Emerging resistance of higher antimicrobials and growing sensitivity of old antimicrobials against existing infections in burns


  • Ajay Lunawat Department of of general surgery, SAIMS & PGI, Indore, Madhya Pradesh
  • Rajesh Sharma Department of of general surgery, SAIMS & PGI, Indore, Madhya Pradesh
  • Venkatesh Kolla Department of of general surgery, SAIMS & PGI, Indore, Madhya Pradesh
  • Shailendra Patel Department of of general surgery, SAIMS & PGI, Indore, Madhya Pradesh




Emerging resistance, Pseudomonas, MRSA, Polymyxin group


Background: The widespread resistance of microorganisms to antibiotics threatens to be a future medical disaster. Antimicrobial resistance among a wide variety of human bacterial and fungal burn wound pathogens, particularly nosocomial isolates, limits the available therapeutic options for effective treatment of burn wound infections Objective: To analyze the emergence of resistance to higher group of antibiotics and shift of sensitivity towards older group of antibiotics.

Methods:The microbial colonization of wounds was studied from day of admission to date of discharge or date of expiry (2011-2014). The sampling included swabs taken from clinically deep areas of burn wounds prior to cleaning. Culture and sensitivity reports of urine, central line, bronchoscopic suction, catheter tips were not included in samples. Tissue biopsy during excision was included in the samples. Analysis done with the help of Chi-square test.

Results:Initially after burn injury there is predominance of staphylococcal group followed by gram negative organism, after which there is a predominance of gram negative organism. In this study we observed an increase in resistance to higher group of antibiotics like imipenem (p>0.005) and increased susceptibility to polymyxin group of drugs (p<0.005).  

Conclusions:It suggests that prevention is better than cure. Developing resistance can be prevented by misuse of antibiotics, premature change of antibiotics and prevention of cross contamination. For effective prevention of developing resistance to higher antibiotics the burn centres should look in and bring a strict antibiotic policy.


Travis J. Reviving the antibiotic miracle? Science. 1994;264:360-2.

Levy SB. Factors impacting on the problem of antibiotic resistance. J Antimicrob Chemother. 2002;49:25-30.

Taneja N, Emmanuel R, Chari PS, Sharma M. A prospectivestudy of hospital-acquired infections in burn patients at a tertiary care referral centre in north India. Burns. 2004;30:665-9

Ekrami A, Kalanter E. Bacterial infections in burn patients at a burn hospital in Iran. Indian J Med Res. 2007;126:541-4.

Revathi G, Puri J, Jain BK. Bacteriology of burns. Burns. 1998;24:347-9.

Altoparlak U, Erol S, Akcay MN, Celebi F, Kadanali A. The time-related changes of antimicrobial resistance patterns and predominant bacterial profiles of burn wounds and body flora of burned patients. Burns. 2004;30:660-4.

Mathur P, Kapil A, Das B. Nosocomial bacteraemia in intensive care unit patients of a tertiary care centre. Indian J Med Res. 2005;122:305-8.

Mathai E. Nosocomial bacteraemia and antimicrobial resistance in intensive care units. Indian J Med Res. 2005;122:285-7.

NNIS. National Nosocomial Infections Surveillance (NNIS) system report, data summary from October 1986-April 1998. Am J Infect Control. 1998;26:522-33.

Hutchison ML, Govan JR. Pathogenicity of microbes associated with cystic fibrosis. Microbes Infect. 1999;1:1005-14.

Tummler B, Kiewitz C. Cystic fibrosis: an inherited susceptibility to bacterial respiratory infections. Mol Med Today. 1999;5:351-8.

Bergogne-Berezin E, Towner KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev. 1996;9:148-65.

Bouza E, Cercenado E. Klebsiella and Enterobacter: antibiotic resistance and treatment implications. Semin Respir Infect. 2002;17:215-30.

14. Hsueh PR, Teng LJ, Yang PC, Chen YC, Ho SW, Luh KT. Persistence of a multidrug resistant Pseudomonas aeruginosa clone in an intensive care burn unit. J Clin Microbiol. 1998;36:1347-51.

Mouton JW, den Hollander JG, Horrevorts AM. Emergence of antibiotic resistance amongst Pseudomonas aeruginosa isolates from patients with cystic fibrosis. J Antimicrob Chemother. 1993;31:919-26.

Krcmery V, Trupl J. Nosocomial outbreak of meropenem resistant Pseudomonas aeruginosa infections in a cancer centre. J Hosp Infect. 1994;26:69-71.

Armstrong D, Neu H, Peterson LR, Tomasz A. The prospects of treatment failure in the chemotherapy of infectious diseases in the 1990s. Microb Drug Resist. 1995;1:1-4.

Jones RN. Resistance patterns among nosocomial pathogens: trends over the past few years. Chest. 2001;119:397S-404S.

Livermore DM. Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare? Clin Infect Dis. 2002;34:634-40.

Schmitz F-J, Krey A, Geisel R, Verhoef J, Heinz H-P, Fluit AC. Susceptibility of 302 methicillin-resistant Staphylococcus aureus isolates from 20 European university hospitals to vancomycin and alternative antistaphylococcal compounds. SENTRY Participants Group. Eur J Clin Microbiol Infect Dis. 1999;18:528-30.

Morovat T, Badrosadat K, Mohammad E, Namam-Ali A. Increased of resistance to antibiotics among bacteria isolated from burn wounds. Rev Epidemiol Control Infect. 2013;3(2):38-9.

Bayram Y, Parlak M, Aypak C, Bayram I. Three-year review of bacteriological profile and antibiogram of burn wound isolates in Van, Turkey. Int J Med Sci. 2013;10(1):19-23.

Branski LK, Al-Mousawi A, Rivero H, Jeschke MG, Sanford AP, Herndon DN. Emerging infections in burns. Surg Infect (Larchmt). 2009;10(5):389-97.

Rezaei E, Safari H, Naderinasab M, Aliakbarian H. Common pathogens in burnwound and changes in their drug sensitivity. Burns. 2011;37(5):805-7.

Jabalameli F, Mirsalehian A, Khoramian B, Aligholi M, Khoramrooz SS, Asadollahi P, et al. Evaluation of biofilm production and characterization of genes encoding type III secretionsystem among Pseudomonas aeruginosa isolated from burn patients. Burns. 2012;38(8):1192-7.

Qader AR, Muhamad JA. Nosocomial infection in Sulaimani burn hospital, Iraq. Ann Burns Fire Disasters. 2010;23(4):177-81.

Sun FJ, Zhang XB, Fang Y, Chen J, Xing H, Shi H, et al. Spectrum and drug resistance of pathogens from patients with burns. Burns. 2012;38(8):1124-30.

Weber JM, Sheridan RL, Schulz JT, Tompkins RG, Ryan CM. Effectiveness of bacteria-controlled nursing units in preventing cross-colonization with resistant bacteria in severely burned children. Infect Control Hosp Epidemiol. 2002;23:549-51.

Weber J, McManus A. Infection control in burn patients. Burns, 2004;30:A16-24.






Original Research Articles