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Davies A, Spickett-Jones F, Jenkins A, Young A. A systematic review of intervention studies demonstrates the need to develop a minimum set of indicators to report the presence of burn wound infection. Burns 2020; 46:1487-1497. [DOI: 10.1016/j.burns.2020.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/15/2019] [Accepted: 03/20/2020] [Indexed: 01/29/2023]
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Csenkey A, Jozsa G, Gede N, Pakai E, Tinusz B, Rumbus Z, Lukacs A, Gyongyi Z, Hamar P, Sepp R, Romanovsky AA, Hegyi P, Vajda P, Garami A. Systemic antibiotic prophylaxis does not affect infectious complications in pediatric burn injury: A meta-analysis. PLoS One 2019; 14:e0223063. [PMID: 31553768 PMCID: PMC6760783 DOI: 10.1371/journal.pone.0223063] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/12/2019] [Indexed: 12/30/2022] Open
Abstract
In pediatric burns the use of systemic antibiotic prophylaxis is a standard procedure in some burn centers, though its beneficial effect on the infectious complications is debated. The present meta-analysis aimed at determining whether systemic antibiotic prophylaxis prevents infectious complications in pediatric patients with burn injuries. We searched the PubMed, EMBASE, and Cochrane Library databases from inception to August 2019. We included 6 studies, in which event rates of infectious complications were reported in children with burn injuries receiving or not receiving systemic antibiotic prophylaxis. We found that the overall odds ratio (OR) of developing an infection (including local and systemic) was not different between the groups (OR = 1.35; 95% CI, 0.44, 4.18). The chances for systemic infectious complications alone were also not different between antibiotic-treated and non-treated patients (OR = 0.74; 95% CI, 0.38, 1.45). Based on the age, affected total body surface area, and country income level, we did not find any subgroup that benefited from the prophylaxis. Our findings provide quantitative evidence for the inefficacy of systemic antibiotic prophylaxis in preventing infections in pediatric burns. To validate our conclusion, multinational, randomized trials in a diverse population of children with burn injuries are warranted.
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Affiliation(s)
- Alexandra Csenkey
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Department of Paediatrics, Surgical Division, University of Pecs, Pecs, Hungary
| | - Gergo Jozsa
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Department of Paediatrics, Surgical Division, University of Pecs, Pecs, Hungary
| | - Noemi Gede
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Eszter Pakai
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Benedek Tinusz
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Zoltan Rumbus
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Anita Lukacs
- Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltan Gyongyi
- Department of Public Health Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Peter Hamar
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Robert Sepp
- Second Department of Internal Medicine and Cardiology Centre, University Szeged, Szeged, Hungary
| | - Andrej A. Romanovsky
- Thermoregulation and Systemic Inflammation Laboratory (FeverLab), Trauma Research, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
| | - Peter Hegyi
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Peter Vajda
- Department of Paediatrics, Surgical Division, University of Pecs, Pecs, Hungary
| | - Andras Garami
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- * E-mail:
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Halstead FD, Lee KC, Kwei J, Dretzke J, Oppenheim BA, Moiemen NS. A systematic review of quantitative burn wound microbiology in the management of burns patients. Burns 2017; 44:39-56. [PMID: 28784345 DOI: 10.1016/j.burns.2017.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/15/2017] [Accepted: 06/24/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND The early diagnosis of infection or sepsis in burns are important for patient care. Globally, a large number of burn centres advocate quantitative cultures of wound biopsies for patient management, since there is assumed to be a direct link between the bioburden of a burn wound and the risk of microbial invasion. Given the conflicting study findings in this area, a systematic review was warranted. METHODS Bibliographic databases were searched with no language restrictions to August 2015. Study selection, data extraction and risk of bias assessment were performed in duplicate using pre-defined criteria. Substantial heterogeneity precluded quantitative synthesis, and findings were described narratively, sub-grouped by clinical question. RESULTS Twenty six laboratory and/or clinical studies were included. Substantial heterogeneity hampered comparisons across studies and interpretation of findings. Limited evidence suggests that (i) more than one quantitative microbiology sample is required to obtain reliable estimates of bacterial load; (ii) biopsies are more sensitive than swabs in diagnosing or predicting sepsis; (iii) high bacterial loads may predict worse clinical outcomes, and (iv) both quantitative and semi-quantitative culture reports need to be interpreted with caution and in the context of other clinical risk factors. CONCLUSION The evidence base for the utility and reliability of quantitative microbiology for diagnosing or predicting clinical outcomes in burns patients is limited and often poorly reported. Consequently future research is warranted.
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Affiliation(s)
- Fenella D Halstead
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK; Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Kwang Chear Lee
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; The Scar Free Foundation Centre for Burns Research, Birmingham, UK.
| | - Johnny Kwei
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; The Scar Free Foundation Centre for Burns Research, Birmingham, UK; Royal North Shore Hospital and Manly District Hospital, Northern Sydney Area Network, New South Wales, Australia.
| | - Janine Dretzke
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK; Institute of Applied Health Research, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Beryl A Oppenheim
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK; Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Naiem S Moiemen
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; The Scar Free Foundation Centre for Burns Research, Birmingham, UK; Birmingham Children's Hospital, Birmingham, UK.
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Davies A, Spickett-Jones F, Brock P, Coy K, Young A. Variations in guideline use and practice relating to diagnosis and management of infection in paediatric burns services in England and Wales: A national survey. Burns 2017; 43:215-222. [DOI: 10.1016/j.burns.2016.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
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Sari E, Dincel GC. Effect of piracetam and nimodipine on full-thickness skin burns in rabbits. Int Wound J 2015; 13:563-71. [PMID: 26192365 DOI: 10.1111/iwj.12478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/29/2015] [Indexed: 11/27/2022] Open
Abstract
The potential of several drugs for full-thickness skin burns has been investigated, but the treatment of such burns remains a challenge in plastic surgery. The present study was designed to determine the effect of systemic and topical administration of piracetam and nimodipine on full-thickness skin burn wound healing. A total of 36 New Zealand male rabbits were divided into six groups. Full-thickness skin burns were produced in all the groups, except the control group. Piracetam was administered systemically (piracetam-IV) and topically (piracetam-C) for 14 days, and nimodipine was administered systemically (nimodipine-IV) and topically (nimodipine-C) over the burn wounds for 14 days. The sham group underwent burn injury but was not administered any drug. After 21 days, gross examination and histopathological analysis were performed and the results were compared statistically. Nimodipine-C and nimodipine-IV had no effect on burn wound healing. However, both piracetam-IV and piracetam-C significantly enhanced the healing of the full-thickness skin burn wounds, although the latter was more effective, useful and practical in burn wound healing. The histopathological features of the wounds in the piracetam-C group were closer to those of the control group than those of the other groups. Piracetam-C rather than piracetam-IV may promote full-thickness burn wound healing in rabbits.
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Affiliation(s)
- Elif Sari
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
| | - Gungor C Dincel
- Gumushane University, Siran Mustafa Beyaz Vocational School, Laboratory and Veterinary Health Program, Gumushane, Turkey
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Mathews ZR, Koyfman A. Blast Injuries. J Emerg Med 2015; 49:573-87. [PMID: 26072319 DOI: 10.1016/j.jemermed.2015.03.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 01/04/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Blast injuries in the United States and worldwide are not uncommon. Partially due to the increasing frequency of both domestic and international terrorist bombing attacks, it is prudent for all emergency physicians to be knowledgeable about blasts and the spectrum of associated injuries. OBJECTIVE Our aim was to describe blast physiology, types of blast injuries associated with each body system, and manifestations and management of each injury. DISCUSSION Blast injuries are generally categorized as primary to quaternary injuries. Primary injuries result from the effect of transmitted blast waves on gas-containing structures, secondary injuries result from the impact of airborne debris, tertiary injury results from transposition of the entire body due to blast wind or structural collapse, and quaternary injuries include almost everything else. Different body systems are affected and managed differently. Despite previous dogma, multiple studies now show that tympanic membrane perforation is a poor predictor of other blast injury. CONCLUSIONS Blast events can produce a myriad of injuries affecting any and every body system. All emergency physicians should be familiar with the presentation and management of these injuries. This knowledge may also be incorporated into triage and discharge protocols guiding management of mass casualty events.
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Affiliation(s)
- Zara R Mathews
- Department of Emergency Medicine, Mount Sinai Medical Center, New York, New York
| | - Alex Koyfman
- Division of Emergency Medicine, University of Texas Southwestern Medical Center/Parkland Memorial Hospital, Dallas, Texas
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Ong CT, Zhang Y, Lim R, Samsonraj R, Masilamani J, Phan THH, Ramakrishna S, Lim I, Kee I, Fahamy M, Templonuevo V, Lim CT, Phan TT. Preclinical Evaluation of Tegaderm™ Supported Nanofibrous Wound Matrix Dressing on Porcine Wound Healing Model. Adv Wound Care (New Rochelle) 2015; 4:110-118. [PMID: 25713753 DOI: 10.1089/wound.2014.0527] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/27/2014] [Indexed: 11/13/2022] Open
Abstract
Objective: Nanofibers for tissue scaffolding and wound dressings hold great potential in realizing enhanced healing of wounds in comparison with conventional counterparts. Previously, we demonstrated good fibroblast adherence and growth on a newly developed scaffold, Tegaderm™-Nanofiber (TG-NF), made from poly ɛ-caprolactone (PCL)/gelatin nanofibers electrospun onto Tegaderm (TG). The purpose of this study is to evaluate the performance and safety of TG-NF dressings in partial-thickness wound in a pig healing model. Approach: To evaluate the rate of reepithelialization, control TG, human dermal fibroblast-seeded TG-NF(+) and -unseeded TG-NF(-) were randomly dressed onto 80 partial-thickness burns created on four female and four male pigs. Wound inspections and dressings were done after burns on day 7, 14, 21, and 28. On day 28, full-thickness biopsies were taken for histopathological evaluation by Masson-Trichrome staining for collagen and hematoxylin-eosin staining for cell counting. Results: No infection and severe inflammation were recorded. Wounds treated with TG-NF(+) reepithelialized significantly faster than TG-NF(-) and control. Wound site inflammatory responses to study groups were similar as total cell counts on granulation tissues show no significant differences. Most of the wounds completely reepithelialized by day 28, except for two wounds in control and TG-NF(-). A higher collagen coverage was also recorded in the granulation tissues treated with TG-NF(+). Innovation and Conclusion: With better reepithelialization achieved by TG-NF(+) and similar rates of wound closure by TG-NF(-) and control, and the absence of elevated inflammatory responses to TG-NF constructs, TG-NF constructs are safe and demonstrated good healing potentials that are comparable to Tegaderm.
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Affiliation(s)
- Chee Tian Ong
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | - Yanzhong Zhang
- Division of Bioengineering, National University of Singapore, Singapore, Singapore
- Department of Bioengineering, National University of Singapore, Singapore, Singapore
| | - Raymond Lim
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | - Rebekah Samsonraj
- Division of Bioengineering, National University of Singapore, Singapore, Singapore
| | | | - Tran Hong Ha Phan
- Division of Bioengineering, National University of Singapore, Singapore, Singapore
| | - Seeram Ramakrishna
- Division of Bioengineering, National University of Singapore, Singapore, Singapore
| | - Ivor Lim
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | - Irene Kee
- SingHealth Experimental Medicine Centre, Donghua University, Shanghai, PR China
| | - Mohammad Fahamy
- SingHealth Experimental Medicine Centre, Donghua University, Shanghai, PR China
| | - Vilma Templonuevo
- SingHealth Experimental Medicine Centre, Donghua University, Shanghai, PR China
| | - Chwee Teck Lim
- Division of Bioengineering, National University of Singapore, Singapore, Singapore
- Mechanobiology Institute, National University of Singapore, Singapore, Singapore
| | - Toan Thang Phan
- Department of Surgery, National University of Singapore, Singapore, Singapore
- Faculty of Dentistry Centre for Craniofacial and Regenerative Biology, National University of Singapore, Singapore, Singapore
- NUS Tissue Engineering and Stem Cell Research Program, National University of Singapore, Singapore, Singapore
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Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society. ACTA ACUST UNITED AC 2011; 71:S210-34. [PMID: 21814089 DOI: 10.1097/ta.0b013e318227ac4b] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite advances in resuscitation and surgical management of combat wounds, infection remains a concerning and potentially preventable complication of combat-related injuries. Interventions currently used to prevent these infections have not been either clearly defined or subjected to rigorous clinical trials. Current infection prevention measures and wound management practices are derived from retrospective review of wartime experiences, from civilian trauma data, and from in vitro and animal data. This update to the guidelines published in 2008 incorporates evidence that has become available since 2007. These guidelines focus on care provided within hours to days of injury, chiefly within the combat zone, to those combat-injured patients with open wounds or burns. New in this update are a consolidation of antimicrobial agent recommendations to a backbone of high-dose cefazolin with or without metronidazole for most postinjury indications, and recommendations for redosing of antimicrobial agents, for use of negative pressure wound therapy, and for oxygen supplementation in flight.
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Abstract
Burns are a very real component of combat-related injuries, and infections are the leading cause of mortality in burn casualties. The prevention of infection in the burn casualty transitioning from the battlefield to definitive care provided at the burn center is critical in reducing overall morbidity and mortality. This review highlights evidence-based medicine recommendations using military and civilian data to provide the most comprehensive, up-to-date management strategies for initial care of burned combat casualties. Areas of emphasis include antimicrobial prophylaxis, debridement of devitalized tissue, topical antimicrobial therapy, and optimal time to wound coverage. This evidence-based medicine review was produced to support the Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update contained in this supplement of Journal of Trauma.
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Histological Assessment of Tangentially Excised Burn Eschars. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2010. [DOI: 10.1177/229255031001800303] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The burn eschar serves as a medium for bacterial growth and a source of local and systemic infection. To prevent or minimize these complications, it is important to debride the eschar as early as possible. OBJECTIVE To identify the presence of viable skin within the excisions by examining tangentially excised burn eschars. METHODS A total of 146 samples of burned human tissue were removed during 54 routine sharp tangential excision procedures (using dermatomes). The samples were histologically examined to identify the relative thickness of the dead, intermediate and viable layers. RESULTS The mean (± SD) thickness of the excised samples was 1.7 ± 1.1 mm. The sacrificed viable tissue (mean thickness 0.7+0.8 mm) occupied 41.2% of the entire thickness of the excision. In 32 biopsies (21.8%; 95% CI 16.0 to 29.3), the excision did not reach viable skin. Only eight biopsies (5.4%; 95% CI 2.8 to 10.1) contained all of the necrotic tissue without removing viable tissue. CONCLUSIONS The thickness of a single tangentially excised layer of eschar is not much greater than the actual thickness of the entire skin and often contains viable tissue. Because surgical debridement is insufficiently selective, more selective means of debriding burn eschars should be explored.
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Prevention and management of infections associated with burns in the combat casualty. ACTA ACUST UNITED AC 2008; 64:S277-86. [PMID: 18316972 DOI: 10.1097/ta.0b013e318163c3e4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Burns complicate 5% to 10% of combat associated injuries with infections being the leading cause of mortality. Given the long term complications and rehabilitation needs after initial recovery from the acute burns, these patients are often cared for in dedicated burn units such as the Department of Defense referral burn center at the United States Army Institute of Surgical Research in San Antonio, TX. This review highlights the evidence-based recommendations using military and civilian data to provide the most comprehensive, up-to-date management strategies for burned casualties. Areas of emphasis include antimicrobial prophylaxis, debridement of devitalized tissue, topical antimicrobial therapy, and optimal time to wound coverage.
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Singer AJ, Brebbia J, Soroff HH. Management of local burn wounds in the ED. Am J Emerg Med 2007; 25:666-71. [PMID: 17606093 DOI: 10.1016/j.ajem.2006.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 12/12/2006] [Accepted: 12/13/2006] [Indexed: 11/28/2022] Open
Abstract
Each year there are over 500,000 burns that present to the emergency department (ED). Most burns are minor, and their care focuses on local wound management. The current article will present a typical case and then review the epidemiology, pathophysiology, diagnosis, and management of minor burns in the ED.
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Affiliation(s)
- Adam J Singer
- Department of Emergency Medicine, Stony Brook University, HSC L3-058, Stony Brook, NY 11794-8350, USA.
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Abstract
PURPOSE OF REVIEW Blast injuries have always occurred both in civilian life and as acts of war or terrorism. Nowadays, the risk of being involved in an explosion has increased even for those living in countries with no previous experience of such events. It is our intention that this review is of assistance to those providing emergency/critical care to patients who have sustained blast injuries. RECENT FINDINGS Exposure to blast may indirectly produce physiological insults such as bradycardia, hypotension, tissue hypoxia and oxidative stress. The use of early goal-directed therapy might be important in minimizing such insults. Explosions in an enclosed environment are associated with increased risk of pulmonary blast injury and also air and fat embolism. Mechanical ventilation after pulmonary blast injury is associated with barotrauma and the use of lung protective strategies previously recommended in acute lung injury may be beneficial. SUMMARY The potential for blast to cause injury depends on the nature of the explosive and environment in which the blast occurs. Soft tissue injury with environmental contamination is frequent. Optimal antimicrobial cover and strategies such as selective digestive decontamination may be advantageous. Early surgery should follow the principles of 'damage control'. Blast injury often leads to severe sepsis/systemic inflammatory response, multiple organ dysfunction and prolonged critical illness. In this clinical scenario, recent studies have shown improved outcome with the use of activated protein C, steroid replacement and aggressive control of blood glucose but have been less convincing regarding the use of immuno-nutrition.
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Affiliation(s)
- Gavin G Lavery
- Critical Care Services, Theatres and Intensive Care, Royal Hospitals Trust, Belfast, Northern Ireland, UK.
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Singh T, Arbuthnot JE, Stevenson H, Brown L. The impact of introducing a care pathway for the treatment of minor paediatrics burns. J Wound Care 2007; 16:79-81. [PMID: 17319623 DOI: 10.12968/jowc.2007.16.2.27002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- T Singh
- New Cross Hospital, Wolverhampton, UK.
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Singer AJ, McClain SA, Hacht G, Batchkina G, Simon M. Semapimod Reduces the Depth of Injury Resulting in Enhanced Re-epithelialization of Partial-Thickness Burns in Swine. J Burn Care Res 2006; 27:40-9. [PMID: 16566536 DOI: 10.1097/01.bcr.0000194276.36691.fb] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Studies suggest that tumor necrosis factor alpha (TNF-alpha) plays a role in burn pathogenesis. We conducted a randomized controlled experiment in swine to determine whether a novel macrophage inhibitor, semapimod (formerly known as CNI-1493), would blunt the local production of TNF-alpha, interleukin (IL)-1, and IL-6 in burns leading to less injury extension and faster re-epithelialization. After creating second-degree burns, animals received one or two intravenous boluses of semapimod 1 mg/kg or normal saline, and all burns were treated with silver sulfadiazine. The depth of follicular necrosis and thrombosis was reduced by either one or two doses of semapimod (P=.04 and .02, respectively). However, no differences were noted between groups in cytokine levels. Depth of scarring was similar in all groups. We conclude that Semapimod reduces the depth of follicular necrosis and thrombosis after second-degree burns in swine, indirectly resulting in more rapid re-epithelialization. However, this affect does not appear to be mediated by reduced local TNF-alpha, IL-1, or IL-6 protein levels.
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Affiliation(s)
- Adam J Singer
- Department of Emergency Medicine, Stony Brook University, Stony Brook, New York 11794-8350, USA
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Steer JA, Papini RPG, Wilson APR, McGrouther DA, Nakhla LS, Parkhouse N. Randomized placebo-controlled trial of teicoplanin in the antibiotic prophylaxis of infection following manipulation of burn wounds. Br J Surg 2005. [DOI: 10.1046/j.1365-2168.1997.02690.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rashid A, Brown AP, Khan K. On the use of prophylactic antibiotics in prevention of toxic shock syndrome. Burns 2005; 31:981-5. [PMID: 16288963 DOI: 10.1016/j.burns.2005.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Accepted: 06/26/2005] [Indexed: 11/26/2022]
Abstract
No consensus exists among burn surgeons on the role of prophylactic antibiotics in prevention of toxic shock syndrome (TSS). We recently reported a series of 71 children admitted with burns to our burn unit. By Centres for Disease Control (CDC) criteria, six of these were 'definite' and four 'probable' cases of TSS. Prior to this report, none of our patients were given prophylactic antibiotics. Thereafter, prophylactic therapy was included in the management of children admitted to the burns unit. The aim of this study was to assess whether prophylaxis with a one off single dose of systemic antibiotics prevented the occurrence of TSS. Data were collected prospectively between 1 January and 31 December 2001, on all children admitted to the burns unit. Out of 50 children admitted to the burns unit, 39 received prophylactic antibiotics in the referring accident and emergency. Two of these became unwell but none fulfilled the CDC criteria. The remaining 11 patients were given antibiotics on admission out of which one child required direct admission to the intensive care unit with a working diagnosis of TSS. Retrospectively, his features did not conform to the CDC criteria. In conclusion, this study suggests that prophylaxis may prevent TSS in children.
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Affiliation(s)
- Abid Rashid
- Northern Ireland Plastic and Maxillofacial Service, Ulster Hospital, Dundonald, Belfast BT16 1RH, Northern Ireland, UK.
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Burd A. Toxic shock syndrome in paediatric burns: A peculiarly British malady or a malady of peculiar British? Burns 2005; 31:937-8. [PMID: 16199302 DOI: 10.1016/j.burns.2005.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 05/30/2005] [Indexed: 10/25/2022]
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Glesinger R, Cohen AD, Bogdanov-Berezovsky A, Krieger Y, Rosenberg L. A Randomized Controlled Trial of Silver Sulfadiazine, Biafine, and Saline-soaked Gauze in the Treatment of Superficial Partial-thickness Burn Wounds in Pigs. Acad Emerg Med 2004. [DOI: 10.1111/j.1553-2712.2004.tb01449.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Glesinger R, Cohen AD, Bogdanov-Berezovsky A, Krieger Y, Rosenberg L. A randomized controlled trial of silver sulfadiazine, biafine, and saline-soaked gauze in the treatment of superficial partial-thickness burn wounds in pigs. Acad Emerg Med 2004; 11:339-42. [PMID: 15064205 DOI: 10.1197/j.aem.2003.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
UNLABELLED Silver sulfadiazine 1% cream (SSD) and biafine (an oil-in-water emulsion containing alginate) are used for the treatment of superficial partial-thickness burns, but comparative effectiveness studies are lacking. OBJECTIVES To compare the uses of SSD, Biafine (Labortoires Medix, Houdan, France), and saline-soaked gauze in the treatment of superficial partial-thickness burns in pigs. METHODS This was a randomized controlled trial in four anesthetized young pigs. Four equal sets of partial-thickness contact burns were inflicted on the pigs. Each burn was randomly assigned to treatment with biafine, SSD, or saline-soaked gauze with dressing changes every other day. Assessment of wound re-epithelialization was performed every other day, for a total of two weeks. The treatment groups were compared by univariable and multivariable analyses of variance (ANOVAs), controlling for the pig and the location of the burns on each pig. RESULTS Thirty-two burns were inflicted on the pigs. Time to re-epithelialization of the burns was 13.5 days (SD +/- 0.9 days) in pigs treated with biafine, 13.3 days (+/-1.3 days) in pigs treated with SSD, and 13.5 days (+/-1.0 days) in pigs treated with saline-soaked gauze (p = not significant [NS]). The decreases in burn area from day 2 to day 12 were 21.4 cm(2) (+/-6.0 cm(2)) in pigs treated with biafine, 20.0 cm(2) (+/-6.3 cm(2)) in pigs treated with SSD, and 19.8 cm(2) (+/-5.9 cm(2)) in pigs treated with saline-soaked gauze (p = NS). A multivariable ANOVA showed a similar decrease in burn area between the treatment arms (p = NS) and a significant difference between the pigs (p = 0.015). CONCLUSION Partial-thickness porcine burns treated with SSD, biafine, and soaked saline gauze re-epithelialize at similar rates.
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Affiliation(s)
- Ronen Glesinger
- Department of Plastic and Reconstructive Surgery and Burn Unit, Soroka University Medical Center, Beer-Sheva 84101, Israel.
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Elsayed S, Gregson DB, Lloyd T, Crichton M, Church DL. Utility of Gram stain for the microbiological analysis of burn wound surfaces. Arch Pathol Lab Med 2003; 127:1485-8. [PMID: 14567718 DOI: 10.5858/2003-127-1485-uogsft] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Surface swab cultures have attracted attention as a potential alternative to biopsy histology or quantitative culture methods for microbiological burn wound monitoring. To our knowledge, the utility of adding a Gram-stained slide in this context has not been evaluated previously. OBJECTIVE To determine the degree of correlation of Gram stain with culture for the microbiological analysis of burn wound surfaces. DESIGN Prospective laboratory analysis. SETTING Urban health region/centralized diagnostic microbiology laboratory. PATIENTS Burn patients hospitalized in any Calgary Health Region burn center from November 2000 to September 2001. INTERVENTION Gram stain plus culture of burn wound surface swab specimens obtained during routine dressing changes or based on clinical signs of infection. MAIN OUTCOME MEASURES Degree of correlation (complete, high, partial, none), including weighted kappa statistic (kappa(w)), of Gram stain with culture based on quantitative microscopy and degree of culture growth. RESULTS A total of 375 specimens from 50 burn patients were evaluated. Of these, 239 were negative by culture and Gram stain, 7 were positive by Gram stain only, 89 were positive by culture only, and 40 were positive by both methods. The degree of complete, high, partial, and no correlation of Gram stain with culture was 70.9% (266/375), 1.1% (4/375), 2.4% (9/375), and 25.6% (96/375), respectively. The degree of correlation for all 375 specimens, as expressed by the weighted kappa statistic, was found to be fair (kappa(w) = 0.32).Conclusion.-The Gram stain is not suitable for the microbiological analysis of burn wound surfaces.
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Affiliation(s)
- Sameer Elsayed
- Division of Microbiology, Calgary Laboratory Services, Calgary, Alberta, Canada.
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Norman D. The use of povidone-iodine in superficial partial-thickness burns. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2003; 12:S30-6. [PMID: 12682580 DOI: 10.12968/bjon.2003.12.sup1.11250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/01/2003] [Indexed: 11/11/2022]
Abstract
Infection is of primary concern to those practitioners treating burns patients, as it is one of the primary complications associated with acute wounds and particularly with superficial partial-thickness burns. In the fight to reduce the risks, many practitioners deploy common antimicrobials agents prophylactically to help reduce risks, e.g. povidone-iodine. This review will examine the evidence to support this practice. The deployment of povidone-iodine in wound care is highly controversial, with questions being raised concerning not only the effectiveness of the product but also its safety and effect on wound healing. The use of povidone-iodine has been investigated both in vitro and in vivo, resulting in conflicting and often contradictory results. Of the work completed to date, researchers have failed to identify or control for extraneous variables which makes it difficult to compare and interpret research findings. The potential benefits or harm that the use of povidone-iodine may elicit in acute wounds is yet to be established.
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Johnson D, Pathirana PDR. Toxic shock syndrome following cessation of prophylactic antibiotics in a child with a 2% scald. Burns 2002; 28:181-4. [PMID: 11900944 DOI: 10.1016/s0305-4179(01)00084-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Toxic shock syndrome (TSS) is a rare but serious complication of burns in children. Symptoms usually start within 3 days of the burn injury and even children with minor burns can be susceptible. Prompt diagnosis and rapid treatment is crucial in limiting the morbidity associated with this condition. We report here a 19-month-old child with a 2% scald who developed TSS following cessation of a 5-day course of flucloxacillin. This case highlights a number of issues regarding the use of prophylactic antibiotics and TSS as well as illustrating the continuing need to educate parents concerning the importance of seeking a prompt medical opinion if the child becomes ill following even a minor burn injury.
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Affiliation(s)
- D Johnson
- Department of Plastic and Reconstructive Surgery, Salisbury District Hospital, Odstock, Salisbury, Wiltshire, UK.
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Abstract
OBJECTIVE To compare the effects of octylcyanoacrylate (OCA), silver sulfadiazine (SSD), polyurethane film (PU), and dry gauze (G) on scarring three months after partial-thickness burns. METHODS This was a prospective, blinded, controlled experimental trial using isoflurane-anesthetized swine. Standardized partial-thickness burns were inflicted by applying an aluminum bar preheated to 80 degrees C to the backs and flanks of a young pig for 20 seconds. Four equal sets of ten burns each were randomly treated with OCA spray, SSD, PU, or G. Dressing changes were performed on days 1, 2, 3, and 4 after injury. Digital images of the burns were obtained immediately and three months later for masked computerized determination of scar surface area. Full-thickness biopsies were taken at three months for masked histopathological evaluation. The primary outcome was the percent reduction in residual wound area (RWA) calculated by subtracting the area of each individual burn from the area of the largest burn and dividing this value by the area of the largest burn (intraobserver correlation, r = 0.99). Secondary outcomes were the proportion of burns with the presence of scar tissue (abnormal collagen under polarized light; intraobserver agreement, kappa = 0.93) and the cosmetic appearance on a 100-mm visual analog scale marked "best scar" at the high end (inter-observer correlation, r = 0.82). Analysis of variance (ANOVA) and chi(2) tests were used for group comparisons as appropriate. This study had 80% power to detect a 33-percentage-point difference in RWA among groups (alpha = 0.05). RESULTS A total of 40 burns were inflicted on the pig. There was no difference in percent RWA across the groups (OCA = 25%, SSD = 40%, PU = 25%, G = 32%; p = 0.13). There was no difference in the proportion of wounds with scarring among the groups (OCA = 10%, SSD = 22%, PU = 2%, G = 30%; p = 0.89). There was also no difference in the cosmetic scores among the groups (OCA = 78 mm, SSD = 75 mm, PU = 74 mm, G = 74 mm; p = 0.96). CONCLUSIONS The effects of OCA spray, SSD, PU, and dry gauze on scarring three months after burns in pigs are similar.
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Affiliation(s)
- A Singer
- Department of Emergency Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.
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Abstract
Toxic shock syndrome (TSS) is a rare complication of a Staphylococcus aureus infection and is primarily seen in children with small burns. The true incidence of TSS in burns patients is not known and the number of presumptive cases rarely reported. This survey was undertaken to determine if the incidence of TSS in children with burns could be related to the type of dressing used to cover the wound. A questionnaire was compiled and sent to the Senior Nurse in charge of each of the UK burns units. General information on the number of admissions, age of the patient, cause of injury and burn wound management was sought. An 81% response was obtained after two mailshots and follow up telephone calls. Seventy percent (23/33) of units which answered the survey nursed children. Of these, eight units had either not encountered TSS previously or not had a case within the past two years. These units were small, admitting a maximum of 50 patients each year. Of the units where TSS was encountered, approximately 2.5% of children admitted showed symptoms of TSS. Of the units who nursed both adults and children, seven units had seen TSS in burned adult patients which has not been reported in the literature. Of the eight units where TSS had not been recently encountered, four routinely administered prophylactic antibiotics to prevent infection whereas routine administration of antibiotics occurred in only two of the 15 units where TSS was seen. Although wound management procedures differed slightly there were many similarities. These included wound cleaning with normal saline, covering with either silver sulphadiazine (1%) or povidone iodine (10%), depending upon the infection status, and dressing with a paraffin tulle, gauze and crepe bandages. No association between the management of the burn wound and subsequent development of TSS could be established.
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Affiliation(s)
- V Edwards-Jones
- Department of Biological Sciences, Manchester Metropolitan University, Chester Street, Manchester, UK.
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26
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Singer AJ, Mohammad M, Thode HC, McClain SA. Octylcyanoacrylate versus polyurethane for treatment of burns in swine: a randomized trial. Burns 2000; 26:388-92. [PMID: 10751707 DOI: 10.1016/s0305-4179(99)00171-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In order to determine whether the enhanced reepithelialization of second-degree burns treated with octylcyanoacrylate (OCA) was due to its occlusive nature we compared reepithelialization (REP) and infection rates of second degree burns treated with OCA and polyurethane film (Tegaderm) in swine. Forty-four standardized partial thickness burns were created by applying an aluminum bar preheated to 80 degrees C to the backs of pigs for 20 s and randomly treated with OCA or Tegaderm. Full thickness biopsies were taken at 7, 10 and 14 days for blinded histopathological evaluation of rates of infection and reepithelialization. T-tests and chi(2) tests were used for group comparisons. There were no between group difference in the rates of reepithelialization and infection. All wounds were reepithelialized by day 14 and there were no infections in either group. We conclude that treatment of partial thickness burns with OCA spray or Tegaderm results in similar rates of reepithelialization and infection, suggesting that the beneficial effects of OCA on reepithelialization are due to its occlusive nature.
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Affiliation(s)
- A J Singer
- Department of Emergency Medicine, University Hospital and Medical Center, State University of New York, L4-515, Stony Brook, NY 11794-7400, USA
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Singer AJ, Mohammad M, Tortora G, Thode HC, McClain SA. Octylcyanoacrylate for the treatment of contaminated partial-thickness burns in swine: a randomized controlled experiment. Acad Emerg Med 2000; 7:222-7. [PMID: 10730828 DOI: 10.1111/j.1553-2712.2000.tb01063.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare infection and reepithelialization rates of contaminated second-degree burns treated with octylcyanoacrylate (OCA), silver sulfadiazine (SSD), polyurethane (PU) film, and dry gauze (control; C) in swine. METHODS Eighty standardized burns were created by applying an aluminum bar preheated to 80 degrees C to the backs and flanks of young pigs for 20 seconds. All burns were immediately contaminated with 0.1 mL of Staphylococcus aureus 10(5)/mL and randomly treated with OCA spray, SSD, PU, or dry gauze (C). Full-thickness biopsies were taken at 3, 7, and 14 days for blinded histopathologic evaluation using hematoxylin and eosin (H&E)-stained slides. Burns were considered infected in the presence of interstitial reticular dermal neutrophils containing bacteria (intraobserver agreement, kappa = 1.00). Quantitative wound cultures were performed on a second day-3 specimen. RESULTS At day 3, wound infection rates were 30% (OCA), 50% (SSD), 55% (PU), and 50% (C); p = 0.40 (Kruskal-Wallis test). At day 7, infection rates were 35% (OCA), 85% (SSD), 70% (PU), and 65% (C); p = 0.01. Median bacterial counts at day 3 were 6,500 (OCA), 20,000 (SSD), 1,000,000 (PU), and 650,000 (C); p = 0.29. The proportion of completely reepithelialized wounds at day 14 were 75% (OCA), 90% (SSD), 85% (PU), and 90% (C); p = 0.50. CONCLUSIONS Treatment of contaminated partial-thickness burns with OCA spray resulted in fewer infections at one week than with the other three treatments.
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Affiliation(s)
- A J Singer
- Department of Emergency Medicine, State University of New York, Stony Brook 11794-7400, USA.
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Singer AJ, Berrutti L, Thode HC, McClain SA. Octylcyanoacrylate for the treatment of partial-thickness burns in swine: a randomized, controlled experiment. Acad Emerg Med 1999; 6:688-92. [PMID: 10433527 DOI: 10.1111/j.1553-2712.1999.tb00436.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare re-epithelialization rates of superficial partial-thickness burns treated with octylcyanoacrylate (OCA), silver sulfadiazine (SSD), and dry gauze (controls) in swine. METHODS This was a prospective, longitudinal, blinded, controlled, experimental trial using anesthetized swine. Sixty-three standardized burns were created by applying an aluminum bar preheated to 80 degrees C for 20 seconds to the flanks of four young pigs. Three equal sets of 21 burns were randomly treated with OCA spray, SSD, or dry gauze (controls). Full-thickness biopsies were taken after 30 minutes and at seven and 14 days for blinded histopathologic evaluation by two dermatopathologists using hematoxylin and eosin staining. The percent of wound re-epithelialization was measured at days 7 and 14, calculated by dividing the length of the regenerated epidermis by the measured width of the biopsy. Analysis of variance (ANOVA) and repeated-measures ANOVA controlling for the individual pig were used for comparisons among groups. This study had 80% power to demonstrate a large between-group difference in percent re-epithelization (alpha = 0.05). RESULTS There were 63 burns and 126 biopsies. Ten biopsies were excluded for technical reasons. At seven days, there was a significant between-group difference in percent re-epithelialization. Percent re-epithelialization was greatest in the OCA group (65.0%), followed by the SSD group (37.6%), and lowest in the control group (8.8%). At 14 days, all wounds demonstrated near complete re-epithelialization and there was no significant difference in the percent of re-epithelialization among the groups. There was only one wound infection in the OCA group. CONCLUSIONS Under these study conditions, treatment of partial-thickness burns with OCA spray resulted in a higher percent of re-epithelialization at seven but not 14 days when compared with both SSD and control, with no significant increase in infection rates. Future studies should evaluate the use of OCA for the treatment of burns in humans.
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Affiliation(s)
- A J Singer
- Department of Emergency Medicine, State University of New York at Stony Brook, USA.
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Chern IF, Steer JA, Wilson AP. Effect of teicoplanin on isolation of Staphylococcus aureus from blood culture media. J Antimicrob Chemother 1999; 43:589-91. [PMID: 10350393 DOI: 10.1093/jac/43.4.589] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Intraoperative bacteraemia has been used as an indicator of the efficacy of prophylactic antibiotics. Two clinical isolates of Staphylococcus aureus in nutrient broth, with or without human serum, were exposed to teicoplanin (50 mg/L) and, either immediately or after 30 min, inoculated into blood culture bottles. Bottles with and without resin were used and the experiment was repeated five times with one strain. In the absence of teicoplanin, an inoculum of 10 cfu/mL produced growth in both resin and non-resin bottles. In the presence of teicoplanin, an inoculum of at least 10(5) cfu/mL was required in non-resin bottles to obtain growth, but this was reduced to 10(2)-10(3) cfu/mL for resin bottles. Intraoperative blood cultures overestimate the efficacy of bacterial killing by prophylactic antibiotics during surgery.
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Affiliation(s)
- I F Chern
- Department of Biology, University College London, UK
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Papini RP, Wilson AP, Steer JA, Hill G, McGrouther DA, Parkhouse N. Plasma concentrations of tumour necrosis factor-alpha and interleukin-6 during burn wound surgery or dressing. BRITISH JOURNAL OF PLASTIC SURGERY 1997; 50:354-61. [PMID: 9245870 DOI: 10.1016/s0007-1226(97)90545-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Clinical deterioration after burn wound manipulation may be related to the release of cytokines including tumour necrosis factor-alpha (TNF) and interleukin-6 (IL-6). METHODS The two cytokines were assayed by immunoenzymetric assay in blood samples taken before and during manipulation of the burn wound. An antibiotic, teicoplanin, was administered to half the patients at the start of the procedure in a randomized fashion as part of a separate trial. FINDINGS Sixty patients with a median burn size of 8% (range 1-56%) were studied during dressing change (n = 40) or burn excision (n = 20). There was little change in TNF levels between preoperative and recovery samples but IL-6 concentrations increased three-fold, particularly in those with large recent burns or bacteraemia, and were correlated with poor clinical outcome. The presence of teicoplanin did not significantly affect the levels of either cytokine. INTERPRETATION The systemic cytokine response to burn wound dressing or debridement is predominantly that of IL-6 and it is not significantly reduced by preventing Gram-positive bacteraemia during the procedure.
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Affiliation(s)
- R P Papini
- Department of Clinical Microbiology, University College London Hospitals, UK
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31
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Steer JA, Papini RPG, Wilson APR, McGrouther DA, Nakhla LS, Parkhouse N. Randomized placebo-controlled trial of teicoplanin in the antibiotic prophylaxis of infection following manipulation of burn wounds. Br J Surg 1997. [DOI: 10.1002/bjs.1800840633] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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32
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Steer JA, Papini RP, Wilson AP, McGrouther DA, Parkhouse N. Quantitative microbiology in the management of burn patients. II. Relationship between bacterial counts obtained by burn wound biopsy culture and surface alginate swab culture, with clinical outcome following burn surgery and change of dressings. Burns 1996; 22:177-81. [PMID: 8726253 DOI: 10.1016/0305-4179(95)00117-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The use of quantitative bacteriology in the burns unit has been thought to be efficient in predicting sepsis or graft loss. To examine the relationship between clinical outcome and bacterial densities on and in the burn wound, 69 biopsy/surface swab pairs were collected from 47 patients on 64 occasions, either immediately prior to excision and grafting, or at routine change of dressings. The mean per cent TBSA burn was 16 (range 1-65). There was a significant correlation between log total bacterial count by biopsy with total white cell count and age (P = 0.028), and a significant negative correlation between total bacterial count by swab with per cent TBSA (P = 0.006). There was no significant difference in bacterial counts between patients judged to be a clinical success or clinical failure (72 h follow-up), either after undergoing excision and grafting, or change of dressings, and no difference in counts between patients with perioperative bacteraemia and those without. With burns > 15 per cent TBSA, a relationship between bacterial counts and subsequent sepsis or graft loss still was not demonstrated. It is suggested that quantitative bacteriology by burn wound biopsy or surface swab does not aid the prediction of sepsis or graft loss.
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Affiliation(s)
- J A Steer
- Department of Microbiology, University College London Hospitals, UK
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Baragwanath P, Salomon RA, Melhuish JM, Finnie A, Salomon RA, Hagelstein SM. From the Journals. J Wound Care 1995; 4:306-308. [PMID: 27925840 DOI: 10.12968/jowc.1995.4.7.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The use of ultrasound therapy in treating pressure sores Ischaemia and reperfusion injury in patients with intermittent claudication Transcutaneous oxygen pressure and pressure sore development Current practice in burn care Use of MRS to monitor healing of leg ulcers Effectiveness of a low air loss bed in treating pressure ulcers.
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Affiliation(s)
- P Baragwanath
- Research registrar, Wound Healing Research Unit, University of Wales College of Medicine, Cardiff
| | - R A Salomon
- Research fellow, Wound Healing Research Unit University of Wales College of Medicine, Cardiff
| | - J M Melhuish
- Research technician, Wound Healing Research Unit, University of Wales College of Med/dne, Cardif
| | | | - R A Salomon
- Research Fellow, Wound Healing Research Unit, University of Wales College of Medicine, Cardiff
| | - S M Hagelstein
- Research nurse, Wound Healing Research Unit, University of Wales College of Medicine, Cardiff
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