Emergence of Multidrug Resistant Microbial Species in the Bacterial Profile of Burn Wounds: A Cohort Study from Pak Italian Modern Burn Center, Multan

Abstract

Objective: To document the prevalence of microflora causing burn wound infections in our setup, track any trends of change in the flora after a 7-day treatment period, and document any rise in the incidence of multidrug-resistant microbes.

Methods: This cohort study was conducted at the Pak Italian Modern Burn Centre (PIBC), Multan, over a one-year period from January 2022 to December 2022. Surface wound swabs were collected from 150 patients admitted to the Burn unit on day 3, day 10, and day 17 after sustaining burns. Standard procedures for isolation and identification of microorganisms were followed, and the growth of microflora obtained was subjected to antibiotic sensitivity testing following the Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: Gram-negative isolates included Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., Citrobacter spp., Proteus vulgaris, and Providencia mirabilis. Gram-positive isolates included Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA). Pseudomonas aeruginosa caused 39.3% of wound infections within 72 hours of admission and 56.9% of wound infections by the first week post-burn. Proteus vulgaris (36%) was the most frequently isolated microorganism in the second week post-burn. All these isolates exhibited an alarming level of resistance to routinely used antibiotics, necessitating the use of older, less safe antibiotics like colistin for gram-negative infections.

Conclusions: The rising incidence of antimicrobial resistance can be attributed to the emergence of multidrug-resistant bacterial species found in burn patients. Overcrowding in burn treatment facilities further exacerbates the risk of cross-contamination.