الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Burn injury is one of the most common and devastating forms of trauma in many areas of the world. It has been estimated that 75% of all deaths following thermal injuries are related to infections.P. aeruginosa is widely known as an opportunistic organism, frequently involved in infections of immunosuppressed patients. P. aeruginosa is one of the causative agents of HAIs, especially in burn patients, which is not only due to its high prevalence and severity but also because of its innate and acquired resistance to antibacterial drugs.
Carbapenems represent one of the most important groups of antibiotics available for appropriate treatment of P. aeruginosa infections. It is, therefore of concern, when carbapenems resistance occurs, as this phenomenon leaves the clinicians a difficult therapeutic challenge. MBLs are able to efficiently hydrolyze carbapenem and other beta-lactams apart from monobactams. MBLs are encoded by genes like IMP, VIM, NDM, etc.
The aim of the work was studying MBL producing P. aeruginosa in Burn Units. Alexandria, Egypt.
Specific objectives:
1. To isolate and identify P. aeruginosa strains from studied burn patients.
2. To test antimicrobial susceptibility patterns of identified P. aeruginosa isolates.
3. To detect MBL producing P. aeruginosa isolates.
4. To detect the MBL-encoding gene by PCR technique
The present study was conducted on 196 patient admitted to burn units at AMUH and RTH. A total of 300 swabs were collected from burn wounds, all swabs were cultured and any growth was subjected to microbiological procedures for isolation and identification. 120 non-duplicate P. aeruginosa isolates were obtained. Each isolate was tested for antimicrobial susceptibility, phenotypic MBL production using CDT and PCR was conducted for identification of some MBL-producing genes.
The results of this study showed that:
1. P. aeruginosa showed a high rate of isolation in burn units (61.2%).
2. Females had a higher rate of infection with P. aeruginosa (68.4%) than males (56.4%).
3. Adults had a higher rate of infection with P. aeruginosa (68.9%) than children (48.6%).
4. P. aeruginosa was isolated in 80% of chemical, followed by electric (72.7%) and flame (72.6%).
5. Both cases of 4th degree burn were positive for P. aeruginosafollowed by 73.3% of 3rd degree burn and 50% of 1st and 2nd degrees.
6. P. aeruginosa isolation rate was highest (81.3%), at percentage of burn range of (31-50%).
7. The highest rate of P. aeruginosa was isolated in > 1 week- 2 weeks of hospital stay.
8. Gentamicin showed the highest rate of resistance (95.8%), followed by cefepime (92.5%) and ceftazidime (91.7%).
9. Imipenem and meropenem showed 86.7% resistance rate.
10. Colistin showed 99.2% susceptibility rate.
11. The majority of P. aeruginosa were MDR (73.3%) and 84.2% were pMBL producers.
12. Genotypically, 99% of P. aeruginosa harbored blaINT,84.2% of P. aeruginosa strains harbored blaVIM, while 1.7% harbored blaNDM.
from this study, it could be concluded that:
1. High rate of P. aeruginosa infection in burn units.
2. The majority of the isolates were MDR.
3. The majority of the isolates were MBL producers.
4. Colistin is the last available antibiotic choicewith the least resistance.
5. PCR detected higher rate of MBLPa than the phenotypic methods.