Risk Factors and Antimicrobial Resistance of Pathogens Isolated from Burn Units at Local Hospitals in Gaza Strip, Palestine

Abstract

Background: Nosocomial infection is a recognized public health problem world-wide with an important cause of burn mortality. It has been estimated that 75% of all deaths following burns are related to infection. The emergence of resistance to antimicrobial agents is a major clinical and public health problem particularly in pathogens causing nosocomial infections. Aim: The present cross sectional study was undertaken to determine burn infection bacterial etiological agents and their antimicrobial resistance pattern, the influence of environmental conditions, and risk factors associated with burn infections. Method: Wound swabs were collected from 118 burn patients from two burn units (Al-Shifa and Nasser hospitals) from October 2010 to March 2011. Different environmental samples, health care workers (HCWs) samples (nasal, throat, fingers) and air samples for culture were investigated to determine possible infection source(s). Isolated bacteria from the samples were identified by conventional biochemical methods and API 20E system. Moreover, antimicrobial susceptibility testing was performed. Statistical analysis was performed using SPSS version 13.0 program. Results and Conclusions: The overall percentage of positive cultures from burn patients samples in both hospitals was 45.8%, Pseudomonas aeruginosa was the most common pathogen isolated (50%) followed by Enterobacter cloacae (27.8%), Coagulase-negative staphylococci (CoNS) (9.3%), and Escherichia coli (5.6%). Meanwhile, fingers and nasal samples that collected from HCWs showed 78.6% and 32.3% positive cultures respectively, where P. aeruginosa was the highest pathogen isolated (32.3%), followed by CoNS (29%). Environmental and air samples also showed higher isolation rate of Pseudomonas and CoNS. P. aeruginosa was resistant to most antimicrobial agents tested in this study. All Enterobacter spp. isolates were resistant to ampicillin and cefazoline but most of them were sensitive to imipenem. Most of Staphylococcus spp. were resistant to oxacilllin and cefuroxime but sensitive to linezolid and imipenem. This study showed that the most common route of transmission of pathogens was cross-infection. Similarities of antimicrobial resistance profiles of the isolated pathogen from patients and environment suggests that hospital environment may play a critical role as a source of nosocomial infections. Moreover, HCWs hands may play a considerable role in transmission of infection in these burn units. Moreover, the hospital and surgical procedures could be risk factors for transmission of nosocomial infections. Finally, the main recommendations were: application of infectious diseases control program, training of HCWs on nosocomial infections control programs, using alcohol-based hand rubs, prevent crowding in burn units, creating isolation care unit and making a database for nosocomial infections.