Profile of microorganisms and antimicrobial resistance at a tertiary care referral burn centre in Iran: Emergence of Citrobacter freundii as a common microorganism

Khorasani, Ghasemali; Salehifar, Ebrahim; Eslami, Gohar

doi:10.1016/j.burns.2007.12.008

Cited by 29 publications

(21 citation statements)

References 35 publications

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“…One possible explanation for this outlier may lie in the susceptibility of the standardised incidence of P. aeruginosa to the overall infection rate reported from the relative burn centre. In fact, the overall infection rate reported from this centre is also high [11].…”

Section: Discussionmentioning

confidence: 87%

“…A possible explanation lies in the presence of an outlier data set [11] (Table 2), hence the long superior whisker for the P. aeruginosa plot in Figure 2. However ANOVA, is remarkably robust to moderate departures from normality caused by outlier data sets.…”

Section: Discussionmentioning

confidence: 99%

“…This data, in turn, provides aetiological targets for rationalised expedited, targeted antimicrobial prescribing, infection control, and antimicrobial development [8]. Traditional teaching is based on incidence data that is non-standardised and difficult to compare; it maintains that Gram negative burn wound isolates differ between burn centres [9]–[11].…”

Section: Introductionmentioning

confidence: 99%

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Gram Negative Wound Infection in Hospitalised Adult Burn Patients-Systematic Review and Metanalysis-

et al. 2014

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BackgroundGram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres.MethodsStudies investigating adult hospitalised patients (2000–2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance.Primary Findings Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens’ incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84).InterpretationGram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative “target organisms” facilitate clinical practice and target research towards a defined clinical demand.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gram Negative Wound Infection in Hospitalised Adult Burn Patients-Systematic Review and Metanalysis-

et al. 2014

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“…Although AGs are used for several decades, the optimum method of administration and their dosing schemes needs more clarification. Our previous studies showed that both in our pediatric (6) and adult settings (7,8), physicians almost always practice the traditional dosing of AG. In addition, experience and clinical evidence regarding this issue in pediatrics is suboptimal.…”

Section: Contextmentioning

confidence: 99%

Extended-Interval Dosing of Aminoglycosides in Pediatrics: A Narrative Review

Salehifar¹,

Rafati

2015

J Pediatr Rev

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Aminoglycosides (AGs) are frequently used in pediatric settings, especially for empiric treatment of early-onset neonatal sepsis. Although AGs are used for several decades, the optimum method of administration and their dosing schemes needs more clarification. The risks of ototoxicity and nephrotoxicity, two main toxicities associated with AGs, have been contributed to the peak and trough plasma levels, respectively. One approach to decrease these potential toxicities of AGs is to administer higher doses with a prolonged interval, named extended-interval dosing (EID). Post-antibiotic effect (PAE) and concentration-dependent killing of AGs provide rational basis for the efficacy of EID. PAE refers to the extended bactericidal activity of AGs against many Gram-negative organisms after the drug was removed by metabolism. One concern is that the higher initial peak concentration with EID may be accompanied with more toxicities, especially ototoxicity. It was demonstrated that due to saturation of binding site of AGs in renal and cochlear tissues, transiently higher concentration of AGs does not cause additional nephrotoxicity or ototoxicity. Experience and clinical evidence regarding EID in pediatrics is suboptimal. In this review, we presented the rational and studies focusing on EID in pediatric setting. The overall finding of trials is that in pediatric setting, EID is a safe and effective dosing method. The risk of serum drug concentration outside the therapeutic range is lower in neonates treated with EID, leading to less need of therapeutic drug monitoring (TDM) with EID. Moreover, there are evidences supporting lower chance of bacterial resistance with EID compared with traditional dosing approach.

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“…Yet, the problems posed by antimicrobial resistance in the burn population are not limited to a few microorganisms (Khosravani et al, 2008). Besides the Gram-positive microorganisms, a number of Gram negative bacteria are losing their susceptibility to mainstay antibiotics, as well (Rastegar 1998;Simor et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Multidrug-resistant Pseudomonas aeruginosa strains in Tehran Reference Burn Hospital, Tehran, Iran

Boujari¹,

Hajia²

2012

Afr. J. Microbiol. Res.

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Pseudomonas aeruginosa is one of the most common causes of burn wound infections. The aim of this study was to determine the frequency of antibiotic resistance burn morbidity during September 2005 to October 2007. The incidence of multi-drug resistant P. aeruginosa infection was indicated in 9238 patients admitted to Tehran Reference Burn Hospital. Specimens were collected after admitting the patients in the hospital wards. Susceptibility test were performed for all isolate. Specimens were collected based on hospital policy and cultures were performed on each patient. Isolated strains were identified by using standard bacteriological methods for isolation and identification of the causative agents. P. aeruginosa was identified in 3012 (70.5%), Staphylococcus aureus in 581 (13.6%), Acinetobacter 426 (9.9%), the rest organisms were 279 (6%). Frequencies resistant of applied antibiotics were tobramycin (82%), ceftazidim (78%), ceftizoxime (82%), ciprofloxacin (72%), amikacin (73%), gentamycin (80%), tetracyclin (60%), teazabactam (81%) and cotrimocxazol (98%), respectively for P. aeruginosa. Due to the high multi resistant rate in pseudomonas infection, there is need to immediately revise the hospital policy in control of nosocomial infection and treatment strategy such as more efficient antiseptic agents or new antibiotics used to reduce the rate of multidrug resistant.

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Profile of microorganisms and antimicrobial resistance at a tertiary care referral burn centre in Iran: Emergence of Citrobacter freundii as a common microorganism

Cited by 29 publications

References 35 publications

Gram Negative Wound Infection in Hospitalised Adult Burn Patients-Systematic Review and Metanalysis-

Gram Negative Wound Infection in Hospitalised Adult Burn Patients-Systematic Review and Metanalysis-

Extended-Interval Dosing of Aminoglycosides in Pediatrics: A Narrative Review

Multidrug-resistant Pseudomonas aeruginosa strains in Tehran Reference Burn Hospital, Tehran, Iran

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