الفهرس 
Etest for ESBLOnly 14 pages are availabe for public view
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Abstract
Burns injury is a public health concern, often associated with pain, emotional stress, prolonged hospitalization, permanent disfigurement and family stress.
Infection remains a major complication in burns and it has been estimated that about 75% of the mortality associated with burn injuries are related to infection. The burn wounds can become infected with different types of organisms and these are increasing in their resistance to antibiotics. The treatment of these infections is one of the most difficult processes to help recovery of patients.
The present study aimed to:
1- Isolate the bacteria associated with infected burn wounds.
2- Determine the antibiogram of the isolated bacterial strains.
3- Detect the presence of ESBL associated with burn infection.
The present study was carried out in the burn unit of Alexandria Main University Hospital during the period from October 2009 to May 2010. It involved 100 burn victims, a questionnaire sheet was filled for every patient including all relevant information.
Admission and follow up surface burn wound swabs (245) were taken weekly or on appearance of any signs and symptoms of burn infection, (early morning after bathing of the patients and change of dressing).
All swabs were immediately transported to the lab in Stuart’s transport medium to be cultured onto each of blood and MacConkey’s agar plates, aerobically incubated for 24h at 37˚C.
Any isolated organisms were identified by standard microbiological techniques and tested for their antibiotic susceptibility by disc diffusion method described by Kirby-Bauer
All clinical isolates of Gram- negative organisms that showed resistance to third- generation cephalosporins (ceftazidime, cefotaxime) and monobactam (aztreonam) were identified as potential ESBL producers and short listed for confirmation of ESBL. Confirmatory test were done by using the double disc approximation test (DDT).
The results of this study revealed that:
1. Out of 100 burn victims 55% were females and 45% were males with mean age of 17.6 years ± 14.7 years. The difference between these figures was not statistically significant.
2. Flame was the most frequent cause of burn affecting 73 victims (73%).
3. There was a positive correlation between burn causes and age; flame burn was frequent in the age group > 15-30 years, while scald burn was more common among the age group of > 1-15 years.
4. A significant association was noted between the percentage of burn TBSA and hospital stay.
5. A positive significant correlation was observed between mortality and percentage of burn TBSA.
6. During the performance of this study the overall mortality rate was 21%.
7. The total isolates were 168 bacterial strains representing 100% infection rate.
8. The occurrence of Gram-negative bacteria was higher than Gram-positive bacteria (69.05%, 30.95% respectively).
9. The most frequent microorganisms isolated were P. aeruginosa (55.36%) followed by S. aureus (26.95%).
10. There was a high level of resistance against commonly used antimicrobials amongst both Gram-positive and Gram-negative bacteria.
11. As regards MRSA in this study, 80% of S. aureus strains were oxacillin-resistant.
12. Multi-drug resistant P. aeruginosa in the present study was found to be 65.59%.
It can be concluded from this study that:
1. Gram-negative bacterial infection is more common than Gram-positive bacterial infection.
2. Pseudomonas aeruginosa is the commonest bacterial cause of infection.
3. Antibiotic resistance profile of isolated bacteria is alarming due to the presence of MRSA, ESBL and MDR P. aeruginosa.
4. The infection control policy at this center is deficient.