Sepsis in Burn Patients

Ghassan Hassan

doi:10.33899/rjs.2019.163292

Abstract

One hundred blood samples and burn swabs from septicemic burn patients were collected over a period from July 2017 until may 2018 at Burn Center in Baghdad Teaching Hospital. The age of patients was between one year to sixty years and they were suffering from burn wound sepsis ,the highest number of patients was female among age group 20-29 years old. The highest frequent cause of burn was flame 78% and the least was chemical 1%, it was found that flame burn patients were more vulnerable to sepsis. The mortality rate among male 56%, females 48% and the highest mortality rate was 100% in the age group less than one year and more than sixty years, the least rate of mortality was 27% in the age group 10-19 years old. The number of septicemic patients 36 who is total body surface area (BSA) burned 30-39% and the mortality in this group was 16.6%, however the least number of patients was two of BSA 90-99% with mortality rate 100%. The most frequent aetiological agents isolated from the blood of septicemic burn patients was staphylococcus aureus 34(28.1) followed by Pseudomonas aeruginosa 25(20.7), Klebsiella pneumonia 13(10.8), Streptococcal pyogenes 10(8.3), Escherichia coli 8(6.6%) and Serratia marcescense, Acinnetobacter calcoceticus were 5(4.1) equally. The incidence of gram negative bacteria was much higher than gram positive bacteria in the septicemic burn cases, most of septicemic attack occur during the first week of admission and especially on the 7th day of staying in hospital and above, and they were much more likely to result from gram positive organism e.g S.aureus and S.pyogene. After the 1st week the septicemic attack was much more likely to result from gram negative organisms e.g. P.aeruginosa K.pneumonia, E.coli, Serratia mercescense, Acintobacter calcoceticus, P vulgaris and P. rettger.

Highlights

The Burn wound sepsis is probably the most serious complication in burns
Invasive sepsis and septicemia are rare during the first week post burn but if they do occur they are much more likely to result from gram positive organisms such as Streptococcus pyogenes or Staphylococcus aureus than from gram negative organisms such as Pseudomonas aeruginosa
The patients include those with infected burn wound who were suffering from septicemia as a complication of burn wound infection

Summary

Introduction

Invasive sepsis occur when pathogenic organism in the burn wound multiply sufficiently to overcome the body natural defense mechanism and actively invade the living tissues adjacent to the burn wound. If this advance remains unchecked, septicemia, active grow of organism in the blood, is a highly probable sequel (Muir et al, 2010). As invasion and septicemia occur, they are associated with conversion of area of partial thickness burn to area of full thickness burn to lysis and degeneration of granulation tissue with formation of a neoeschar (Pruitt, 2012) This due to damage to the tenuous blood supply caused by vascular invasion and occlusion (Cruickshank et al, 2013). Increase risk of septicemia is associated with burn over 30% body surface area (BSA), full thickness skin destruction, infancy and old age, diabetes, cardiopulmonary disease, inhalation injury, obesity and malnutrition, poor blood supply to the wound and moist warm wound environment (Gang et al, 2000; Muir et al, 2010)

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