of recovery after major burn, however its performance and validity in a population with a high volume of minor burns is uncertain. Utilizing the tool across burns of all sizes would be useful in service wide clinical practice.

Aim

This study was designed to examine the reliability and validity of the BSHS-B across a sample of mostly minor burn patients.

Method

BSHS-B scores of patients, obtained between January 2006 and February 2013 and stored on a secure hospital database were collated and analyzedCronbach's alpha, factor analysis, logistic regression and longitudinal regression were used to examine reliability and validity of the BSHS-B.

Results

Data from 927 burn patients (2031 surveys) with a mean % total burn surface area (TBSA) of 6.7 (SD 10.0) were available for analysis. The BSHS-B demonstrated excellent reliability with a Cronbach's alpha of 0.95. First and second order factor analyses reduced the 40 item scale to four domains: Work; Affect and Relations; Physical Function; Skin Involvement, as per the established construct. TBSA, length of stay and burn surgery all predicted burn specific health in the first three months of injury (p < 0.001, p < 0.001, p = 0.03). BSHS-B whole scale and domain scores showed significant improvement over 24 months from burn (p < 0.001).

Discussion

The results from this study show that the structure and performance of the BSHS-B in a burn population consisting of 90% minor burns is consistent with that demonstrated in major burns.

Conclusion

The BSHS-B can be employed to track and predict recovery after burns of all sizes to assist the provision of targeted burn care.     

Paediatric injuries associated with the use of disposable barbecues: Are we finding ourselves in hot sand?

Aim

To document, describe and raise awareness of a preventable injury associated with the use of disposable barbecues.

Methods

We conducted a retrospective study of incidents involving barbecue burns. Cases were identified through the burn injury database of a tertiary paediatric burns referral centre and case notes reviewed. Experiments were performed to evaluate the dissipation of heat from sand.

Results

Over a 3-month period, 9 children were identified out of a series of 296. The median age was 5 years and burns were sustained through contact with hot sand where disposable barbecues had been used. 87% (n = 13) of the burns were partial thickness and most affected critical areas such as the hands and feet. The majority (93%) responded well to debridement and simple dressings and all patients made a complete recovery. Experiments show that, even after a prolonged period of time, sand can retain sufficient heat to cause a contact burn.

Discussion and conclusion

We have noted an increased incidence of burns with this mechanism of injury. The burns are usually superficial, they tend to occur predominantly in children and involve critical areas. We suggest that areas where disposable barbecues have stood should be cooled and children kept away from the area for at least 5 min. The results of the study have been forwarded to the Prevention Committee of the British Burn Association with the aim of raising awareness of this mechanism of burn.     

Simple,effective and affordable approach for the treatment of burns infections

Objective

The aim of the present study was to develop a simple and effective treatment modality using citric acid as a sole antimicrobial agent to control infections in burns patients not responding to conventional treatment.

Methods

Forty-six cases with 5–60% superficial to deep burns in a study group and 20 cases with 10–70% superficial to deep burns in a control group were investigated for culture and susceptibility. The isolates in study group were further tested for susceptibility to citric acid. Three percent citric acid gel was applied to burns wounds in study group; however, the control group received conventional antibiotic therapy and local wound care.

Results

In the control group, Pseudomonas aeruginosa (44.44%) and Staphylococcus aureus (33.33%) were found to be the commonest bacterial isolates and, amikacin and ciprofloxacin (40.74%) were found to be most effective antibacterial agents. In study group, P. aeruginosa (30.48%) and S. aureus (23.17%) were found to be the commonest bacterial isolates. Ceftazidime (52.43%), ciprofloxacin (47.56%) and amikacin (46.34%) were found to be most effective antibacterial agents. Application of citric acid to burn wounds resulted in complete healing in 40 (86.95%) cases in 7–25 applications (P value 0.145); however, in a control group conventional antibiotic therapy and local wound care resulted in complete healing in nine (45%) patients only.

Conclusions

Citric acid treatment was found effective in the control of burns infections as compared to conventional therapy. Complete healing in 86.95% cases as compared to 45% in a control group indicates that citric acid is nontoxic, economical and quite effective in the management of burns infections.     

Epidemiology of severe burn among children in Newfoundland and Labrador, Canada

Purpose

The objective of this study was to identify the epidemiologic characteristics of childhood burns in the province of Newfoundland and Labrador.

Methods

A population-based study was carried out on children aged 0–16 years who were hospitalized due to burns in Newfoundland and Labrador between April 1995 and March 2001. Hospital and mortality data were obtained from the provincial hospital admission database and Mortality System, respectively. The Newfoundland and Labrador population was considered as a whole and as two separate geographic areas.

Results

A total of 157 hospital admissions due to burns were identified during the study period. The rate of burns requiring hospitalization in the province was 22.3 per 100,000 person-years (P-Y). The rates for males and females was 27.7 and 16.6 per 100,000 P-Y, respectively (P = 0.006). Infants (0–1 year) had the highest rate of burn (88.8 per 100,000 P-Y) followed by children aged 2–4 years (26.0 per 100,000 P-Y) (P < 0.0001). Labrador, a region with high Aboriginal population (51.4 per 100,000 P-Y), had a higher rate of burn compared to Newfoundland (20.3 per 100,000 P-Y) (P < 0.0001). Median age of patients with burns was 2 years for the island portion of the province and 9 years in Labrador (P < 0.01). Overall, scald burn (52.2%) was the most frequent type of burn followed by flame (32.5%). In the island portion of the province, scald burn was the most common type of burn (56.4%), while in Labrador flame was the most frequent type (66.7%). Overall mortality rate due to burns was 0.9 per 100,000 P-Y.

Conclusion

Age (infants) and sex (male) are factors associated with burn in Newfoundland and Labrador. Study results indicate a difference in the epidemiologic pattern of burn between the island portion of the province, Newfoundland, and mainland Labrador. It is recommended that preventive programs be directed towards high risk groups to reduce the incidence of burns.     

Epidemiologic investigation of geriatric burns in Southwest China

Objective

To study the epidemiologic characteristics of burns in the elderly patients to reduce risks.

Methods

Features, including causes, seasonality, co-morbidities and mortality among 280 burned patients over 60 years old, admitted to Burn Unit, Southwest Hospital from 1999 to 2006, were analyzed retrospectively.

Results

The incidence of burns in the elderly has been decreasing gradually from 4.35% in 1999 to 3.81% in 2006. The geriatric burns could happen any time during a year, but most frequently in summer and winter. Seventy percent of the geriatric burns were related to activities of daily life. The co-morbid conditions in the elderly, which comprised 83.9% of the victims, contributed to the burn outcomes. No difference in morbidity was found between rural and urban patients. However, mortality was significantly higher in the rural patients with 30% over TBSA burns.

Conclusion

The incidence of geriatric burns has been decreasing associated with social and individual living levels in China. However, the disparity in the mortality rates between rural and urban suggests investment in rural China is needed to reduce health inequalities.     

Activity of topical antimicrobial agents against multidrug-resistant bacteria recovered from burn patients

Background

Topical antimicrobials are employed for prophylaxis and treatment of burn wound infections despite no established susceptibility breakpoints, which are becoming vital in an era of multidrug-resistant (MDR) bacteria. We compared two methods of determining topical antimicrobial susceptibilities.

Methods

Isolates of Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae, and Acinetobacter baumanii-calcoaceticus (ABC) from burn patients were tested using broth microdilution and agar well diffusion to determine minimum inhibitory concentrations (MICs) and zones of inhibition (ZI). Isolates had systemic antibiotic resistance and clonality determined. MDR included resistance to antibiotics in three or more classes.

Results

We assessed 22 ESBL-producing K. pneumoniae, 20 ABC (75% MDR), 20 P. aeruginosa (45% MDR), and 20 MRSA isolates. The most active agents were mupirocin for MRSA and mafenide acetate for the gram-negatives with moderate MICs/ZI found with silver sulfadiazene, silver nitrate, and honey. MDR and non-MDR isolates had similar topical resistance. There was no clonality associated with resistance patterns.

Conclusion

Despite several methods to test bacteria for topical susceptibility, no defined breakpoints exist and standards need to be established. We recommend continuing to use silver products for prophylaxis against gram-negatives and mafenide acetate for treatment, and mupirocin for MRSA.