Medical Investigation and Clinical Changes in the Early Phases of Post Burn Adult Inpatients as Indicators for Prompt Infection Diagnosis, in the Hospital for Burn and Plastic Surgery, Sulaimanyah, Iraq

Abstract

Background: Burn injury is one of the leading causes of morbidity and mortality worldwide. Burn related hospital acquired infections is one of the major problems in the management of these injuries. Aim of the study: To elaborate on the early laboratory and microbial culture changes in adult burn inpatients, and to make use of subtle changes in the laboratory investigations, to predict and detect infections in burn victims, in its early phases. Patients and Methods: A Clinical observational study included a random sample of one hundred adult burn inpatients from Sulaymaniyah Burn Hospital, admitted from April 2019 to January 2021, retrospectively and prospectively followed up during the course of the study. Results: thirty one (31%) patients were male and 69% were female, all patients were adults and aged ≥18 years. 51 % of them had mix II-III degree burns, while 38% second and 11% third degree burns. Hematocrit decreased, total WBC count increased while platelet in most of the patients was normal. Blood urea was increased, Serum creatinine levels were normal in most of the patient in first three weeks of their admission. Eleven patients (11%) died. Whereas 36% of the patients who died had Total Body Surface Area burn of more than 60%, while 72% of them had II and III degree burns. Also 90% of the patients had infections, majority of the isolate results were Gram-negative bacteria (66.8%), and (33.2%) were Gram-positive. Pseudomonas aeruginosa (32.5%) was the most common gram negative. The Staphylococcus aureus (33.2%) was the gram positive organism recovered. While 66.6% of patients had fever during the first week, 55.5% of patients had fever in second week. Most of the patients, who had fever, were infected with S.aureus and Pseudomonas aeruginosa throughout the second week post burn. Conclusion and recommendations; Many laboratories and microbial parameter changes occur in the early phases of post burning, of which Leukocytosis can be a good predictor for infection in burns, especially when it happens in the second week and beyond. Yet it cannot distinguish gram negative from gram positive bacterial infections. To detect any change in the back ground laboratory parameters, as soon as they happen, infections in burns can be detected or suspected