Microbiological Studies of Four Patients Extensively Burned by the Pyroclastic Flow of Mt. Fugen in Unzen, Japan

Abstract

Serial microbiological tests were performed on 4 patients burned by the pyroclastic flow of Mt. Fugen in Unzen, Japan on June 3, 1991. The patients were young (average age, 30 years) and had extensive burns (average total burn surface area, 83%) and inhalation injury. All 4 patients died of multiple organ failure and septicemia. Methicillin-resistantStaphylococcus aureus (MRSA) andPseudomonas aeruginosa were persistently isolated from bronchial aspirates, burn wounds and the blood until death. There were no differences in isolates among the 3 specimen sites.S. aureus isolated from all patients became resistant to all antibiotics used, and the use of imipenem/cilastatin sodium, and ceftazidime transformedP. aeruginosa to a resistant strain within a short period of time. On the other hand, the sensitivity to gentamicin varied from one patient to another. From a study of the phenotypic character ofS. aureus strains, there was a suggestion of nosocomial infection in 2 patients. Our results demonstrate that extensive burns are usually associated with bacteremia and septicemia. In spite of prudent management with antibiotics, the control of resistant bacteria is difficult. We stress the need for the development of specific therapy for severe infections in burn patients, encompassing immunotherapy, antibiotic treatment, and wound treatment.