ANTIBACTERIAL THERAPY FOR PATIENTS WITH BURN INJURIES

Abstract

Background. Treatment of burn wound infection is an urgent issue of contemporary medicine, including surgery, combustiology and microbiology. It is established that infectious complications are a challenge for burn patients. In the course of wound reparation, infectious complications may worsen. Along with surgical treatment, mechanical removal of pathogens from burn wounds is also important as well as antimicrobials for patients with severe burns.

Objective. The aim of the study was to define the most common pathogens of purulent-inflammatory complications of burn wounds and their susceptibility to antibiotics.

Methods. The study involved patients treated at the Center of Thermal Trauma and Plastic Surgery of Lviv I-Territorial Medical Association, the unit of St. Luke Hospital of Lviv. Collection of material from wound secretions of burn wounds was performed with sterile swab. The study was performed before prescription of antibiotics, at the end of the first and second weeks of the disease. The pathogens were isolated and identified. Antibiotic susceptibility was studied using standard research methods. The obtained results were analyzed by means of the software package of the microbiological monitoring system WHONET 5.2 (WHO Collaborating Centre for Surveillance of Antimicrobial Resistance) and the program Microsoft Office Excel 2007.

Results. The study of smears from burn wounds proved that 240 strains of gram-positive and gram-negative microorganisms that caused purulent-inflammatory processes were isolated. Among the selected causative agents of a burn wound complicated by a purulent-inflammatory process, gram-negative bacteria predominated (60.8% of all detected microorganisms). Gram-positive flora of S. epidermidis and S. aureus were more common in the wound surface during the first week of the disease. In most patients with severe burns, bacterial associations were isolated from the wound surface (66.3%) in two and three weeks, and in three weeks Candida spp. were isolated. Non-fermenting rods A. baumannii and P. aeruginosa dominated among the gram-negative flora isolated from the wound surface of burns. The analysis of susceptibility of microorganisms isolated from patients with burns to antibiotics showed that almost all of the cultures were polyresistant.

Conclusions. Gram-negative microorganisms, strains of non-fermenting bacteria predominated among the pathogens isolated from burn wounds complicated by purulent inflammation; Staphylococcus aureus prevailed among the gram-positive ones. The most significant clinical strains were highly polyresistant to antibiotics.