Department of Microbiology and Molecular Genetics, University of Punjab, Lahore, Pakistan.
J Infect Dev Ctries. 2020 Dec 31;14(12):1410-1417. doi: 10.3855/jidc.12828.
Gram-negative bacterial pathogens are associated with complications of post-burn infections that showed significant association with different genotypic variants of extended-spectrum β-lactamases. In this study, we aimed to determine the distribution of ESBL gene variants among bacterial pathogens from post-burn infections.
Cephalosporin-resistant isolates were collected from Jinnah Burn and Reconstructive Surgery Centre, Lahore. Phenotypic testing: double-disk synergy test, combination disk test, multiplex PCR for blaOXA, blaTEM, and blaSHV genes were performed.
Of the 53.5% cephalosporin-resistant isolates, 50.7% were community-acquired and 49.3% were nosocomial pathogens. Seventy-two percent of post-burn infections were found in males (p-value = 0.92, OR = 1.04). The age of burn victims ranged from 4 to 85 years (mean = 28.9, SD = 15.6). Pseudomonas aeruginosa was most predominant at a rate of 49%. There were 83.3% multidrug-resistant isolates, which showed susceptibility to meropenem, imipenem, and amikacin in 28.7%, 25.3%, and 26% respectively. In phenotypic tests 16% ESBLs detected by the DDST and 14% confirmed by the CDT. Molecular detection proved effective for the detection of 79.7% blaTEM, 37.7% blaOXA, and 18.8% blaSHV isolates. blaTEM genes were confirmed in 18.1% CDT-positive isolates, with 62.6% diagnostic accuracy (95% CI = 54.7-70) and 88% specificity (95% CI = 80.4-93.4).
The antimicrobial resistance associated with the ESBL-producing Pseudomonas spp. and Enterobacteriaceae is becoming a challenge for the treatment and survival of burn patients. The high rate blaTEM, blaOXA, and blaSHV genes confirm the need to improve the management of burn patients in order to prevent post-burn infections.
革兰氏阴性细菌病原体与烧伤后感染的并发症有关，这些并发症与不同基因型的超广谱β-内酰胺酶变体显著相关。在这项研究中，我们旨在确定烧伤后感染的细菌病原体中 ESBL 基因变体的分布。
从拉合尔的 Jinnah 烧伤和重建外科中心收集头孢菌素耐药分离株。进行表型检测：双碟协同试验、联合碟试验、blaOXA、blaTEM 和 blaSHV 基因的多重 PCR。
在 53.5%的头孢菌素耐药分离株中，50.7%为社区获得性，49.3%为医院获得性病原体。72%的烧伤后感染发生在男性（p 值=0.92，OR=1.04）。烧伤患者的年龄从 4 岁到 85 岁不等（平均 28.9，SD=15.6）。铜绿假单胞菌的比例最高，为 49%。有 83.3%的多药耐药分离株对美罗培南、亚胺培南和阿米卡星的敏感性分别为 28.7%、25.3%和 26%。在表型试验中，DDST 检测到 16%的 ESBLs，CDT 检测到 14%。分子检测对检测 blaTEM 基因的 79.7%、blaOXA 基因的 37.7%和 blaSHV 基因的 18.8%有效。在 18.1%的 CDT 阳性分离株中证实了 blaTEM 基因，其诊断准确率为 62.6%（95%CI=54.7-70），特异性为 88%（95%CI=80.4-93.4）。
与产 ESBL 的铜绿假单胞菌和肠杆菌科相关的抗生素耐药性对烧伤患者的治疗和生存构成挑战。blaTEM、blaOXA 和 blaSHV 基因的高比率证实需要改进烧伤患者的管理，以防止烧伤后感染。
