Risk factors analysis: screening of extended-spectrum-β-lactamase producing Gram-negative isolates of burn infections from tertiary care hospital Lahore, Pakistan

Abstract

Background Burnt patients are highly susceptible to invasion of multidrug resistant strains after the skin damage. The main objective of this study was to estimate the frequency of ESBLs producing Gram-negative in post-burn infections and its correlation with different risk factors (age, gender, socio-economic status, burns etiology etc.) Methods The descriptive case-series study was conducted at Jinnah Hospital Lahore’s Burn and Reconstructive Surgery Centre (JB & RSC) and the Department of Microbiology and Molecular Genetics (MMG), University of the Punjab, Lahore. The clinical specimens of wound swabs, biopsy, and blood were collected from 300 patients during 12th August, 2017 to 12th August 2018. The cephalosporins resistant Gram-negative isolates were further analyzed. The clinical history of burnt patients was recorded which included the age, gender, socio-economic status, residence, occupation, hospital stay, wards, burn degree, total burnt surface area (TBSA%), etiology of burn and other factors. CLSI guidelines 2017 were followed for the antimicrobial susceptibility testing (AST) and ESBLs screening. Results Pseudomonas spp. were the most-frequently isolated 49.33% (n=74) followed by 22.67% (n=34) Klebsiella spp., and 20.00% (n=30) Acinetobacter spp., strains. Pseudomonas spp., were the most frequently isolated from burnt specimens 70 (46.67%) having a significant correlation (x2=24.11, p < 0.001). Community acquired infections were observed in 50.70% (n=76) and nosocomial infections in 49.30% (n=74) patients. Burnt people having the age of ≤ 29 years were found to be significantly associated with the MDR infections (x2=24.96, p = 0.003). Low socio-economic status, longer hospitalization and all other risk factors had non-significant correlation (p > 0.05). A large fraction of the isolates 86.00% (n=129) were not confirmed as ESBLs producers by phenotypic screening. Conclusion It has been concluded that Gram-negative MDR strains are rapidly causing infections in burnt patients and need to be properly alleviated. The high frequency of multidrug resistant Pseudomonas spp., was associated with the burn infections. The patients belonging to young age were significantly found to be infected by MDR strain after burns.