ﻓﺮاواﻧﻲ ﻋﻔﻮﻧﺖ ﺑﺎﻛﺘﺮﻳﺎل زﺧﻢ ﻫﺎي ﺳﻮﺧﺘﮕﻲ و ﻣﻘﺎوﻣﺖ داروﻳﻲ آﻧﻬﺎ در ﻣﺮاﺟﻌﻴﻦ ﺑﻪ ﺑﺨﺶ ﺳﻮﺧﺘﮕﻲ ﺑﻴﻤﺎرﺳﺘﺎن ﺑﻌﺜﺖ ﻫﻤﺪان

Frequency of Bacterial Burn Wounds Infection and Antimicrobial Resistance in Burn Center of Bessat Hospital of Hamedan

ﺍﺻﻠﻲ ﺗﺮﻳﻦ ﻣﺸﮑﻞ ﺗﻴﻢ ﺩﺭﻣﺎﻧﻲ ﺳﻮﺧﺘﮕﻲ، ﻋﻔﻮﻧﺖ ﻣﻲ ﺑﺎﺷﺪ ﮐﻪ ﻋﺎﻣﻞ ﺑﻴﺶ ﺍﺯ 50 ﺍﺯ ﻣﺮﮒ ﻫﺎﻱ ﻧﺎﺷﻲ ﺍﺯ ﺳﻮﺧﺘﮕﻲ ﺷﻨﺎﺧﺘﻪ ﺷﺪﻩ ﺍﺳﺖ. ﺯﺧﻢ ﺳﻮﺧﺘﮕﻲ ﻳﮏ ﻣﺤﻴﻂ ﺍﻳﺪﻩ ﺁﻝ ﺭﺍ ﺑﺮﺍﻱ ﺭﺷﺪ ﺍﻧﻮﺍﻉ ﺍﺭﮔﺎﻧﻴﺴﻢ ﻫﺎﻱ ﻋﻔﻮﻧﺖ ﺯﺍ ﻓﺮﺍﻫﻢ ﻣﻲ ﮐﻨﺪ. ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﻫﺪﻑ ﺗﻌﻴﻴﻦ ﺗﻮﺯﻳﻊ ﻓﺮﺍﻭﺍﻧﻲ ﻋﻔﻮﻧﺖ ﻫﺎﻱ ﺑﺎﮐﺘﺮﻳﺎﻝ ﺯﺧﻢ ﻫﺎﻱ ﺳﻮﺧﺘﮕﻲ ﺍﺯ ﻃﺮﻳﻖ ﻛﺸﺖ ﻧﺴﺞ ﺩﺭ ﻣﺮﺍﺟﻌﻴﻦ ﺑﻪ ﺑﺨﺶ ﺳﻮﺧﺘﮕﻲ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺑﻌﺜﺖ ﻫﻤﺪﺍﻥ ﻭ ﺗﻌﻴﻴﻦ ﻣﻘﺎﻭﻣﺖ ﺩﺍﺭﻭﻳﻲ ﺑﺎﻛﺘﺮﻱ ﻫﺎﻱ ﺍﻳﺰﻭﻟﻪ ﺷﺪﻩ، ﺍﻧﺠﺎﻡ ﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﻃﻲ ﻳﮏ ﺑﺎﺯﻩ ﺯﻣﺎﻧﻲ 6 ﻣﺎﻫﻪ، 82 ﺑﻴﻤﺎﺭ ﺑﺴﺘﺮﻱ ﺩﺭ ﺑﺨﺶ ﺳﻮﺧﺘﮕﻲ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺑﻌﺜﺖ ﻫﻤﺪﺍﻥ ﮐﻪ ﺗﺤﺖ ﻋﻤﻞ ﺍﮐﺴﻴﺰﻳﻮﻥ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺑﻮﺩﻧﺪ، ﻭﺍﺭﺩ ﻣﻄﺎﻟﻌﻪ ﮔﺮﺩﻳﺪﻧﺪ. ﺍﻳﺰﻭﻻﺳﻴﻮﻥ ﻭ ﺗﺸﺨﻴﺺ ﻣﻴﮑﺮﻭﺍﺭﮔﺎﻧﻴﺴﻢ ﻫﺎ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺷﻴﻮﻩ ﻫﺎﻱ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﺍﻧﺠﺎﻡ ﮔﺮﺩﻳﺪ. ﺣﺴﺎﺳﻴﺖ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﮑﻲ ﺑﺎ ﺭﻭﺵ ﺍﻧﺘﺸﺎﺭ ﺩﺭ ﺩﻳﺴﮏ ﺗﻌﻴﻴﻦ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻣﻴﺎﻧﮕﻴـﻦ ﺳﻨﻲ ﺑﻴﻤـﺎﺭﺍﻥ 20 ﺳﺎﻝ ﺑﺎ ﻣﺤـﺪﻭﺩﺓ1 ﺗﺎ 63 ﺳﺎﻝ( ﺑﻮﺩ. ﻣﻴـﺰﺍﻥ ﮐﻠﻲ ﮐﺸﺖ ﻣﺜﺒﺖ ﺩﺭ ﻣﻄﺎﻟﻌﺔ ﺣﺎﺿﺮ 93/3 ﺑﻮﺩ. ﺗﻌﺪﺍﺩ ﻣـﺮﺩﻫﺎ ﺩﺭ ﻣﻄﺎﻟﻌﺔ ﺣﺎﺿﺮ ﺑﺎ 46/5 ﮐﻤﺘﺮ ﺍﺯ ﺯﻧﺎﻥ ﺑﻮﺩ. ﻣﻬﻤﺘـﺮﻳﻦ ﻣﻴﮑﺮﻭﺍﺭﮔﺎﻧﻴﺴـﻢ ﻫﺎﻱ ﻋﺎﻣﻞ ﻋﻔﻮﻧﺖ ﺑﻪ ﺗﺮﺗﻴﺐ ﺷﻴﻮﻉ ﺷﺎﻣﻞ ﭘﺴﻮﺩﻭﻣﻮﻧﺎﺱ ﺁﺋﺮﻭﮊﻳﻨﻮﺯﺍ 72/7%( ، ﺍﺳﺘﺎﻓﻴﻠـﻮﮐﻮﮎ ﺍﻭﺭﺋﻮﺱ )14/4 ﻭ ﺍﺳﺘﺎﻓﻴﻠـﻮﮐﻮﮎ ﺍﭘﻴﺪﺭﻣﻴﺲ7/8 ﺑﻮﺩﻧﺪ. ﭘﺴﻮﺩﻭﻣﻮﻧﺎﺱ ﺁﺋﺮﻭﮊﻳﻨﻮﺯﺍ ﺩﺭ ﺑﻴﺶ ﺍﺯ 90 ﻣﻮﺍﺭﺩ ﻧﺴﺒﺖ ﺑﻪ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﮏ ﻫﺎﻱ ﺁﻣﻴـﮑﺎﺳﻴﻦ، ﺟﻨﺘﺎﻣﺎﻳﺴﻴﻦ ﺗﻮﺑﺮﺍﻣﺎﻳﺴﻴﻦ ، ﺳﻔﺘﺮﻳﺎﮐﺴﻮﻥ ، ﺳﻔـﻮﺗﺎﮐﺴﻴﻢ ، ﺗﻴﮑﺎﺭﺳﻴﻠﻴـﻦ ، ﭘﻴﭙﺮﺍﺳﻴﻠﻴﻦ ﻭ ﺳﻔﻴﭙﻴﻢ ﻣﻘﺎﻭﻡ ﺑﻮﺩ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺷﻴﻮﻉ ﺑﺎﻻﻱ ﻋﻔﻮﻧﺖ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﺳﻮﺧﺘﮕﻲ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺑﻌﺜﺖ ﻫﻤﺪﺍﻥ ﻭ ﺳﻄﻮﺡ ﺑﺎﻻﻱ ﻣﻘﺎﻭﻣﺖ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﮑﻲ ﺩﺭ ﺑﺎﮐﺘﺮﻱ ﻫﺎﻱ ﺍﻳﺰﻭﻟﻪ ﺷﺪﻩ، ﻟﺰﻭﻡ ﺍﻧﺪﻳﺸﻴﺪﻥ ﺗﺪﺍﺑﻴﺮ ﻻﺯﻡ ﺑﺮﺍﻱ ﺩﺭﻣﺎﻥ ﻋﻔﻮﻧﺖ ﺩﺭ ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﻭ ﻫﻤﻴﻦ ﻃﻮﺭ ﮐﻨﺘﺮﻝ ﻣﻘﺎﻭﻣﺖ ﺁﻧﺘﻲ ﺑﻴﻮﺗﻴﮑﻲ ﺭﺍ ﻳﺎﺩﺁﻭﺭ ﻣﻲ ﺳﺎﺯﺩ.

Introduction & Objective: The major challenge for a burn team is infection, which is known to cause over 50% of burn deaths. Burns become infected, because the environment at the site of the wound is ideal for the proliferation of infecting organisms. This study analyzes the distribution of bacterial infection of burn wounds through the tissue culture in patients hospitalized at the burn center of Bessat hospital of Hamadan it also studied the antibiotics resistance patterns of isolated bacteria. Materials & Methods: During a six months period, 82 patients were included in this study. Wound biopsy samples were collected days after admission to Burn ward in Bessat hospital. Isolation and identification of microorganisms was done using the standard procedure. Disk diffusion test was performed for antimicrobial susceptibility. Results: The mean age of the patients was 20 years (in the range, 1-63 years). The overall ratio of infections was 93.3%. There were fewer male patients (46.5%) than female patients. The microorganisms causing infections were Pseudomonas aeruginosa (72.7%), Staphylococcus aureus (14.4%), and Staphylococcus epidermis (7.8%). Among these pseudomonas aeruginosa was found to be over 90 per cent resistant to amikacin, gentamicin, tobramycin, Cefteriaxone, Cefotaxim, Ticracillin and Cefepime. Conclusions: High prevalence of nosocomial infection in patients hospitalized at the burn center of Bessat hospital of Hamadan and the detection of high levels of antibiotics resistance patterns of isolated bacteria suggest continuous surveillance of burn infections and the developing of strategies for antimicrobial resistance control and the treatment of infectious complications. A nosocomial infection surveillance system may be introduced to reduce the rate of nosocomial infections among burn patients, and for better therapeutic options.