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Calum H, Trøstrup H, Laulund AS, Thomsen K, Christophersen L, Høiby N, Moser C. Murine burn lesion model for studying acute and chronic wound infections. APMIS 2022; 130:477-490. [PMID: 35441434 DOI: 10.1111/apm.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/13/2022] [Indexed: 02/05/2023]
Abstract
Acute wounds, such as thermal injury, and chronic wounds are challenging for patients and the healthcare system around the world. Thermal injury of considerable size induces immunosuppression, which renders the patient susceptible to wound infections, but also in other foci like the airways and urinary tract. Infected thermal lesions can progress to chronic wounds with biofilm making them more difficult to treat. While animal models have their limitations, murine wound models are still the best tool at the moment to identify strategies to overcome these challenges. Here, we present a murine burn model, which has been developed to study biofilm formation, the significance of wound healing, and for identifying novel treatment candidates. Investigating the effect of a thermal injury in mice, we observed that 48 h after introduction of the injury, the mice showed a reduction in polymorphonuclear neutrophil granulocytes (PMNs) and a reduced capacity for phagocytosis and oxidative burst. Regarding the chronic wound, Pseudomonas aeruginosa biofilm arrested wound healing and kept the wound in an inflammatory state, but suppressing PMN function by means of the PMN factor S100A8/A9, corresponding to observations in human venous leg ulcers. Monotherapy and dual treatment with S100A8/A9 and ciprofloxacin on P. aeruginosa biofilm-infected murine wounds have been investigated. In combination, S100A8/A9 and ciprofloxacin reduced the bacterial quantity, lowered the proinflammatory response, and increased anti-inflammatory cytokines after 4 days of treatment. When the treatment was prolonged, an additional prevention of resistance development was detected in all the dual-treated mice. In the present review, we provide data on using the murine model for research with the aim of better understanding pathophysiology of wounds and for identifying novel treatments for humans suffering from these lesions.
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Affiliation(s)
- Henrik Calum
- Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hannah Trøstrup
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Sofie Laulund
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Thomsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Christophersen
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Høiby
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology (ISIM), University of Copenhagen, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
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High Level of Multidrug-Resistant Gram-Negative Pathogens Causing Burn Wound Infections in Hospitalized Children in Dar es Salaam, Tanzania. Int J Microbiol 2021; 2021:6644185. [PMID: 34306091 PMCID: PMC8270727 DOI: 10.1155/2021/6644185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/24/2021] [Indexed: 12/15/2022] Open
Abstract
Background Bacterial infection remains the most common cause of morbidity and mortality in pediatric patients with burn wounds. The increase in infection and multidrug-resistant (MDR) pathogens necessitates a periodic review of antimicrobial susceptibility patterns in the burn units. The study aimed to determine the magnitude of multidrug-resistant Gram-negative (MDRGN) bacteria in children with burn wound infections and describe the resistance patterns in the tertiary and regional hospitals in Dar es Salaam, Tanzania. Materials and Methods The study was a hospital-based cross-sectional study design conducted between May 2017 and February 2018. Bacterial isolates from 103 wound swabs of pediatric patients with burn wounds were identified using conventional methods and API 20E. The antimicrobial susceptibility pattern was determined by the Kirby-Bauer disc diffusion method. Data were analyzed using Statistical Package for Social Science (SPSS) version 23.0. Results A total of 136 pathogenic Gram-negative organisms were isolated from burn wound infections in pediatric patients. The most isolated Gram-negative bacterium was Pseudomonas aeruginosa (39.0%), followed by Acinetobacter spp. (28.7%) and Klebsiella spp. (16.2%). MDRGN strains made up 80.1% of all Gram-negative isolates. All (100%) Klebsiella spp. and E. coli were MDR, while 69.2% and 79.2% of Acinetobacter spp. and P. aeruginosa, respectively, displayed MDR strains. We observed high levels of resistance to commonly prescribed antibiotics. Among P. aeruginosa isolates, highest resistance (81.8%) was seen toward meropenem and piperacillin, 79.5% of Acinetobacter spp. showed resistance to aztreonam, while 93-100% of Klebsiella spp and E. coli displayed resistance to amoxyclavulanic acid, ceftriaxone, and ceftazidime. The proportion of extended-spectrum beta-lactamase producers among Enterobacteriaceae was 78.6%. There was a significant higher rate of infection with MDRGN organisms in pediatric patients with a higher percentage of total burn surface area (TBSA) than patients with lower TBSA (p = 0.016). Conclusions P. aeruginosa, Acinetobacter spp., and Klebsiella spp. are the common Gram-negative pathogens causing burn wound infections in hospitalized pediatric patients in our setting. A high proportion of these organisms were multidrug resistant. The findings appeal for regular antimicrobial resistance surveillance in burn wound infection to inform empirical therapy.
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Malta DC, Bernal RTI, Lima CMD, Cardoso LSDM, Andrade FMDD, Marcatto JDO, Gawryszewski VP. Profile of cases due to burn attended in emergency care units in Brazilian capitals in 2017. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23 Suppl 1:e200005.SUPL.1. [PMID: 32638990 DOI: 10.1590/1980-549720200005.supl.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/17/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To describe the profile of burn victims attended in emergency services and to identify associations between the variables investigated. METHODS Cross-sectional study based on data from the 2017 survey "Surveillance of violence and accidents in emergency units". We used descriptive analysis, according to demographic characteristics and aspects related to the burn injury, as well as the correspondence analysis technique, which allowed to verify possible associations between the variables investigated. RESULTS Burns were more frequent: in adults aged between 20 and 39 years (40.7%); in men (57.0%); in the household (67.7%); due to hot substances (52.0%). Household accidents were more frequent in the age group 0-15 years (92.0%) and elderly (84.4%), and in women (81.6%). Accidents in commerce, services and industry affected individuals aged 16 to 59 years (73.6%). Referral to other hospitals was associated with cases in the elderly and hospitalization with the cases in individuals aged between 0 and 15 years old. Events in the working age population were associated with alcohol use and the workplace. Among women, it is suggested to associate burn accidents with household and hot substances. CONCLUSIONS The results point to the need for oriented actions in the field of health education, as well as labor regulation and supervision.
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Affiliation(s)
- Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Regina Tomie Ivata Bernal
- Programa de Pós-Graduação, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - Juliana de Oliveira Marcatto
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Calum H, Høiby N, Moser C. Mouse Model of Burn Wound and Infection: Thermal (Hot Air) Lesion-Induced Immunosuppression. ACTA ACUST UNITED AC 2017. [DOI: 10.1002/cpmo.25] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Henrik Calum
- Department of Clinical Microbiology, Hvidovre Hospital; Copenhagen Denmark
| | - Niels Høiby
- Department of Clinical Microbiology, Rigshospitalet; Copenhagen Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet; Copenhagen Denmark
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Ramirez-Blanco CE, Ramirez-Rivero CE, Diaz-Martinez LA, Sosa-Avila LM. Infection in burn patients in a referral center in Colombia. Burns 2017; 43:642-653. [PMID: 28185802 DOI: 10.1016/j.burns.2016.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 06/29/2016] [Accepted: 07/14/2016] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Worldwide, burns are responsible for more than 300,000 deaths annually; infection is a major cause of morbidity and mortality in these patients. Early identification and treatment of infection improves outcome. Toward this end it's necessary to identify the institutions flora and organisms that most frequently produces infection. OBJECTIVES To characterize infections developed by burn patients hospitalized at the University Hospital of Santander (HUS). METHODOLOGY Burn patients hospitalized in the HUS from January 1 to December 2014 were followed. Medical information regarding infections, laboratory and pathology reports were obtained. Statistical analysis with measures of central tendency, proportions, global and specific incidence density plus overall and specific incidence was obtained. For the microbiological profile proportions were established. RESULTS 402 burn patients were included, 234 (58.2%) men and 168 (41.8%) women, aged between 6 days and 83 years, median 12.5 years. The burn agents include scald (52.5%), fire (10.0%), gasoline (9.2%), electricity (7.5%), among others. Burn area ranged from 1% to 80% TBS. Cumulative mortality was 1.5%. 27.8% of burned patients had one or more infections. Identified infections include folliculitis (27.0%), urinary tract infection (19.0%), infection of the burn wound (10.4%), pneumonia (8.6%), Central venous catheter (7.4%), bloodstream infection (7.4%) and skin grafts infection (4.3%) among others. Bacteria were responsible for 88.5% of the cases and fungi 11.5%. The most frequently isolated germs were P. aeruginosa, A. baumannii, E. coli, S. aureus and K. pneumoniae. Most gram-negative bacteria were sensitive to Amikacin, gram positive bacteria were sensitive to multiple antibiotics. CONCLUSION Burns is a severe trauma that occurs in adult and pediatric patients, has several causative agents and can compromise the patient's life. The burned patient is at risk for a variety of infections. According to the type of infection it is possible to infer the most common causative organisms and their antibiotic sensitivity/resistance which allow a directed early empiric treatment.
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Affiliation(s)
- Carlos Enrique Ramirez-Blanco
- Division of Plastic and Reconstructive Surgery, Burn Center, University Hospital of Santander, Universidad Industrial de Santander, Colombia.
| | - Carlos Enrique Ramirez-Rivero
- Division of Plastic and Reconstructive Surgery, Burn Center, University Hospital of Santander, Universidad Industrial de Santander, Colombia.
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Soltan Dallal MM, Safdari R, Emadi Koochak H, Sharifi-Yazdi S, Akhoondinasab MR, Pourmand MR, Hadayatpour A, Sharifi-Yazdi MK. A comparison between occlusive and exposure dressing in the management of burn wound. Burns 2016; 42:578-82. [PMID: 26970838 DOI: 10.1016/j.burns.2015.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 04/29/2015] [Accepted: 05/04/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIM Two types of dressing, occlusive and exposure dressing, are commonly used in burn units. A dressing is said to be occlusive if a moist wound surface is maintained when the dressing is in place. This study was designed to compare the effectiveness of occlusive and exposure dressing in controlling burn infections. PATIENTS AND METHODS Two hundred patients with second-degree burns admitted to Mottahari Hospital, Tehran, Iran, over a period of 12 months from May 2012 to May 2013 were studied. They were divided into two groups of 100 each, to receive either occlusive or exposure dressing. During the first week of treatment, wound specimens were obtained by sterile swab and cultured in selective media. Demographics (age and gender), burn areas, cause of burn, length of hospital stay (LOS), type of infections and time to total healing were compared between the two groups. RESULTS Occlusive dressing was more susceptible to microbial contamination and infections than exposure dressing. The mean duration of treatment based on epithelialization and healing in occlusive dressing was longer than for exposure dressing. The most common isolate was Pseudomonas spp., followed by Enterobacter, Escherichia coli, Staphylococcus aureus, Acinetobacter, and Klebsiella spp. CONCLUSIONS Exposure dressing was more suitable than occlusive dressing for treating partial-thickness at our center. Pseudomonas aeruginosa was the most common organism encountered in burn infection.
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Affiliation(s)
- M M Soltan Dallal
- Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran; Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - R Safdari
- Health Information Management Department, School of Allied Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - H Emadi Koochak
- Zoonosis Research Centre, Tehran University of Medical Sciences, Tehran, Iran; Infectious Diseases Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - S Sharifi-Yazdi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - M R Akhoondinasab
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - M R Pourmand
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - A Hadayatpour
- Department of Anatomical Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - M K Sharifi-Yazdi
- Zoonosis Research Centre, Tehran University of Medical Sciences, Tehran, Iran; Department of Medical Laboratory Sciences, School of Para Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Gil CSB, Gil VSB, Carvalho SM, Silva GR, Magalhães JT, Oréfice RL, Mansur A, Mansur HS, Patricio PSO, Oliveira LCA. Recycled collagen films as biomaterials for controlled drug delivery. NEW J CHEM 2016. [DOI: 10.1039/c6nj00674d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recyclable collagen is a potential candidate to be used as development prototypes in biomaterial scientific research.
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Affiliation(s)
- Camila S. B. Gil
- Department of Metallurgical
- Materials and Mines Engineering
- Federal University of Minas Gerais
- Belo Horizonte
- Brazil
| | - Viviane S. B. Gil
- Department of Metallurgical
- Materials and Mines Engineering
- Federal University of Minas Gerais
- Belo Horizonte
- Brazil
| | - Sandhra M. Carvalho
- Department of Metallurgical
- Materials and Mines Engineering
- Federal University of Minas Gerais
- Belo Horizonte
- Brazil
| | - Gisele R. Silva
- Department of pharmacy of Federal University of São João Del Rei
- Divinópolis
- Brazil
| | - Juliana T. Magalhães
- Department of pharmacy of Federal University of São João Del Rei
- Divinópolis
- Brazil
| | - Rodrigo L. Oréfice
- Department of Metallurgical
- Materials and Mines Engineering
- Federal University of Minas Gerais
- Belo Horizonte
- Brazil
| | - Alexandra Mansur
- Department of Metallurgical
- Materials and Mines Engineering
- Federal University of Minas Gerais
- Belo Horizonte
- Brazil
| | - Herman S. Mansur
- Department of Metallurgical
- Materials and Mines Engineering
- Federal University of Minas Gerais
- Belo Horizonte
- Brazil
| | - Patrícia S. O. Patricio
- Department of Chemistry of Centro Federal de Educação Tecnológica de Minas Gerais
- Belo Horizonte
- Brazil
| | - Luiz C. A. Oliveira
- Department of Chemistry of Federal University of Minas Gerais
- Belo Horizonte
- Brazil
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Panghal M, Singh K, Kadyan S, Chaudary U, Yadav JP. The analysis of distribution of multidrug resistant Pseudomonas and Bacillus species from burn patients and burn ward environment. Burns 2014; 41:812-9. [PMID: 25468476 DOI: 10.1016/j.burns.2014.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/02/2014] [Accepted: 10/09/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Infections caused by multidrug resistant bacteria act as a risk factor for mortality in burns patients. So keeping in view the crucial importance of reliable therapeutic decisions of multidrug resistance bacteria and role of hospital environment in bacteria colonization, our study is based on the evaluation of distribution of Pseudomonas sp. and Bacillus sp. in burn patients and burn ward environment. METHODS The present prospective analysis was conducted on the patients undergoing treatment in the Burn ward of Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, during the period of January 2012 to March 2013. The multidrug resistant bacteria were characterized by following the CLSI guidelines. Molecular identification isolates were done by amplifying and sequencing 16S rDNA. RESULTS In our study out of 510 samples of 280 burn patients, 263 samples were observed sterile and bacterial isolates were obtained from 247 samples. In burn patients out of 247 samples 43 MDR strains, and in burn ward out of 60 samples 4 MDR strain were observed. After 16S rDNA amplification of MDR isolates the prevalent bacterium was belonged to the genus Bacillus (8 species; 26 isolates) followed by genus Pseudomonas (5 species; 17 isolates). The burn ward environment isolates were Pseudomonas aeruginosa, Pseudomonas stutzeri, Bacillus cereus and Acinetobacter baumanii. CONCLUSION The major finding of our study is the predominance of B. cereus followed by P. aeruginosa in burn patients of Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana. While considering the role of hospital environment, no direct role of environmental isolates was observed in transfer of bacterial infection.
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Affiliation(s)
- Manju Panghal
- Department of Genetics, M. D. University, Rohtak, 124001, Haryana, India
| | - Khushboo Singh
- Department of Genetics, M. D. University, Rohtak, 124001, Haryana, India
| | - Sangeeta Kadyan
- Department of Genetics, M. D. University, Rohtak, 124001, Haryana, India
| | - Uma Chaudary
- Department of Microbiology, Pt. B.D. Sharma University of Health Sciences, Rohtak 124001, Haryana, India
| | - J P Yadav
- Department of Genetics, M. D. University, Rohtak, 124001, Haryana, India.
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Elkafssaoui S, Hami H, Mrabet M, Bouaiti E, Tourabi K, Quyou A, Soulaymani A, Ihrai H. Facteurs prédictifs de mortalité des brûlés : étude sur 221 adultes hospitalisés entre 2004 et 2009. ANN CHIR PLAST ESTH 2014; 59:189-94. [DOI: 10.1016/j.anplas.2012.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 02/11/2012] [Indexed: 11/26/2022]
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Abstract
Severe thermal injury induces immunosuppression, involving all parts of the immune system, especially when large fractions of the total body surface area are affected. An animal model was established to characterize the burn-induced immunosuppression. In our novel mouse model a 6 % third-degree burn injury was induced with a hot-air blower. The third-degree burn was confirmed histologically. At 48 h, a decline in the concentration of peripheral blood leucocytes was observed in the group of mice with burn wound. The reduction was ascribed to the decline in concentration of polymorphonuclear neutrophil leucocytes and monocytes. When infecting the skin with Pseudomonas aeruginosa, a dissemination of bacteria was observed only in the burn wound group. Histological characterization of the skin showed an increased polymorphonuclear neutrophil granulocytes dominated inflammation in the group of mice with infected burn wound compared with the burn wound only group. The burn mouse model resembles the clinical situation and provides an opportunity to examine or develop new strategies like new antibiotics and immune therapy, in handling burn wound victims much.
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Affiliation(s)
- Henrik Calum
- Department of Clinical Microbiology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Chen J, Yan H, Luo G, Luo Q, Li X, Zhang J, Yuan Z, Peng D, Peng Y, Hu J, Wu J. Characteristics of burn deaths from 2003 to 2009 in a burn center: A retrospective study. BURNS & TRAUMA 2013; 1:80-6. [PMID: 27574629 PMCID: PMC4978095 DOI: 10.4103/2321-3868.118933] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mortality remains one of the most important end-point quality control parameters to evaluate a burn care system. We retrospectively reviewed the characteristics and multiple organ dysfunction syndrome (MODS) patterns of burn deaths in our center from January 2003 to December 2009. The mortality rate during this time period was 2.3%. Fifty-six patients died, including 49 males and 7 females. The mean survival time was 28.45 ± 24.60 days. The burn percentage was (76.70 ± 26.86) % total burn surface area (TBSA), with (27.74 ± 24.95) % deep-partial thickness burns and (46.88 ± 33.84) % full-thickness burns. Inhalation injury was diagnosed in 36 (64.29%) patients. Patients who had undergone an operation, particularly in the first week post-burn, had a significantly longer survival time. An average of 5.50 ± 1.35 malfunctioning organs per patient and a mean sequential organ failure assessment (SOFA) score of 13.91 ± 3.65 were observed. The most frequently malfunctioning organs were involved in the respiratory, hematologic, circulatory, and central nervous systems. Most of the organ damage occurred during the first week post-burn, followed by 4 weeks later, with relatively less organ damage observed in the third week. Among patients with a TBSA over 50%, non-survivors had larger burn sizes (particularly larger full-thickness burns) and a higher incidence of inhalation injury compared with survivors; non-survivors were also more likely to have microorganism-positive blood and sputum cultures. In conclusion, burn deaths are related to a higher burn percentage, inhalation injury, MODS, and infection. Early operation may help improve survival duration.
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Affiliation(s)
- Jian Chen
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Hong Yan
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Qizhi Luo
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Xiaolu Li
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Jiaping Zhang
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Zhiqiang Yuan
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Daizhi Peng
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Yizhi Peng
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Jianian Hu
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Jun Wu
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
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Barajas-Nava LA, López-Alcalde J, Roqué i Figuls M, Solà I, Bonfill Cosp X. Antibiotic prophylaxis for preventing burn wound infection. Cochrane Database Syst Rev 2013:CD008738. [PMID: 23740764 DOI: 10.1002/14651858.cd008738.pub2] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Infection of burn wounds is a serious problem because it can delay healing, increase scarring and invasive infection may result in the death of the patient. Antibiotic prophylaxis is one of several interventions that may prevent burn wound infection and protect the burned patient from invasive infections. OBJECTIVES To assess the effects of antibiotic prophylaxis on rates of burn wound infection. SEARCH METHODS In January 2013 we searched the Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE - In-Process & Other Non-Indexed Citations (2013); Ovid EMBASE; EBSCO CINAHL and reference lists of relevant articles. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA All randomised controlled trials (RCTs) that evaluated the efficacy and safety of antibiotic prophylaxis for the prevention of BWI. Quasi-randomised studies were excluded. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed the risk of bias, and extracted relevant data. Risk ratio (RR) and mean difference (MD) were estimated for dichotomous data and continuous data, respectively. When sufficient numbers of comparable RCTs were available, trials were pooled in a meta-analysis to estimate the combined effect. MAIN RESULTS This review includes 36 RCTs (2117 participants); twenty six (72%) evaluated topical antibiotics, seven evaluated systemic antibiotics (four of these administered the antibiotic perioperatively and three administered upon hospital admission or during routine treatment), two evaluated prophylaxis with non absorbable antibiotics, and one evaluated local antibiotics administered via the airway.The 11 trials (645 participants) that evaluated topical prophylaxis with silver sulfadiazine were pooled in a meta analysis. There was a statistically significant increase in burn wound infection associated with silver sulfadiazine compared with dressings/skin substitute (OR = 1.87; 95% CI: 1.09 to 3.19, I(2) = 0%). These trials were at high, or unclear, risk of bias. Silver sulfadiazine was also associated with significantly longer length of hospital stay compared with dressings/skin substitute (MD = 2.11 days; 95% CI: 1.93 to 2.28).Systemic antibiotic prophylaxis in non-surgical patients was evaluated in three trials (119 participants) and there was no evidence of an effect on rates of burn wound infection. Systemic antibiotics (trimethoprim-sulfamethoxazole) were associated with a significant reduction in pneumonia (only one trial, 40 participants) (RR = 0.18; 95% CI: 0.05 to 0.72) but not sepsis (two trials 59 participants) (RR = 0.43; 95% CI: 0.12 to 1.61).Perioperative systemic antibiotic prophylaxis had no effect on any of the outcomes of this review.Selective decontamination of the digestive tract with non-absorbable antibiotics had no significant effect on rates of all types of infection (2 trials, 140 participants). Moreover, there was a statistically significant increase in rates of MRSA associated with use of non-absorbable antibiotics plus cefotaxime compared with placebo (RR = 2.22; 95% CI: 1.21 to 4.07).There was no evidence of a difference in mortality or rates of sepsis with local airway antibiotic prophylaxis compared with placebo (only one trial, 30 participants). AUTHORS' CONCLUSIONS The conclusions we are able to draw regarding the effects of prophylactic antibiotics in people with burns are limited by the volume and quality of the existing research (largely small numbers of small studies at unclear or high risk of bias for each comparison). The largest volume of evidence suggests that topical silver sulfadiazine is associated with a significant increase in rates of burn wound infection and increased length of hospital stay compared with dressings or skin substitutes; this evidence is at unclear or high risk of bias. Currently the effects of other forms of antibiotic prophylaxis on burn wound infection are unclear. One small study reported a reduction in incidence of pneumonia associated with a specific systematic antibiotic regimen.
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Affiliation(s)
- Leticia A Barajas-Nava
- Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain.
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Elmanama AA, Laham NAA, Tayh GA. Antimicrobial susceptibility of bacterial isolates from burn units in Gaza. Burns 2013; 39:1612-8. [PMID: 23664775 DOI: 10.1016/j.burns.2013.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/12/2013] [Accepted: 04/14/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bacterial infections continue to be a leading cause of morbidity and mortality among burn patients despite intensive prophylaxis and treatment. Often treatment is complicated by the emergence of antimicrobial resistance pathogens. There are no reports or published data on the susceptibility profiles of bacteria isolated from burn patients in the Gaza strip. PATIENTS AND METHODS A cross sectional study was performed in the two burn units of Al-Shifa and Naser hospitals for 6 months from October 2010 to March 2011. A total of 118 wound samples from burn patients, 97 environmental samples and 28 samples from health care workers (HCWs) were collected and cultured according to the standard microbiological procedures. The bacterial isolates were identified by conventional methods and the antibiotic susceptibility profiles were determined by the standard disc diffusion method according to CLSI guidelines. RESULTS The overall percentage of positive cultures from both hospitals was 45.8%, where Nasser burn unit revealed higher positive cultures than Al-Shifa burn unit. Pseudomonas aeruginosa was the most common pathogen isolated (50%) followed by Enterobacter cloacae (28.3%). Meanwhile, fingers and nasal samples that collected from HCWs showed 78.6% and 32.3% positive cultures respectively, where P. aeruginosa was the highest pathogen isolated (32.3%), followed by Coagulase Negative Staphylococci (CoNS) (29%). Environmental samples also showed higher isolation rate of Pseudomonas and CoNS. Pseudomonas isolates from patients samples were found to be resistant to most of antimicrobials used except for piperacillin-tazobactam. The family Enterobacteriaceae isolated from patients and environmental samples were resistant to most of the tested antimicrobials. However, the Enterobacteriaceae isolates from HCWs samples were sensitive to the most of the tested antimicrobials. The incidence of methicillin-resistant Staphylococci according to oxacillin sensitivity test was 60% in patient's samples, 77.8% in HCWs samples and 90% in environmental samples. CONCLUSION High percentage of resistance was found among clinical isolates in general to the commonly used antibiotics with a notable increase in MRSA incidence among both patients and environmental samples as well as HCWs.
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Affiliation(s)
- Abdelraouf A Elmanama
- Medical Laboratory Science Department, Islamic University-Gaza, P.O. Box 108, Gaza Strip, PNA.
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Bayram Y, Parlak M, Aypak C, Bayram I. Three-year review of bacteriological profile and antibiogram of burn wound isolates in Van, Turkey. Int J Med Sci 2013; 10:19-23. [PMID: 23289001 PMCID: PMC3534873 DOI: 10.7150/ijms.4723] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 11/26/2012] [Indexed: 12/21/2022] Open
Abstract
The risk of infection in burns is well-known. In recent decades, the antimicrobial resistance of bacteria isolated from burn patients has increased. For this reason, a retrospective study was conducted at Van Training and Research Hospital to analyze the bacterial isolates from the wounds of patients admitted to the Burn Unit and to determine the susceptibility patterns of the commonly cultured organisms over a 3-year period, January 2009 to December 2011.A total of 250 microorganisms were isolated from burn wounds of 179 patients. Our results revealed that the most frequent isolate was Acinetobacter baumannii (23.6%), Pseudomonas aeruginosa (12%), Staphylococcus aureus (11.2%), Escherichia coli (10%) respectively. Multidrug-resistance has emerged as an important concern in our burn unit. Tigecycline, and colistin were found to be the most active drugs against Acinetobacter baumannii. Carbapenems and amikacin, were found to be the most active drugs against other gram negative bacteria. Vancomycin and linezolid were active against gram positive bacteria.Aggressive infection control measures should be applied to limit the emergence and spread of multidrug-resistant pathogens.
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Affiliation(s)
- Yasemin Bayram
- Microbiology Laboratory, Van Training And Research Hospital, Van, Turkey
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Risk factors for nosocomial infection and mortality in burn patients: 10 years of experience at a university hospital. J Burn Care Res 2012; 33:379-85. [PMID: 22079911 DOI: 10.1097/bcr.0b013e318234966c] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To evaluate the risk factors for nosocomial infection (NI) and mortality in a university hospital, 10-year data of burn patients were assessed retrospectively. The study was conducted at Erciyes University's Burn Center during 2000 and 2009. The records of 1190 patients were obtained. Overall, 131 (11%) patients had 206 NIs with an incidence density of 14.7 infections/1000 patient days. Burn wound infection (n = 109, 53%) was the most common NI. High (%TBSA burned) and late excision were found to be the most significant risk factors for the development of NI. Pseudomonas aeruginosa was the most frequent causative microorganism. However, the prevalence of multidrug-resistant Acinetobacter baumannii has increased in recent years with a prevalence of 47% in 2009. The carbapenem resistance of P. aeruginosa has decreased in recent years, whereas that of A. baumannii increased and it had a prevalence of 94% in the last year. Conversely, the most important risk factors for mortality were advanced age, high %TBSA and having an underlying disease. Prevention of NI is an important issue in burn units to reduce mortality rates. Early excision and wound closure are important therapeutic approaches for the prevention of burn wound infection.
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Gawryszewski VP, Bernal RTI, Silva NND, Morais Neto OLD, Silva MMAD, Mascarenhas MDM, Sá NNBD, Monteiro RA, Malta DC. Atendimentos decorrentes de queimaduras em serviços públicos de emergência no Brasil, 2009. CAD SAUDE PUBLICA 2012; 28:629-40. [DOI: 10.1590/s0102-311x2012000400003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 12/13/2011] [Indexed: 11/22/2022] Open
Abstract
O objetivo foi analisar os atendimentos por queimaduras em serviços de emergência, e fatores associados. Estudo transversal de 761 atendimentos coletados pelo Sistema de Vigilância de Violências e Acidentes em 2009. A maioria foi do sexo masculino (58,6%); adultos de 30 a 49 anos (23,1%) e crianças de 0 a 9 anos (23%). A residência foi o local de ocorrência mais frequente (62,1%), especialmente para crianças e mulheres; em seguida comércio, serviços, indústria e construção (19,1%), especialmente entre homens de 20 a 49 anos. Queimaduras no trabalho foram 29,1% do total. Uso de álcool chegou a 5,1%. Agentes causadores em todas as idades: substância quente (43,6%) e fogo/chama (24,2%); na faixa produtiva: substâncias químicas. As queimaduras entre 0 e 14 anos foram associadas com residência, substância e objeto quente e internação hospitalar; entre os de 15 a 49 anos associaram-se com fogo/chama e choque elétrico, via pública e alta da emergência. Estratégias de prevenção para crianças e trabalhadores devem ser implantadas.
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Fadeyibi IO, Raji MA, Ibrahim NA, Ugburo AO, Ademiluyi S. Bacteriology of infected burn wounds in the burn wards of a teaching hospital in Southwest Nigeria. Burns 2012; 39:168-73. [PMID: 22386976 DOI: 10.1016/j.burns.2012.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 01/24/2012] [Accepted: 02/04/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Burns are characterized by the loss of varying proportions of the protective layers of the skin, depression of immune responses, and increased wound susceptibility to infection. Wound infection is a major cause of morbidity and mortality in burn cases. This study characterizes those factors that predispose burn wounds to infection and the bacteriology of the microorganisms in our environment. PATIENTS AND METHODS Prospective study of burns patients that were admitted and treated at the Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria between January 1 and May 31, 2010 was carried out. Information about the demographics, aetiology/mechanism of burns, interval between the time of injury and admission, microbial studies, and antibiotic therapy were collected and analyzed. RESULTS A total of 74 patients consisting of 43 males and 31 females were seen. The ages range between one week and 95 ± 22.42 years. Wound infections were confirmed in 28 patients (infection rate of 37.84 per 100 patients). Delayed presentation at LASUTH and length of hospital stay were significantly related to the development of wound infection. Pseudomonas aeruginosa and Proteus mirabilis were the most common infective organisms occurring in 53.6 and 10.7 percentages respectively. The isolated organisms were resistant to the beta-lactam antibiotics and mostly sensitive to carbapenem and aztreonam preparations. CONCLUSION Factors predisposing to invasive wound infections in our environment were highlighted and suggestions made on methods that could reduce the infections and thus reduce morbidity and mortality in burns.
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Affiliation(s)
- Idowu Olusegun Fadeyibi
- Burns and Plastic Surgery Unit, Department of Surgery, College of Medicine, Lagos State University (LASUCOM)/Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria.
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Macedo JLSD, Rosa SC, Silva MGE. Queimaduras autoinfligidas: tentativa de suicídio. Rev Col Bras Cir 2011; 38:387-91. [DOI: 10.1590/s0100-69912011000600004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 05/13/2011] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar a incidência, características, conduta e taxa de mortalidade de pacientes com autolesão por queimaduras internados no Centro de Queimaduras de Brasília, Distrito Federal, Brasil. MÉTODOS: Os pacientes do estudo consistiram das vítimas de queimaduras consecutivamente internadas na Unidade de Queimados do Hospital Regional da Asa Norte, Brasília, Distrito Federal, Brasil, durante o período de fevereiro de 2008 e fevereiro de 2009. Os dados foram obtidos na admissão e foram registrados prospectivamente durante a internação. Os pacientes foram seguidos até a alta ou o óbito. RESULTADOS: No período do estudo, foram admitidos 15 casos de autolesão por queimaduras na Unidade de Queimados. A média de idade foi 38,0 ± 20,6 anos; 66,7% dos casos de autolesão por queimadura eram mulheres. Na maioria dos casos eram casadas, provedoras do lar, e pobres. O maior motivo foi conflito conjugal. A taxa de mortalidade foi 40%. A área média de superfície corporal queimada foi 38,7 ± 26,1%. O álcool foi usado por 66,7% dos pacientes como causa das queimaduras. A média de duração do tratamento foi 20,1 ± 14,8 dias. Pacientes com autoinjúria por queimadura apresentaram lesões mais extensas, permaneceram mais tempo no hospital e pior prognóstico. CONCLUSÃO: Pacientes com autolesão por queimaduras apresentaram média de idade mais elevada, maior superfície corporal queimada, maior período de internação, mais complicações infecciosas e maior taxa de letalidade do que os pacientes com queimaduras acidentais. Esses pacientes precisam de constante suporte psiquiátrico, o qual pode ser útil na prevenção de futuros episódios de autoagressão.
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Singh M, Singh S, Nath V, Sahu V, Rawat AKS. Antibacterial activity of some bryophytes used traditionally for the treatment of burn infections. PHARMACEUTICAL BIOLOGY 2011; 49:526-30. [PMID: 21391844 DOI: 10.3109/13880209.2010.523007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
CONTEXT Plagiochasma appendiculatum L. & L. (Aytoniaceae), Conocephalum conicum (L.) Necker (Conocephalaceae), Bryum argenteum Hedw. (Bryaceae), and Mnium marginatum (With.) P. Beauv. (Mniaceae) are bryophytes (liverworts and mosses) used by traditional healers for the treatment of burn, cuts, wounds, and skin disorders. OBJECTIVE This study evaluated the antibacterial activity of four bryophytes against some common bacteria responsible for burn infections. MATERIALS AND METHODS Different fractions of bryophytes were screened using the disc diffusion (qualitative) and broth microdilution (quantitative) methods, according to the guidelines of the National Committee for Clinical and Laboratory Standards. RESULTS AND DISCUSSION Chloroform fractions of liverworts were more active against Gram negative strains while butanol fractions of mosses had significant activity against Gram positive bacteria. Staphylococcus aureus was the most sensitive strain of those tested with the butanol fraction of M. marginatum (moss), with the strongest inhibition zone of 102.92% and minimum inhibitory concentration of 30 μg mL(-1). CONCLUSION Our findings support the use of the bryophytes in traditional medicine for burn infections because of their significant antibacterial activity.
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Affiliation(s)
- Meenakshi Singh
- Pharmacognosy and Ethnopharmacology Division, National Botanical Research Institute, Lucknow, India
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Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011; 377:228-41. [PMID: 21146207 DOI: 10.1016/s0140-6736(10)61458-4] [Citation(s) in RCA: 1267] [Impact Index Per Article: 97.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Health-care-associated infection is the most frequent result of unsafe patient care worldwide, but few data are available from the developing world. We aimed to assess the epidemiology of endemic health-care-associated infection in developing countries. METHODS We searched electronic databases and reference lists of relevant papers for articles published 1995-2008. Studies containing full or partial data from developing countries related to infection prevalence or incidence-including overall health-care-associated infection and major infection sites, and their microbiological cause-were selected. We classified studies as low-quality or high-quality according to predefined criteria. Data were pooled for analysis. FINDINGS Of 271 selected articles, 220 were included in the final analysis. Limited data were retrieved from some regions and many countries were not represented. 118 (54%) studies were low quality. In general, infection frequencies reported in high-quality studies were greater than those from low-quality studies. Prevalence of health-care-associated infection (pooled prevalence in high-quality studies, 15·5 per 100 patients [95% CI 12·6-18·9]) was much higher than proportions reported from Europe and the USA. Pooled overall health-care-associated infection density in adult intensive-care units was 47·9 per 1000 patient-days (95% CI 36·7-59·1), at least three times as high as densities reported from the USA. Surgical-site infection was the leading infection in hospitals (pooled cumulative incidence 5·6 per 100 surgical procedures), strikingly higher than proportions recorded in developed countries. Gram-negative bacilli represented the most common nosocomial isolates. Apart from meticillin resistance, noted in 158 of 290 (54%) Staphylococcus aureus isolates (in eight studies), very few articles reported antimicrobial resistance. INTERPRETATION The burden of health-care-associated infection in developing countries is high. Our findings indicate a need to improve surveillance and infection-control practices. FUNDING World Health Organization.
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Ryssel H, Gazyakan E, Germann G, Hellmich S, Riedel K, Reichenberger MA, Radu CA. Antiseptic therapy with a polylacticacid-acetic acid matrix in burns. Wound Repair Regen 2010; 18:439-44. [PMID: 20731796 DOI: 10.1111/j.1524-475x.2010.00610.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Bacterial colonization and infection are still the major causes of delayed healing and graft rejection following burns and they are furthermore the basis for second and third hit sepsis. Topical treatment is necessary to reduce the incidence of burn wound infection. Silver sulphadiazine (SD-Ag) is a frequently used microbicidal agent. However, this treatment causes adverse reactions and side-effects. Additionally, in recent years multiresistant bacteria, which have not been treated sufficiently, are on the rise. On the basis of experimental data and clinical application of a polylacticacid-acetic acid matrix, we performed this study to establish the effectiveness of the antiseptic therapy with the topical application of a polylacticacid-acetic acid matrix to provide an alternative method for burn treatment, using SD-Ag as a reference. Twenty patients with IIb° or III° burns from the Plastic Surgery and Burns Unit were treated within a matched pair comparative setting. One burned area was treated with SD-Ag, the other corresponding area with the polylacticacid-acetic acid matrix. All patients underwent a necrectomy 4-5 days after the trauma. The excised burned skin was sent to our microbiological laboratory to determine the different bacteria per gram in this tissue. Despite the number of 20 patients, statistical significance was not achieved, there were tendencies to a better antiseptic effectiveness of the polylacticacid-acetic acid matrix. These results suggest that the polylacticacid-acetic acid matrix should be studied in greater depth and could be used as a valid alternative for the topical treatment of burns, as it is equivalent or even more effective than SD-Ag.
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Affiliation(s)
- Henning Ryssel
- Department of Hand, Plastic and Reconstructive Surgery-Burn Center-BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.
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Ciofi-Silva CL, Rossi LA, Dantas RS, Costa CS, Echevarria-Guanilo ME, Echevarria-Guanilo ME, Ciol MA. The life impact of burns: the perspective from burn persons in Brazil during their rehabilitation phase. Disabil Rehabil 2010; 32:431-7. [DOI: 10.3109/09638280802532555] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Contribution of bacterial and viral infections to attributable mortality in patients with severe burns: an autopsy series. Burns 2010; 36:773-9. [PMID: 20074860 DOI: 10.1016/j.burns.2009.11.007] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 10/02/2009] [Accepted: 11/11/2009] [Indexed: 11/20/2022]
Abstract
Bacterial infections are a common cause of mortality in burn patients and viral infections, notably herpes simplex virus (HSV) and cytomegalovirus (CMV) have also been associated with mortality. This study is a retrospective review of all autopsy reports from patients with severe thermal burns treated at the US Army Institute of Research (USAISR) burn unit over 12 years. The review focused on those patients with death attributed to a bacterial or viral cause by autopsy report. Of 3751 admissions, 228 patients died with 97 undergoing autopsy. Death was attributed to bacteria for 27 patients and to virus for 5 patients. Bacterial pathogens associated with mortality included Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus. This association with mortality was independent of % total body surface area burn, % full-thickness burn, inhalation injury, and day of death post-burn. Bloodstream infection was the most common cause of bacteria related death (50%), followed by pneumonia (44%) and wound infection (6%). Time to death following burn was < or =7 days in 30%, < or =14 days in 59% and < or =21 days in 67%. All of the viral infections associated with mortality involved the lower respiratory tract, HSV for 4 and CMV for 1. Four of these 5 patients had evidence of inhalation injury by bronchoscopy, all had facial and neck burns, and 2 had concomitant Staphylococcus pneumonia. Time to death following burn ranged from 14 to 42 days for the 5 patients. Despite advances in care, gram negative bacterial infections and infection with S. aureus remain the most common cause of bacteria related mortality early in the hospital course. Viral infections are also associated with mortality and numbers have remained stable when compared to data from prior years.
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Toscano Olivo TE, de Melo EC, Rocha C, Fortaleza CMC. Risk factors for acquisition of Methicillin-resistant Staphylococcus aureus among patients from a burn unit in Brazil. Burns 2009; 35:1104-11. [DOI: 10.1016/j.burns.2009.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 01/29/2009] [Accepted: 02/17/2009] [Indexed: 10/20/2022]
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Abstract
Bacterial colonisation and infection remain the major causes of delayed healing and graft rejection following burns. Topical treatment is necessary to reduce the incidence of burn wound infection. Silver sulphadiazine (SD-Ag) is an often used microbicidal agent. However, this treatment produces adverse reactions and side-effects. On the basis of experimental data and clinical application of lactobacilli as probiotics, we performed this exploratory study to establish the effectiveness of bacteriotherapy with topical application of the innocuous bacteria Lactobacillus plantarum cultured in De Man, Rogosa and Sharpe medium to provide an alternative method for burn treatment using SD-Ag as a reference. These innocuous bacteria would compete with other bacteria that are wound pathogens and would modify the wound environment and promote tissue repair. Eighty burned patients from the Plastic Surgery and Burns Unit were grouped into infected (delayed) second- and third-degree and non infected (early) third-degree burns and treated with L. plantarum or SD-Ag. The proportion of patients with delayed second-degree burns was 0.71 for L. plantarum and 0.73 for SD-Ag (relative rate: -2.72%) with respect to the decrease in bacterial load (<10(5) bacteria/g of tissue), promotion of granulating tissue wound bed and healing. In early third-degree burns, the values were 0.75 for L. plantarum and 0.84 for SD-Ag (relative rate: -1.07%) in preventing wound infection and promotion of granulation tissue, 0.90 in graft taking for both treatments (relative rate: 0%) and 0.75 for L. plantarum and 0.77 for SD-Ag (relative rate: -2.60%) in healing. In delayed third-degree burns, values were 0.83 for L. plantarum and 0.71 for SD-Ag (relative rate: +16.90%) with respect to the decrease in the bacterial load (<10(5) bacteria/g of tissue) and providing a granulating tissue wound bed, 0.90 in graft taking for both treatments (relative rate: 0%) and 0.75 for L. plantarum and 0.64 for SD-Ag (relative rate: + 17.19%) in healing. Although the number of patients (between 12 and 15 per group) did not enable the application of a power statistical test, these results suggest that the L. plantarum treatment should be studied in greater depth and could be used as a valid alternative for the topical treatment of burns.
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Affiliation(s)
- Maria C Peral
- Cátedra de Biología, Departamento Biomédico, Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
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Silva JLD, Hirata RDC, Hirata MH. Bacteriophage: laboratorial diagnosis and phage therapy. BRAZILIAN JOURNAL OF MICROBIOLOGY : [PUBLICATION OF THE BRAZILIAN SOCIETY FOR MICROBIOLOGY] 2009; 40:547-9. [PMID: 24031398 PMCID: PMC3768525 DOI: 10.1590/s1517-838220090003000017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Revised: 09/24/2008] [Accepted: 05/03/2009] [Indexed: 11/26/2022]
Abstract
Bacteriophages have been researched as a new alternative to antibiotics. These viruses inject their genetic material into bacteria and use their host machinery to multiply themselves. The research of bacteriophages in Brazil will certainly provide low-cost treatment of multidrug resistant bacteria, new microbiological diagnosis and advantages for the Brazilian food industry.
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Affiliation(s)
- Joas L Da Silva
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo , São Paulo, SP , Brasil
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Macedo JLSD, Santos JB. Predictive factors of mortality in burn patients. Rev Inst Med Trop Sao Paulo 2007; 49:365-70. [DOI: 10.1590/s0036-46652007000600006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 07/03/2007] [Indexed: 11/21/2022] Open
Abstract
Burn mortality statistics may be misleading unless they account properly for the many factors that can influence outcome. Such estimates are useful for patients and others making medical and financial decisions concerning their care. This study aimed to define the clinical, microbiological and laboratorial predictors of mortality with a view to focus on better burn care. Data were collected using independent variables, which were analyzed sequentially and cumulatively, employing univariate statistics and a pooled, cross-sectional, multivariate logistic regression to establish which variables better predict the probability of mortality. Survivors and non-survivors among burn patients were compared to define the predictive factors of mortality. Mortality rate was 5.0%. Higher age, larger burn area, presence of fungi in the wound, shorter length of stay and the presence of multi-resistant bacteria in the wound significantly predicted increased mortality. The authors conclude that those patients who are most apt to die are those with age > 50 years, with limited skin donor sites and those with multi-resistant bacteria and fungi in the wound.
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