Burn Wound Sepsis Research Articles

Fighting A New Front On An Old Battlefield: Examining the Development of Topical Antimicrobial Care to Control Burn Wound Sepsis.

Recognition of invasive burn wound sepsis as a major cause of morbidity and mortality in burn injured patients has profoundly changed the management of burn wounds and its associated complications. The development of effective topical antimicrobial therapy is one of the last major developments of modern burn care and has been driven by major world events and scientific breakthroughs. Topical antimicrobial burn care has evolved from the use of anecdotal remedies to scientific breakthroughs such as Moyer's successful dilution of silver nitrate solution, Fox's described benefit of silver sulfadiazine use in animal models, and Pruitt's dramatic improvement in post-burn mortality using topical mafenide acetate in burn wounds. The objective of this manuscript is to review the definition of burn wound sepsis and highlight the major developments and breakthroughs in topical burn wound care throughout history. This includes historical events like major wars or domestic fires that have influenced or impacted the understanding and treatment of burn wounds. Newer advances in topical antimicrobial care such as nanosilvers and dressing technologies that improve the morbidity and mortality associated with burn wound sepsis and novel approaches to management will also be discussed. To improve burn care, it is prudent to look to the past and learn from the experiences of those who contributed to the control of burn wound sepsis.

Development of an enzyme-linked phage receptor-binding protein assay (ELPRA) based on a novel biorecognition molecule- receptor-binding protein Gp130 of Pseudomonas aeruginosa bacteriophage Henu5

Pseudomonas aeruginosa is a Gram-negative bacterium associated with life-threatening healthcare-associated infections (HAIs), including burn wound infections, pneumonia and sepsis. Moreover, P. aeruginosa has been considered a pathogen of global concern due to its rising antibiotic resistance. Efficient identification of P. aeruginosa would significantly benefit the containment of bacterial infections, prevent pathogen transmission, and provide orientated treatment options. The accuracy and specificity of bacterial detection are primarily dictated by the biorecognition molecules employed. Lytic bacteriophages (or phages) could specifically attach to and lyse host bacterial cells. Phages’ host specificity is typically determined by their receptor-binding proteins (RBPs), which recognize and adsorb phages to particular bacterial host receptors. This makes RBPs promising biorecognition molecules in bacterial detection. This study identified a novel RBP (Gp130) from the P. aeruginosa phage Henu5. A modified enzyme-linked phage receptor-binding protein assay (ELPRA) was developed for P. aeruginosa detection employing Gp130 as biorecognition molecules. Optimized conditions provided a calibration curve for P. aeruginosa with a range from 1.0 × 103 to 1.0 × 107 CFU/mL, with a limit of detection as low as 10 CFU/mL in phosphate-buffered saline (PBS). With VITEKⓇ 2 Compact system identification (40 positives and 21 negatives) as the gold standard, the sensitivity of ELPRA was 0.950 (0.818–0.991), and the specificity was 0.905 (0.682–0.983) within a 95 %confidence interval. Moreover, the recovery test in spiked mouse serum showed recovery rates ranging from 82.79 %to 98.17%, demonstrating the prospect of the proposed ELPRA for detecting P. aeruginosa in biological samples.

Epidemiological and bacteriological profile of sepsis in burns patients: A report from tertiary care hospital, India

Background: Burns are one of the most prevalent and mortifying forms of trauma. Patients burn with significant thermal injury require immediate intensive care unit (ICU) care to minimize morbidity and mortality. Burns patients are generally more predisposed to sepsis because of two main reasons, i.e., burn wound infection and catheter-related bloodstream infection (CRBSI). Due to extensive skin barrier disruption and an alteration in the cellular and humoral immune responses burn wounds has a much higher incidence of sepsis as compared to other forms of trauma. Aims and Objectives: The present study was undertaken to study the bacteriological profile and sources of sepsis in burns patients and their antimicrobial susceptibility pattern. Materials and Methods: It is a prospective observational study conducted in the Department of Burns, Plastic and Maxillofacial Surgery, ICU and Department of Microbiology of a tertiary care hospital, Uttar Pradesh, India, between January 2020 and June 2022. Adult patients with 30–70% of total body surface area burns with central venous catheter (CVC) inserted during ICU admission were enrolled in the study. The presence of clinical sepsis in the burn patients was evaluated using the American Burn Association Sepsis criteria. For all patients with suspected clinical sepsis, paired blood cultures were collected simultaneously; one from the CVC and another from a peripheral site and were sent for bacteriological culture. Blood culture samples were processed as per standard procedures. CRBSI was defined if the same organism was isolated in paired blood cultures. Burn wound biopsy was sent for quantitative culture and 105 organisms/g of tissue were considered significant. Results: In the present study, the overall incidence of clinical sepsis was 28.4% (39/137), out of which 48.7% of cases were found to be due to CRBSI and the most common organism involved was Klebsiella spp. (42.1%), 33.3% of cases were due to burn wound sepsis and the most common organism involved was Pseudomonas spp. (61.5%); and 18.0% of cases were those in which no known source could be found. Possible explanations for these cases could be sepsis without bacteremia due to endotoxins and Gram-negative endotoxemia. Conclusion: To find out microorganisms causing burn wound infection by culture and provide suitable antibiotics according to their antibiotic sensitivity patterns helping us in managing these infection and decreasing overall morbidity and mortality in burn patients.

USEFULNESS OF PROCALCITONIN AS A BIOMARKER IN BURN PATIENTS PLASTIC SURGERYDEPARTMENT, MOHAMMED VI UNIVERSITYHOSPITAL, MARRAKECH, MOROCCO

Infection is the most common complication and cause of death in patients suffering burnsinjuries.These patients are susceptible to infection and burn wound sepsis secondary to the alterations in their physiology .Procalcitonin is an inflammatory biomarkers , the serum concentration of which increases specifically during bacterial infections. For a burn patient, its sometimes difficult to differentiate, on the basis of the clinical examination , those who suffer from an acute inflammatory syndrome from those who show the first signs of a severe bacterial infection. However, a correct diagnosis is essential for the prompt initiation of appropriate treatment . Many markers associated with an infectious state have recently been investigated. Among them , serum pro calcitonin has the best sensitivity and specificity for sepsis or other severe bacterial infections. The aim of this work is to evaluate the impact of the implementation of procalcitonin (PCT) on the management of infected patients in the burns resuscitation department of the plastic surgery department at CHU Med VI.Our study is retrospective , observational, and conducted over a period of 6 months, extending from July 1, 2022, to December 31, 2022, for 24burned patients hospitalized in the intensive care unit of the plastic surgery department .The average age of the patients was 38 years they were predominantly male with a sex ratio of about 1.5 . The average burned skin surface was 27.75% 40.3% had a deepening with signsof skin infection all patients CRP was high 60% had a fever higher than 38.5 13.3% had a stay in the surgical resuscitation department and were discharged a PCT returned positive in 16.6% of patientsthe determination was repeated in 4 patients after 24h returned Negatif 26.6% had a positive bacteriological examination and 40% of patients received antibiotic therapy .PCT maybe used as a useful bio marker for the early diagnosis of burn sepsis in adults, and maybe combined with other diagnostic indexes to further improve the sensitivity and specificity. Thus, even throughout study provides us with the knowledge that the PCT maybe a helpful sepsis biomarker in burned patients, the findings should be viewd with caution.

764 Comparison of Topical Silver Sulfadiazine and Triple Antibiotic Ointment in a Porcine PT Burn Model

Abstract Introduction The standard of care for partial thickness burns is topical antibiotics or occlusive dressing. Silver Sulfadiazine (SSD) emerged at a time of burn wound infection and sepsis prevalence and is now the most used topical worldwide. Despite its antimicrobial benefits, SSD has been shown to inhibit keratinocytes and there is concern that it might delay wound healing. This study compared time to complete wound closure and reepithelialization in partial thickness porcine burns treated with SSD, triple antibiotics ointment or petrolatum ointment Methods We created 21 deep partial thickness (DPT) burns per animal on the backs and flanks of 3 anesthetized domesticated pigs (30-35 kg) using an established vertical progression model (aluminum bar preheated to 80° C for 20s). In each pig, burns were randomly assigned SSD, triple antibiotic ointment, or petrolatum ointment (in a 1:1:1 ratio) applied daily for two weeks followed by twice weekly for another 2 weeks. Healing progression was measured by wound digital photography and punch biopsies to assess gross wound closure, reepithelization and scar depth respectively. Results The median (IQR) days to complete wound closure were 17 (17-21), 17 (14-21), and 21 (17-21) for wounds treated with SSD, petrolatum and triple antibiotic ointment respectively (p=0.06). The mean percentage of wound reepithelization at days 10, 14, 17, 21, and 28 for wounds treated with, SSD, petrolatum, and triple antibiotic ointment were 10%±20 vs. 8%±14 vs. 3%±12 (p=0.34), 45%±49 vs. 37%±44 vs. 48%±42 (p=0.74), 82%±38 vs. 86%±20 vs. 90%±27 (p=0.7), 74%±38 vs. 65%±50 vs. 93%±16 (p=0.049), and 92%±17 vs. 91%±28 vs. 98%±5 (p=0.4). The mean scar depth was 3.9 (1.1), 4.2 (0.9), and 3.4 (0.9) mm for wounds treated with SSD, petrolatum, and triple antibiotic ointment respectively (p=0.07). RMANOVA analysis showed significant change over time (p< 0.001) and a near significant difference between groups (p=0.054). On macroscopic analysis, appreciable pseudoeschar formation and erythematous allergic reactions were identified on wounds treated with SSD and triple antibiotic ointment respectively. Conclusions No significant differences in wound healing were found between groups in this porcine DPT burn model. SSD did not delay closure. Hypersensitivity to topical triple antibiotics was common. Applicability of Research to Practice This study provides insight into the topical ointment standard of care for burns and helps establish the standard comparator topical treatment for future preclinical and clinical studies.

Isolation and identification of Staphylococcus aureus and Pseudomonas aeruginosa bacteria from burns and wounds patients in Diyala governorate

Patients with burns and wounds are more likely to contract an infection in the hospital than other patients due to the loss of the protective barrier (skin) and immune system disorders that appear in these patients, making the affected tissues a suitable environment for the infection. Hospital infection is one of the most severe complications that affect patients and significantly increases the rates of disease and death. Burn wound infections frequently harbor the bacteria that cause nosocomial infection, pneumonia, and other systemic infections that may eventually lead to multiple organ failures and death. Burn wound infection or sepsis may be indicated by an abrupt change in the burn wound's appearance or the burn patient's clinical status. This retrospective study was conducted at the Ba'aqubah teaching hospital.in duration march -May 2022 -, Data were collected for a number of variables including the severity of burns, demographic and clinical characteristics, laboratory data, and therapeutic devices. A total of 100 specimens,50 samples from wounds, and 50 samples from burns were collected from hospitalized burn and wound patients.

Role of Early Enteral Glutamine Supplementation in Reducing Infectious Morbidity in Burn Patients: A Case-Control Study

Severe burn injury is more challenging to sustain life than a preburn status. The situation changes drastically in terms of energy demands/ expenditure and the great degree of susceptibility to infections due to the loss of amino acids. Glutamine stimulates the immune system and prevents catabolism. The bacterial translocation from the gut can be decreased by glutamine supplementation, thereby suppressing the inflammatory response. In acute burn injury, plasma and muscle glutamine depletion is observed to contribute to muscle wasting, weight loss, and infection. Patients with 20%–50% TBSA burns presenting within 24 hours of injury to the emergency department or outpatient department were included in the study. The patients were divided into two groups randomly. In group 1 (Cases), all patients were given enteral glutamine supplementation at the dose of 0.5 mg/kg/day either orally or through a nasogastric tube started within 24 hours of injury. Group 2 (Control) had all the patients in whom enteral glutamine supplementation was not given. In both groups, blood analysis for total leucocyte count (TLC) and total serum proteins (TSP) was done upon admission. On Day 4, followed by analysis every fourth day, after that, till healing occurred or the patient was taken up for grafting. Blood and wound swab cultures were done on the third day of admission, then the first week, followed by weekly cultures for 4 weeks or till healing occurred or the patient was taken up for grafting. A total of 123 patients were studied. There was a decreasing trend in the mean values of the TLC and an increasing trend in TSP in both groups. The difference became statistically significant from Day 20 onwards. The pattern of wound cultures was found to be statistically significant in Week 3 and Week 4, whereas the difference in blood culture positivity among the groups was statistically significant in Week 3. We noted, in our study, that the glutamine supplementation to the early enteral nutrition increased the TSP levels and decreased the TLC, wound, and blood culture positivity rates in the study group. Glutamine supplementation can contribute to improved immunity and reduce burn wound sepsis and bacteremia. All these combined can lead to decreased morbidity, improved wound healing, and better outcomes with lesser costs.

Silver Sulfadiazine: Action on Burn Wound Sepsis and Infections

The purpose of this systematic review and meta-review has shifted from assessing the consequences of silver sulfadiazine with most different drugs (SSD) for burn recovery and contamination prevention to different novel dressings, without or with silver. Burn units have to be able to better control sepsis. The degree to which a burn topical antibacterial agent is absorbed determines its effectiveness. Absorption of a topical antibacterial agent may be evaluated against the absorption of a test solute in isolated preparation of the stratum corneum in a cell in an in vitro model. Despite the fact that adding silver sulfadiazine (AgSu) to pure deoxyribonucleic acid (DNA) resulted in the formation of silver sulfadiazine (AgSu)the formation of AgSu-DNA complexes, no such complexes were detected in bacteria treated with AgSu. In treated bacteria, AgSu inhibited macromolecular syntheses as DNA synthesis was slightly more sensitive. A tiny amount of sulfadiazine appears to be active in this situation. Pediatric patients were randomly assigned to treatment with either Silva-Sorb® Gel or Silvadene® silver sulfadiazine cream for up to 21 days or to the point of full reepithelialization of the wound.
 Keyword: Silver, Sulfadiazine, Silvasorb, Bacteria, Burn, Wound.

Evaluation of Burn Wound Infection in a Referral Center in Colombia.

Introduction Burn wound infection (BWI) is the second most important cause of death in burn patients. There is currently limited data about the incidence and clinical presentation of BWI using quantitative techniques as quantitative biopsy culture (QBC) to prevent progress to burn wound sepsis (BWS). Methods This is a prospective cohort study of patients diagnosed with BWI, confirmed by QBC, from February 2018 to July 2019 at University Hospital of Santander (HUS). The primary outcome was to determine clinical, microbiological, and histopathological characteristics of patients diagnosed with BWI along with a positive QBC and their relationship with early diagnosis and progression to BWS. Results 525 patients were admitted to HUS Burn Center. Of those, 44/525 (8.23%) presented a clinical diagnosis of BWI (median age, 20.5 years [1–67 years]; 25/44 [56.8%] male). QBC was positive in 26/44 (59%), Staphylococcus aureus 14/44 (31.8%), and Pseudomonas aeruginosa 7/44 (15.9%) were the mainly etiological agents isolated. Bacterial resistance to antibiotics was mostly to beta-lactams in 14/44 (31.8%), corresponding to methicillin-resistant Staphylococcus aureus (MRSA). Clinical signs more related to infection were erythema in 33/44 (61.3%). As many as 10/44 (22.7%) progressed to sepsis and 2/44 (6%) died. Conclusion BWI increases hospitalization time and number of surgeries, increasing the risk of sepsis and death. The QBC allows an accurate diagnosis with lesser false-positive cases that impact antibiotic resistance and mortality. Protocols targeting this problem are needed to decrease the impact of this.

The Role of Phage Therapy in Burn Wound Infections Management: Advantages and Pitfalls.

Burn wound infections are often the source of bacteria responsible for systemic infections, including bloodstream infections and pneumonia that ultimately can result in multisystem organ failure and death. Any rapid change in the burn wound appearance or the clinical condition of the burn patient may herald burn wound infection or sepsis. The revival of phage therapy, either in single mode or in combination with conventional antibiotics may represent a valuable alternative, to treat specific bacterial infections such as burn wound infections, including those caused by multidrug-resistant organisms. This systematic review addresses the: 1) general characteristics of bacteriophages; 2) activity of bacteriophages vs conventional antibiotics; 3) activity of bacteriophages against biofilms; 4) bacteriophage administration; and 5) use of bacteriophages in burn wound infections. Although several scientific organizations/societies recognized that phage therapy could be of key value in modern wound care, specific aspects are critical for a burn surgeon and might represent pitfalls discouraging phage therapy adoption in burn wound management; in particular, the unavailability of consensual therapeutic guidelines/regulatory policies and the lack of laboratorial support that might be predictive of its efficacy. The availability of a product/formulation convenient to use, with adequate stability and shelf half-life is also a key condition.

The implementation of an infection control bundle within a Total Care Burns Unit

AimTo evaluate the impact of the implementation of a best practice infection prevention and control bundle on healthcare associated burn wound infections in a paediatric burns unit. BackgroundBurn patients are vulnerable to infection. For this patient population, infection is associated with increased morbidity and mortality, thereby representing a significant challenge for burns clinicians who care for them. MethodsAn interrupted time series was used to compare healthcare associated burn wound infections in paediatric burn patients before and after implementation of an infection prevention and control bundle. Prospective surveillance of healthcare associated burn wound infections was conducted from 2012 to 2014. Other potential healthcare associated infection rates were also reviewed over the study period, including urinary tract infections, pneumonia, upper respiratory tract infections and sepsis. An infection prevention and control bundle developed in collaboration between the paediatric burn unit and infection control clinicians was implemented in 2013 in addition to previous standard practice. ResultsDuring the study period a total of 626 patients were admitted to the paediatric burns unit. Healthcare associated burn wound infections reduced from 34 in 2012 to 0 in 2014 following the implementation of the infection prevention and control bundle. Pneumonia and sepsis also reduced to 0 in 2013 and 2014, however one upper respiratory tract infection occurred in 2013 and urinary tract infections persisted in 2013. ConclusionThe implementation of an infection prevention and control bundle was effective in reducing healthcare associated burn wound infections, pneumonia and sepsis within our paediatric burns unit. Urinary tract infections remain a challenge for future improvement.

Antibacterial Activity of Prunus Scoparia Root Methanol Extract against Most Common Burn Wound Pathogens.

Background: Burn wound infection and sepsis are serious medical conditions requiring prompt intervention. Plants are a good natural source for the development of novel, safe, and cost-effective antibacterial agents. The objective of the present study was to assess the antibacterial potential of aqueous, chloroform, and methanol extracts of the Prunus scoparia (P. scoparia) root against the most common burn wound pathogens.Methods: The present experimental study was conducted at Shiraz University of Medical Sciences (Shiraz, Iran) during 2018-2019. The antibacterial activity of the total plant extract was assayed using the broth microdilution method. Fractionation was performed using a separation funnel and solvents with different polarities. Broth microdilution and agar well diffusion assays were performed to determine the antibacterial potential of the obtained fractions. Quantitative and qualitative phytochemical analyses were performed to confirm the presence of secondary metabolites in both the total extract and the fractions.Results: Methanolic extract of P. scoparia root exhibited antibacterial activity against all tested bacterial strains, especially against Methicillin-resistant Staphylococcus aureus (MRSA) isolates. This extract, compared to the aqueous and chloroformic extracts, exhibited the presence of active antibacterial compounds. The quantitative and qualitative results of phytochemical screening showed that phenols and flavonoids were the main antibacterial compounds in the methanolic extract of the plant.Conclusion: For the first time, we demonstrated the antibacterial activity of the P. scoparia root against MRSA isolates and other common burn wound pathogens.

Burn Wound Colonization, Infection, and Sepsis.

Background: Infection is a major cause of morbidity and mortality among burn patients, and it is important to understand the progression of wound colonization to wound infection to systemic sepsis. Methods: After a review of the literature we describe the clinical characteristics of burn wound colonization, infection, and sepsis, and conclude with best practices to decrease these complications. Results: Burn wounds are initially sterile after the thermal insult but become colonized by gram-positive organisms and subsequently by gram-negative organisms. Some populations are especially susceptible to initial or subsequent colonization by drug-resistant organisms. An increase in fungal colonization has been observed because of the widespread use of topical antibiotic agents. Male gender, older age, lower extremity burn, scald burn, full-thickness burn, delay in treatment, and pre-existing diabetes place patients at increased risk of infection. These infections range from cellulitis that requires systemic antibiotic agents, to invasive burn wound infection that requires prompt treatment with antibiotic agents and excision. Fungal wound infections pose a special challenge and cause substantial morbidity. Infection that leads to systemic sepsis is difficult to define in burn patients because of the body's compensatory hypermetabolic response to the burn injury. Potential sources of sepsis include wound infections and common nosocomial infections. The American Burn Association Sepsis criteria, defined in 2007, has demonstrated poor specificity for identifying sepsis and septic shock. The best approach to decrease wound infections is prevention. Practices that have been beneficial include isolation rooms, handwashing, appropriate wound care, early excision and grafting, antibiotic stewardship, and nutritional support. Conclusions: A burn patient remains at a substantial risk of wound infection despite advances in care. A burn care provider must understand the natural progression of colonization to infection to sepsis, and the multidisciplinary approach to wound care to limit the morbidity and mortality from these infectious.

Clinical evidence based nano crystalline silver dressing rationality, efficacy and strategy in extensive burn patients survival

Extensive burns of more than 50% have high mortality and those over 90% have almost nil survival rate. All resuscitative measures fail as patient gets infected leading to burn wound sepsis causing septicemia and leading to mortality as the end clinical result. So we need clinically evidenced and rationally based burn dressing strategy to increase extensive burn patient survival. This is random retrospective selection of five patients in each two groups from second degree burn patients of more than 50 percent treated by collagen in one group and other by Nanocrystalline Silver dressings and observed for clinical evidence of patients survival keeping all resuscitative and treatment modalities as standard treatment protocol in all cases. The nano crystalline silver dressing is cost effective, rational and evidence based strategy. It is easy to use, has powerful anti bacterial effect, decreased frequency of dressing changes, shortened time of wound cleaning and painless dressing. It helps make the wound sterile for further treatment within a week. It is a great weapon in the hand of Burn Surgeon for rapid and better recovery of patients. This nano crystalline sustained release silver dressings are best suited to take care of burn wounds of more than 50%. Bacteriophages treatment is reserved for multiple drug resistant bacteria and had good recovery.

Innovations in Infection Prevention and Treatment.

Background: Patients with large, acute burn injuries are a major challenge for clinicians. The loss of skin barrier protection against micro-organisms combined with the induced immunosuppression after burn injury makes this population especially vulnerable to infection. For burn-injured patients who survive immediate management considerations and burn resuscitation after acute injury, sepsis remains the primary cause of death. The purpose of this article is to describe current strategies and innovations in burn sepsis prevention and management. Methods: This work reviews the current understanding of the systemic inflammatory response to burn injury and burn sepsis as well as current strategies in insolation and infection prevention, newer burn unit design strategies in the context of infection prevention, and novel therapies being considered in topical antimicrobial wound care management. Results: A review of burn sepsis is key to understanding current paradigms and innovation in burn management and prevention. Key management principles begin from the time of injury and persist throughout the patient's hospital course. This includes use of personal protective equipment, burn unit design considerations, and knowledge of critical care principles such as central venous catheter management strategies. Innovations on wound dressing types, forms, and use have been key to better controlling burn wound sepsis and improving wound healing. Products incorporating nanotechnology, novel anions, oxygen, and even light have been key to introducing previously unconsidered methods to fight or prevent infection. Conclusion: Understanding the pathophysiology and source identification of sepsis from burn wounds has been a key contributor in developing innovative prevention and therapeutic strategies in burn management. The emergence of drug-resistant pathogens and the difficulty of systemic antibiotic agents to reach poorly vascularized wounds have further reinforced the need to anticipate management strategies moving forward. A proactive, multidisciplinary approach is necessary to minimize the morbidity and mortality associated with infection control.

Evaluation of burn sepsis with reference to platelet count as a prognostic indicator

Background: Burn is the oldest form of injury to inflict humankind, and infection is a major challenge in the management of burn patients and is a leading cause of morbidity and mortality. The onset of standard clinical indicators of sepsis is known to be delayed and is preceded by fall in platelet count. Thus, the declining platelet count in burn patients is useful prognostic indicator Aim: The following study is undertaken to examine the value of platelet count in predicting the development of sepsis and outcome. Settings and Designs: This was a retrospective study. Materials and Methods: The present study was conducted with eighty-four patients of burn. Routine investigation was done for all the patients. Total platelet count was calculated manually in 84 cases of burn patients. Results: A consistent correlation was noticed between the total platelet count, the presence of burn wound sepsis, and the final outcome. The Platelet count decreased initially in all cases of burn wound sepsis and later on got normal in those who survived while got more decreased in non survivors. Conclusion: Thus the declining platelet count in burn patients is useful prognostic indicator.

Sepsis in Burn Patients

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.

506 A Burn Center’s Four Year Experience with a Cerium Nitrate & Silver Sulfadiazine Burn Cream

Morbidity from burn wound infection & sepsis remains high, but can be improved by early excision & grafting. However, certain situations preclude early surgery. In these cases, topical agents allow for staged excision. The combination of cerium nitrate & silver sulfadiazine (Cerium) is an inexpensive burn cream with broad antibacterial activity. It also forms an eschar over the wound that may promote reepithelialization. Methemoglobinemia (MetHba), an oft-cited side effect, is rare, but the compound is infrequently used worldwide. This is a retrospective cohort study investigating the effects of Cerium at a regional burn center. After IRB approval, patients admitted between 7/1/2014 & 7/1/2018 were screened to determine if they received Cerium. Data including demographics, burn injury & management, laboratory values & cerium application were extracted. Primary endpoints were time to surgery of Cerium-treated burns, reepithlialization & incidence of MetHba & its treatment. Of the 142 patients meeting inclusion criteria, the mean age was 56.3 & the majority were black (46%) males (67%). The most common etiologies were flame (43%), contact (25%) & scald (18%). Smoking was prevalent (28.5%). Mean TBSA was 9.9% with mean adjusted Baux score of 67.9 & APACHE II score of 10.8. 64.3% were admitted to the ICU & 10.7% had inhalation injury. Time to Cerium application was 1.67 days with 15.5 total doses received. Total TBSA treated with Cerium was 6.1% (4.5% full thickness, 1.6% partial thickness). Time to any surgery was 2.6 days whereas the time to surgery for areas treated with Cerium was 4.8 days. 10.7% of patients had treated wounds smaller than presentation at time of surgery. The mean pre-Cerium methemoglobin (MetHb) value was 1.2, while checks 12-36 h & 48-72 h post first application were 1.2 & 1.4, respectively. 9.8% developed MetHba levels >2.5%. All patients except 1 were asymptomatic. The symptomatic patient became hypoxic with MetHb of 9.4%, required reintubation, & was treated with Methylene Blue. At our center, Cerium is a well-tolerated medication with a minimal side-effect profile. Only one patient (0.7%) developed clinically significant MetHba requiring intervention. Reintubation in this patient was multifactorial as he had been extubated the same day & required frequent suctioning for copious, thick secretions, in addition to MetHba. Previous reports have described patients tolerating MetHb levels up to 31.8% without intubation. It can successfully be used to temporize burn wound excision & grafting, with our data supporting reepithelialization. Future work will study Cerium prospectively. Cerium cream is a topical dressing with few side effects which allows delayed burn excision & may improve tissue salvage.

The study of wound surface thinning combined with acellular dermal matrix transplantation for severe burn wound sepsis

The study of wound surface thinning combined with acellular dermal matrix transplantation for severe burn wound sepsis

Candida tropicalis burn wound sepsis: A series of histopathology-confirmed cases

Fungal infection in severely burned patients is a serious problem due to various factors, such as the extensive application of antibiotics. In this study, we report on the course of severely burned patients with Candida tropicalis burn wound sepsis. Five such cases were reviewed. The patients were treated with itraconazole intravenously and simultaneous antibiotics to prevent bacterial infections. In addition, dermabrasion was used to excise the eschar and the wound surface was covered immediately with dermatoplasty. Meanwhile, the skin necrosis related to the fungal infection was removed. The wound surfaces of all five patients were healed well and the parameters of laboratory examination went back to normal. We assume that prompt diagnosis and timely treatment including extensive debridement of necrosis, antifungal drugs, and antibiotics were the key points leading to favourable outcome.