Recent studies in the control of burn infection

Abstract

I N T R O D U C T I O N FOR many years clinicians and microbiologists neglected the role of infection as a cause of illness and death in patients with burns. There were obvious reasons for this neglect. The pathology of burn injury is complex, with infection superimposed upon and, to a large extent, obscured by other pathological effects of the injury. Burn wounds, especially those of minor extent, were often found to suffer no obvious ill effects from heavy bacterial colonization, and before effective methods for controlling fluid loss were introduced patients with extensive burns often died in the first days from hypovolaemic shock. Another reason for the neglect of infection was the apparently insuperable difficulty both of prevention and of treatment. Systematic studies Of burn bacteria were not made until the mid 1920s, and even when such studies were made their clinical relevance was not widely appreciated. The tide changed in the late 1940s and 1950s. Antibiotics provided highly effective methods for treatment and prophylaxis against Streptococcus pyogenes, which had hitherto been the most obvious of the pathogens of burn wounds, causing the complete failure of skin grafts and, in some patients, invasive infection. In the same period Pseudomonas aeruginosa came to be recognized as a major clinical hazard of severely burned patient~; frith poor antimicrobial resistance, and One against which the antibiotics--even the one (polymyxin) which was always active h~ vitro against Ps. aeruginosa--had little therapeutic or prophylactic value. Infection was widely reported to be a major cause of illness and death in the severely burned, and Ps. aerughmsa, though