title: Changes in bacterial isolates from burn wounds and their antibiograms: a 20-year study (1986-2005).
abstract: BACKGROUND
  Our aim is to elucidate shifts in the bacterial spectrum colonising burn wounds and corresponding antibiotic susceptibilities during a 20-year study period.
  
  
  METHODS
  Microbiological results from burn patients collected between 1986 and 2005 were analysed retrospectively.
  
  
  RESULTS
  Staphylococcus aureus was isolated most frequently (20.8%), followed by Escherichia coli (13.9%), Pseudomonas aeruginosa (11.8%), coagulase-negative staphylococci (CNS) (10.9%), Enterococcus sp. (9.7%), Enterobacter cloacae (5.6%), Klebsiella pneumoniae (5%), Acinetobacter sp. (3.2%), Proteus mirabilis (2%) and Stenotrophomonas maltophilia (1.4%). Susceptibility of S. aureus to broad-spectrum substances such as ciprofloxacin or penicillinase-stable penicillins has waned, others such as cotrimoxazole or netilmicin remained effective. Not a single resistance against vancomycin was recorded. Increases in methicillin-resistant S. aureus (MRSA) were pronounced (3% in 1986-1997 (the first of the three study periods) to 16% in 1998-2001 and 13% in 2002-2005). Results for methicillin-resistant CNS (MRCNS) show an even greater increase. P. aeruginosa has shown increasing susceptibility against netilmicin (1986-1989: 84%, 2002-2005: 95%). Susceptibility of P. aeruginosa to ceftazidime has decreased markedly. S. maltophilia has shown clinically relevant susceptibility mainly against ciprofloxacin. Acinetobacter sp. have shown little susceptibility to most antibiotics. Imipenem or meropenem have been very reliable reserve antibiotics throughout the study period for the fermenting Enterobacteriaceae (E. coli, K. pneumoniae, E. cloacae and P. mirabilis), with susceptibilities of or near 100%.
  
  
  CONCLUSIONS
  In-depth knowledge of the bacteria causing infectious complications and of their antibiotic susceptibilities is a prerequisite for treating burn patients. Our study shows shifts in the microbial spectrum and their antibiogram, which mandate frequent reassessments.
authors.affiliation: Division of Hand, Plastic and Reconstructive Surgery, University Hospital Zurich, Zurich, Switzerland. Merlin@gmx.ch
authors.forename: Merlin
authors.initials: M
authors.lastname: Guggenheim
authors.forename: Reinhard
authors.initials: R
authors.lastname: Zbinden
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Handschin
authors.forename: Andreas
authors.initials: A
authors.lastname: Gohritz
authors.forename: Mehmet A
authors.initials: MA
authors.lastname: Altintas
authors.forename: Pietro
authors.initials: P
authors.lastname: Giovanoli
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002056:Burns / Q000382:microbiology* / Q000401:mortality; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents