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Abstract

Background: Burn wound infections are a significant cause of morbidity, extended hospital stays, and death, especially in resource-constrained environments. Multidrug-resistant (MDR) organism colonization and infection of burn patients are predisposed by the compromised skin barrier, immune dysregulation, and the frequent exposure to invasive procedures. The most frequently reported of these are Pseudomonas aeruginosa and Staphylococcus aureus, which have significant therapeutic implications.
Objective: The aim of this study was to thoroughly analyze the patterns of antibiotic susceptibility, identify the prevalence of multidrug resistance, and measure epidemiological risk using Multiple Antibiotic Resistance (MAR) index in P. aeruginosa and S. aureus isolates collected in Iraq (burn wound infections).
Methods: 30 non-duplicate clinical isolates of burn wound infections were analyzed by cross-sectional studies. The identification of bacteria was conducted with the help of the usual microbiological methods such as the culture characteristics, Gram staining, and biochemical tests. The Kirby Bauer disk diffusion test to determine antibiotic susceptibility was done on the Mueller Hinton agar as per the CLSI. Imipenem, amikacin, ciprofloxacin, gentamicin and vancomycin were used as antibiotics in the test. MDR was determined as the resistance to three or more classes of antimicrobials. The MAR index was calculated for each isolate. The statistical analysis was performed in SPSS with the descriptive statistics, Chi-square analysis, and estimation of confidence interval with a significant level of p < 0.05.
Results: P. aeruginosa isolates portrayed high resistance percentages (60) to ciprofloxacin and gentamicin (55), but had comparatively higher susceptibility to imipenem (80). Isolates of S. aureus were also highly sensitive to vancomycin (90%) with a mixed response to other antibiotics. The prevalence of MDR was 65% in P. aeruginosa and 55% in S. aureus. Values of MAR index fell between 0.2 and 0.8, which suggests that they are highly exposed to antibiotic-selective environment. Further investigation revealed that high MAR values were clustered on isolates with a long hospital stay.
Conclusion: The high incidence of MDR pathogens in burn units highlights the importance of antimicrobial stewardship measures, stringent infection control measures and incorporation of molecular surveillance to gain a better understanding of resistance mechanisms and direct treatment.

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