Management of Β - Lactamase Producers Through Infection Control Measures in Burn Icu

Abstract

BACKGROUND AND OBJECTIVESMulti-Drug Resistant (MDR) pathogens due to various β-lactamases are major contributors in increasing morbidity and mortality rates in Burn Intensive Care Units, ICU. This study is aimed to apply the various infection control measures and to compare the results of two halves of study and to establish a relation between environment, Health Care Workers (HCWs) and patients regarding manifestation of nosocomial infection. DESIGN AND SETTINGOver a period of three years (June 2010 to June 2013), Clinical, Environment and Health care providers samples from Burn ICU were processed in the Department of Microbiology, Sri Guru Ramdas Institute of Medical Sciences and Research, Amritsar. Organisms were identified by standard microbiological techniques and their antibiotic susceptibility was determined by Kirby Bauer disc diffusion method. The MDR were further tested for various β-lactamases by Clinical Laboratory Standard Institute (CLSI) disc diffusion method using Ceftazidime and Ceftazidime + clavulanate and Cefotaxime and Cefotaxime clavulanate for Extended Spectrum Beta Lactamases (ESBL), Meropenem and meropenem + EDTA for Metallo Beta Lactamases (MBLs) and 3-Dimensional test for AmpC beta lactamases. MATERIAL AND METHODS307 clinical, 210 environmental and 117 HCWs samples in 1 st and 192 clinical, 62 environmental and 92 HCWs samples in 2 nd half of study were processed by standard microbiological techniques. After identification all MDR isolates were first screened for ESBL, AmpC and MBL then confirmed by the respective confirmatory tests. Results of two halves were statistically analyzed. RESULTSInfection rate was reduced from 50.16% to 40.10% in Burn patients. Culture positivity was reduced from 38.0% to 27.41% in environmental and 27.35% to 7.60% in HCWs samples. β-lactamases prevalence in Gram positive was 54.23% and Gram negative was 60.86% before and 37.03% and 54.05% after interventions. CONCLUSIONIn addition to the economic burden for antibiotic treatment, it is important to monitor the bacteriology, resistance pattern, antibiotic susceptibility and β-lactamases production in burn ICU. The development of new agents, strict antibiotic policy and effective infection control measures are paramount in the ongoing battle against multi-resistant organisms.