INFECTION AND ANTIBIOTIC-THERAPY IN 4000 BURNED PATIENTS TREATED IN MILAN, ITALY, BETWEEN 1976 AND 1988

The pathogenic flora, isolated from burn wounds of patients admitted t o a burn care unit during the years between 1976 and 1988 were typed a nd the in vitro susceptibility to antibacterial agents was recorded. B etween 1976 and 1988 the general therapeutic approach was changed thre e times, in congruence with the prevalent nosocomial bacterial resista nce. The most frequent isolates were: Pseud. aeruginosa, Staphylococcu s aureus, Enterococcus spp., Proteus mirabilis, Escherichia coli, Ente robacter cloacae, Klebsiella spp. and other Enterobacteriaceae, such a s Acinetobacter, Citrobacter. The most striking finding was the increa se in antibiotic-resistant Enterococcus isolates. Staph. aureus, Klebs iella and E. cloacae showed susceptibility to cephalosporins, imipenem , pefloxacin, vancomycin; Enterococcus susceptibility to perfloxacin a nd vancomycin, and Pseud. aeruginosa sensitivity to piperacillin, amik acin, tobramycin was generally good. E. coli showed a satisfactory sus ceptibility on average, and P. mirabilis showed a good sensitivity to piperacillin, cephalosporins, amikacin, tobramycin, aztreonam and imip enem. Thus, the general bacterial flora and ability have remained most ly unchanged over the years, with the conspicuous exception of Enteroc occus spp. and E. cloacae, which demonstrated a marked increase in inc idence, with a concomitant dramatic decrease in the sensitivity of Ent erococcus spp. to antibiotics.