The evaluation of nosocomial infection during 1-year-period in the burn unit of a training hospital in Istanbul, Turkey

Cost-drivers of medical expenses in burn care management

BACKGROUND

Profound differences exist in the cost of burn care globally, thus we aim to investigate the affected factors and to delineate a strategy to improve the cost-effectiveness of burn management.

METHODS

A retrospective analysis of 66 patients suffering from acute burns was conducted from 2013 to 2015. The average age was 26.7 years old and TBSA was 42.1% (±25.9%). We compared the relationship between cost and clinical characteristics.

RESULTS

The estimated cost of acute burn care with the following formula (10,000 TWD) = -19.80 + (2.67 × percentage of TBSA) + (124.29 × status of inhalation injury) + (147.63 × status of bacteremia) + (130.32 × status of respiratory tract infection).

CONCLUSION

The majority of the cost were associated with the use of antibiotics and burns care. Consequently, it is crucial to prevent nosocomial infection in order to promote healthcare quality and reduce in-hospital costs.

Dissemination of Multidrug-Resistant, Class I and II Integrons and Molecular Typing of CTX-M-producing Klebsiella pneumoniae

Introduction

Klebsiella pneumoniae (K. pneumoniae) is an important opportunistic pathogen causes serious community and hospital-acquired infections, which is highly resistant to antibiotics. We aimed to determine the frequency of multidrug resistant (MDR) and molecular typing of clinical isolates of K. pneumoniae.

Methodology

One hundred isolates of K. pneumoniae were collected from clinical samples in three general hospitals in Kermanshah. The antimicrobial susceptibility and extended-spectrum beta-lactamases (ESBL) production of isolates were determined using disk diffusion and combined disk methods, respectively. The bla_CTX-M gene, class I and II integrons were detected using polymerase chain reaction. The bla_CTX-M positive isolates were selected for genotyping using pulsed-field gel electrophoresis (PFGE).

Results

MDR phenotype was observed in 56% of isolates. The 40% of isolates were ESBL positive and 35 isolates contained bla_CTX-M. Class I and II of integrons were detected in 50 (89.2%) and 39 (69.6%) of MDR isolates, respectively. PFGE patterns of K. pneumoniaebla_CTX-M positive isolates indicated 19 clusters (X_1-19) with different genotype patterns.

Conclusions

The study findings highlight the concern of circulating MDR strains of K. pneumoniae with bla_CTX-M and class I and II integrons in Kermanshah hospitals. The presence of integrons among isolates may facilitate the spread of new resistance genes in this bacterium. Therefore, surveillance for the spread of MDR strains of this bacterium is recommended in hospitals.

Profile of infections and antimicrobial treatment among burn-injury patients

Infections are the leading cause of morbidity and mortality among burn-injury patients. Even in the absence of documented infection, antibiotics are often given to burn-injury patients at the beginning of treatment, an empirical measure in response to signs and symptoms of infection. The choice of antimicrobial therapy for these patients should be based on technical criteria, based on laboratory findings, at the risk of further increasing antimicrobial resistance levels.