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This study aimed to establish the incidence, significance and microbial aetiology of catheter-related bacteraemia (CRB) in burn patients treated in the Sofia Burns Centre, Bulgaria. During the period 1993-97, 1,346 central venous catheters (CVCs) from 1183 burn patients were investigated. Bacterial growth was found in 367 CVCs. Of a total of 675 bacteraemic episodes registered during the study period, 132 were catheter-related (19.5% of all bacteraemic episodes in 6.6% of all patients). Generalized burn infections were responsible for 29.5% of the bacteraemic episodes in 9.9% of the patients. The main pathogens isolated in cases of CRB were Staphylococcus aureus (84/132), coagulase-negative staphylococci (CNS) (20/132) and Acinetobacter spp. (18/132). The incidence of S. aureus was considerably higher than that of CNS and Acinetobacter spp. A total of 11 patients with CRB died. Contaminated CVCs were the second most common cause of bacteraemia in burn patients, after generalized wound infection. S. aureus and Acinetobacter spp. were equally important as causes of systemic infection. We conclude that careful management of CVCs, prevention and subsequent treatment of CRB are of great importance for a favourable outcome in burn patients.

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The aim of this study was to analyze the beta-lactamases and the molecular epidemiology of 19 clinically significant isolates of Proteus mirabilis with decreased susceptibility to imipenem, which have been collected from seven hospitals, located in different Bulgarian towns (Sofia, Varna, and Pleven). The isolates were obtained from blood, urine, tracheal and wound specimens. One additional isolate from hospital environment was included. Susceptibility testing, conjugation experiments, and plasmid replicon typing were carried out. Beta-lactamases were characterized by isoelectric focusing, PCR, and sequencing. Clonal relatedness was investigated by RAPD and PFGE. Integron mapping was performed by PCR and sequencing. All isolates showed a multidrug-resistance profile, but remained susceptible to piperacillin/tazobactam, cefepime, meropenem, and fosfomycin. They produced identical beta-lactamases, namely: TEM-1, VIM-1, and CMY-99. PCR mapping revealed that the bla gene was part of a class 1 integron that additionally included the aac(6')-I, dhfrA1, and ant(3″)-Ia genes. In addition, 17 of the isolates carried the armA gene. Conjugation experiments and plasmid replicon typing were unsuccessful. The isolates were clonally related according to RAPD and PFGE typing. This study reveals the nationwide distribution of a multidrug-resistant P. mirabilis clone producing VIM-1 and CMY-99 along with the presence of different aminoglycoside resistance mechanisms.

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