Epidemiological Trends and Evolving Antibiotic Resistance Profiles of Pseudomonas aeruginosa in Burn Patients: A 3-Year Cross-Sectional Surveillance in Northern Iran

Abstract

Background and Aim

Pseudomonas aeruginosa (P. aeruginosa) is a major cause of burn wound infections, posing a significant challenge due to its increasing antibiotic resistance. This study evaluated the prevalence and antibiotic resistance patterns of P. aeruginosa isolates from burn patients admitted to a referral burn center in Northern Iran over 3 years (March 2018–March 2021).

Methods

A retrospective cross-sectional study was conducted on 535 samples collected from burn patients. P. aeruginosa isolates were identified using standard microbiological methods and tested for susceptibility to various antibiotics through the disc diffusion method. Data analysis involved descriptive statistics to assess the prevalence and resistance patterns of the isolates.

Results

P. aeruginosa accounted for 36.1% (193/535) of bacterial isolates. The annual prevalence of P. aeruginosa varied from 19.6% to 44.4%, with the highest frequency observed among patients with 26%–50% total body surface area burns. Skin and soft tissue infections were the most common source (75.1%), followed by bloodstream infections (15%). Notably, 62.7% of isolates originated from intensive care unit (ICU) patients. High resistance was observed against ceftazidime (80%), ciprofloxacin (77.2%), imipenem (76.6%), and meropenem (76.1%). Conversely, amikacin (78.2%) and gentamicin (45%) exhibited the highest susceptibility.

Conclusion

The findings indicate a high prevalence of Pseudomonas with DTR, highlighting the need for stricter antibiotic stewardship and alternative treatment options. While amikacin showed higher susceptibility in our study, the recent CLSI 2023 guidelines suggest its use should be limited to urine isolates. In light of these updated recommendations, the use of aminoglycosides in treating P. aeruginosa infections requires cautious evaluation. Further multicenter studies with larger sample sizes are warranted to generalize these findings.