Clinical Features and Epidemiological Patterns of Infections by Multidrug Resistance Staphylococcus Aureus and Pseudomonas Aeruginosa in Patients with Burns

Worldwide different plants were studied for their role in the treatment
and correction of different types of anaemia’s. The Medicinal and Aromatic Plants
Research Institute (MAPRI) of the National Centre for Research (NCR) plays major role
in medicinal and aromatic plants investigation, determination of therapeutic properties
and documented in Sudan.


Introduction
Burns are more prevalent devastating type of trauma and require a critical care as well as handling. Mortality due to burns can be reduced by fluid replacement, excision, and coverage of burn wounds, infection treatment, and early resuscitation Shirani Vaughan et al. [1][2][3][4][5][6]. A better result for rigorously burned individuals has been credited to medical evolution in burn wound care, pulmonary care, nutritional support, fluid resuscitation and infection management. As a consequence, burn mortality, depending on the degree of a wound, has been decreased (up to 50 %) within the last severe burns (over more than 40 % of the total body surface area (TBSA) is affected), are linked to sepsis developed from infection of burn wounds or inhalation injury and / or other complications Fitzwater Purdue et al. [9][10][11][12][13]. Based on the preceding lines, it is very necessary to identify and isolate the multiple drugs=resistant bacteria, which will be very helpful to identify and manage the burn-wound infections in hospitals. The burns are totally different from other types of burn wounds on the body, such as the degree of systemic inflammation [14], healing of all burn wounds is an active procedure with overlapping stage Gurtner Werner et al. [15]. The

Multidrug Resistant
Multidrug resistant is among the main three threats to global public health and is usually caused by substandard pharmaceuticals, excessive drug usage or prescription and inappropriate use of antimicrobials Santajit [17].

Staphylococcus Aureus (MRSA)
The sensitivity of isolated strains was against vancomycin, clindamycin, Kanamycin and Erythromycin, but high resistant was found against penicillin G. Multi drug resistance was found in all isolated strains while one isolated strain was found resistant to all the antibiotics Alebachew Yismaw et al. [18]. About

Mechanisms of Antibiotic Resistance in MRSA
Primarily, several strains of MRSA were considered to possess a single common ancestor due to the various pigmentations than

MRSA Infections in Humans
In human, S. aureus causes a variety of diseases. It is amongst aureus and sometimes it requires antibiotic therapy through IV. In Europe, USA and Canada S. aureus is the most commonly isolated microorganisms, while throughout the world pneumonia and blood stream infections caused by S. aureus are more prevalent Diekema et al. [35]. In Finland a study reported that annually 700-900 cases of septic infection were reported that are caused by S. aureus Lyytikäinen et al. [36]. Cather related and post-operative infections are frequently caused by S. aureus. Catheter associated diseases are designated as the most common source of nosocomial bacteremia [37]. Toxic Shock Syndrome (TSS) is an acute disease that effect many organ systems and is caused by S. aureus. The clinical manifestations of disease are desquamation of skin, hypotension, multiple organ dysfunction and high-grade fever Dings et al. [38].

Epidemiology of Human MRSA Infections
Most of the infections occurring in health care facilities and in community are due to MRSA Drews et al. [39] Throughout the world it was reported that S. aureus has shown resistance to various drugs particularly to fluroquinolones, aminoglycosides, macrolides, methicillin, lincosamides, or mixtures of all these Deshpande et al. [40] Earlier researches from United State of America, Japan, United Kingdom and Australia have stated that prevalence of MRSA vary from 8 -53 % [41]. MRSA has a worldwide distribution and has a great impact on mortality rate. In a meta-analysis of thirty studies, average mortality rate of methicillin susceptible S. aureus (MSSA) was 24 % as compared to 36 % of MRSA. Seven studies in this metaanalysis represent a mortality rate of 50 % whereas two researches showed mortality rate of 80 % Kuikka et al. [42,43] Vancomycin resistant strains (VRSA) also has a lethal effect Fridkin et al. [44] Patient infected with vancomycin intermediate S. aureus (VISA) has a mortality rate of 63 % Fridkin et al. [45].
In hospitals of USA, MRSA was appeared to be the most prevalent pathogen that is responsible for antibiotic resistance (NNIS, 2004

MRSA Treatment in Humans
Septicemia caused by vancomycin / rifampicin resistance strains of staphylococcus has a mortality of higher than 78 % Burnie et al. [53] This high rate of mortality and advancement in the resistance patterns shows the conditions of last sixty years and future concerns. It has been recommended that all over the world, widespread prevalence of MRSA strains are the main reasons for However, some resistance was also observed [59].

Pseudomonas Aeruginosa
Pseudomonas aeruginosa is a leading cause of healthcare associated infection especially in admitted patients with burn [60].
It is an opportunistic pathogen and can survive in the hospital environment. It is associated with increased morbidity and mortality in immunosuppressed patients [61]. According to a study, the most prevalent organism isolated from patients with burn was  [66] Around one hundred and thirty three P. aeruginosa disconnects were gathered from copy patients. 88.7% separated strains were from wounds took after by 5.26% detaches from blood, 4.15% from subclavian catheters and 1.5% from pee test. including the imipenem-safe detaches [59]. In patients with burn, fifty-six strains of P. aeruginosa were isolated. Aminoglycosides resistance was found in 58 (81%) P. aeruginosa strains. While 41-70% isolated strains had resistance against beta-lactamspiperacillin, ceftazidime, and aztreonam. Piperacillin-tazobactum resistance was found in 34.5% while 12.06% strains were found to be resistant against ciprofloxacin. About 13-19%, isolates were resistant to carbapenems. Celestin was found sensitive against all strains. P. aeruginosa was found to be resistant to three of the four 'in-use' drugs i.e. piperacillin+ tazobactam, ceftazidime, imipenem and gentamicin, which was taken as MDR, which depicted MDR percentage as 36.2% Biswal et al. [67] Seventeen P. aeruginosa were isolated from 100 burn wound infected patients in India.
Multidrug resistance was found in all strain of P. aeruginosa. The resistance profile of the tested antibiotics was as done by using Kirby Bauer's Disc Diffusion Method. All the isolates were resistant to Tobramycin. While resistance against Meropenem was 94.1%, against Cefoperazone was 94.1%.
A total 40 (71%) isolates were resistant to ciprofloxacin and 26 (47%) were resistant to levofloxacin. Imipenem resistance was seen in 34 (61%) isolates whereas 30 (54%) isolates were found to be resistant to meropenem. The retrospective study evaluated bacteria from sputum, urine, feces, blood, catheters, and wounds of hospitalized patients of burn. Resistance of P. aeruginosa and quantity of antibacterial medicines to anti gram-negative antibiotics were observed. Annual detection rate of S. aureus were declined significantly, as compare to Klebsiella pneumonia and P. aeruginosa whose rates were significantly raised. MDR strains of P. aeruginosa were also increasing day by day. Rate of resistance of P. aeruginosa is positively correlated to the intensity of use of the antimicrobials. Extra care should be given to K. pneumoniae and P. aeruginosa in burn wards. To counter emergence of resistance, use of cefoperzone/salbactam ceftazidime, and ciprofloxacin should be avoided Song et al. [70].