Complications In Burn Patients Research Articles

Bacteriological characteristics of infectious complications in burn patients

Bacteriological characteristics of infectious complications in burn patients

57 HIV Infection Increases Risk of Sepsis and Other Complications in Burn Patients

57 HIV Infection Increases Risk of Sepsis and Other Complications in Burn Patients

Effect of glycemic variability on infectious outcomes in critically Ill burn patients

After acute burn injury, patients experience a hypermetabolic state often complicated by a stress-induced hyperglycemia. Recent research points towards glycemic variability as a contributing factor in adverse outcomes in critically ill patients. In burn patients, greater glycemic variability has been associated with increased rates of mortality and sepsis. However, no studies to date have examined the impact of glycemic variability on rates of infection in this population or determined which measure may be most useful. Infection, and subsequent sepsis, remains the leading contributor to morbidity and mortality after burn injury. The primary objective of this study is to evaluate the relationship between different measures of glycemic variability and infectious complications in burn patients. This retrospective study included patients admitted to a single American Burn Association-verified burn center between January 1, 2020 and December 31, 2020 with burn or inhalation injury. The primary outcome was a composite of autograft loss, mortality, and proven infection. Secondary outcomes included hospital length of stay and a further analysis of the proven infection component of the composite primary outcome. In addition to mean glucose, several different measures of glycemic variability were used for comparison, including standard deviation, coefficient of variation, mean amplitude of glycemic excursions, and J-index. Outcomes were analyzed using multiple logistic regression analysis while controlling for revised Baux score. A quantile analysis was performed to do determine the optimal mean threshold. Three hundred and ninety-two patients were admitted and screened for inclusion during the study period. Most patients were excluded due to a LOS less than 72 h. 112 patients were included in the study. Of the 112 patients, 22.3% experienced an infectious complication (25 patients with 28 complications). Mean glucose (OR 1.024; 95% CI 1.004–1.045) and J-index (OR 1.044; 95% CI 1.003–1.087) were associated with occurrence of infectious complications. Regarding target mean glucose threshold, a daily mean glucose above 150 mg/dL showed the strongest association with infectious complications (OR 3.634; 95% CI 1.008–13.101). Mean glucose, standard of deviation, and J-index were all independently associated with proven infection.

Phage therapy for burn wound infections in the era of antibiotic resistance

Infection of burn wounds caused by antibiotic-resistant pathogens is the leading cause of systemic infectious complications in burned patients and a key link in the pathogenesis of burn disease, causing its course and outcome. The use of phage therapy to overcome antibiotic resistance of infection agents is a promising direction, the development of which can improve the results of treatment of burned. The article discusses: 1) features of the infectious process in burned; 2) the effect of antibacterial chemotherapy of burn wound infection on the microbiome and the processes of reparative regeneration; 3) principles of phage therapy; 4) ways of delivering bacteriophages; 5) development of resistance to bacteriophages 6) personalization of phage therapy.

Reports on vascular catheter-associated thromboembolic events in a burn unit - a gap in the literature?

Indwelling intravascular catheters are important tools in the care of critically ill patients; however, they have an inherent risk of infection or thromboembolic events. Reports on catheter associated thromboembolic events in burn units are rare, despite being well recognized that burn patients bear an increased baseline risk for thromboembolic events. We describe two catheter-associated thromboembolic complications in burn patients in a burn unit and the morbidity associated with these events. Patients with endovascular catheters in burn units may be at increased risk for severe thromboembolic events associated with intravascular catheters, but specific guidelines for prevention and management of these patients are still missing.

A Bibliometric Analysis of the Trends and Evolution on Inhalation Injury Research.

Inhalation injury is a common complication in burn patients and is also a factor that can affect the multiple prognoses of burn patients. Attention to inhalation injury began early globally, but few articles have systematically analyzed its development. We employed bibliometric methods to analyze articles on inhalation injury published in 3 medical databases. A total of 3056 relevant articles on inhalation injury were included in our analysis and divided into 3 distinct periods based on Price's law. Notably, a slowdown in publication growth was observed in period III. The majority of these articles were authored by a small group of individuals, with a significant proportion of them being American scholars. In fact, nearly half of the articles were published by American researchers. Applying Bradford's Law, we identified 4 major output sources in the field, namely Burns, Journal of Burn Care & Research, Journal of Trauma, and Critical Care Medicine. Recent research has focused on the clinical risks and outcomes associated with inhalation injury, while basic research in this area has been relatively neglected over the last decade. In conclusion, the growth of publications on inhalation injuries has largely followed standard scientific growth patterns, with a small number of countries and established research groups contributing the majority of articles. However, the recent slowdown in scientific output is a cause for concern, and the lack of emphasis on basic research and clinical trials in this field raises questions about the foundation for widespread clinical management of inhalation injuries.

707 Comparing VTE Prophylaxis Strategies in Thermal Injuries: Don't Get Burned by Heparin!

Abstract Introduction Burn patients are at high risk of venous thromboembolism (VTE) as well as bleeding complications, thus choosing the best option for thromboprophylaxis can be challenging. Previous studies have analyzed the preferred antithrombotic agent in trauma patients, but this has not been established in burns. We hypothesize that low molecular weight heparin (LMWH) is associated with better outcomes than unfractionated heparin. Methods The Trauma Quality Improvement Project (TQIP) dataset was used to identify all patients with second- or third-degree burns that were administered VTE prophylaxis. Cases with missing data, < 24-hour hospital length of stay, other serious traumatic injuries (any AIS >3), interhospital transfer, history of kidney disease, or pre-hospital history of anticoagulant use were excluded. Bleeding complications were defined as hemorrhage control surgery, embolization procedures, or blood transfusion occurring after the initiation of thromboprophylaxis, consistent with other studies analyzing bleeding complications in TQIP. Rates of VTE and bleeding complications were compared between those who received heparin versus LMWH. Propensity score matching was performed to control for age, total body surface area percent (TBSA%) burned, and ICU admission (Table 1). Results The analysis included 9,857 patients (69% male). Median age was 50 (34-62) years. LWMH was associated with fewer complications including pulmonary embolism, any VTE, and bleeding (Table 2). Initiation of thromboprophylaxis within 24 hours of arrival was associated with a lower risk of VTE (1.0% vs 2.1%, p< 0.001) without showing a significant difference in bleeding complications (6.4% vs 7.2%, p=0.206). Conclusions This propensity score matched analysis of nearly ten thousand burn patients has demonstrated that low molecular weight heparin is associated with reduced risk of VTE and bleeding compared to heparin. Initiation of thromboprophylaxis within 24 hours is linked to lower rates of VTE. In burn patients without contraindications, thromboprophylaxis with LMWH should be started within 24 hours. Applicability of Research to Practice Venous thromboembolism is an important complication in burn patients, which may negatively impact patient outcomes. These patients regularly receive DVT prophylaxis and it is important for their care team to be able to select the proper agents.

62 Effect of Glycemic Variability on Infectious Outcomes in Patients with Severe Burn Injuries

Abstract Introduction Stress-induced hyperglycemia is a common manifestation of severe burn injury, due to increased catecholamines, glucagon, corticosteroids, and cytokines. The primary objective of this study was to evaluate the relationship between different measures of glycemic variability and infectious outcomes in burn patients. Methods This retrospective electronic chart review included patients admitted to a single American Burn Association-verified burn center for the year of 2020. Infectious complication was defined as occurrence of proven infection, autograft loss, or death. Glycemic variability indices tested include standard deviation, mean amplitude of glycemic excursions, J-index, and coefficient of variability. Demographics were compared utilizing Fisher’s exact or Mann-Whitney U test, depending on dichotomy. Logistic regression analysis was utilized to control for revised Baux score. Likelihood ratio test statistic was utilized to compare strength of association. Results Three-hundred and ninety-two patients were admitted during 2020 and screened for inclusion. After applying exclusion criteria, 112 patients remained in the study group. More than half were excluded for length of stay less than 3 days. Twenty-five (22%) had at least one infectious complication (21 infections, 3 with graft loss, and 4 deaths). Revised Baux, age, percent total body surface area burned, history of diabetes, and admission blood glucose were all higher in the group with an infectious complication. Out of the indices tested, only mean glucose (Odds ratio, 95% confidence interval: 1.024, 1.004-1.045) and J-index (1.044, 1.002-1.087) were significantly associated with higher risk of an infectious complication. Quantile analysis of mean glucose thresholds indicated > 150 mg/dL to have the strongest association with infectious complications in burn patients. Conclusions Although J-index was significantly associated with infectious complications, mean glucose was also and has a simpler derivation. Applicability of Research to Practice A liberal glucose control strategy should continue to be avoided in patients with burn injuries due to higher risk of infectious complication.

The modified 5-item frailty index as a predictor of complications in burn patients

The modified 5-item frailty index (mFI-5), as a measure of frailty and biological age, has been shown to be a reliable predictor of complications and mortality in a variety of surgical specialties. However, its role in burn care remains to be fully elucidated. We, therefore, correlated frailty with in-hospital mortality and complications after burn injury. The medical charts of all burn patients admitted between 2007 and 2020 who had ≥ 10 % of their total body surface area affected were retrospectively reviewed. Data on clinical, demographic, and outcome parameters were collected and evaluated, and mFI-5 was calculated on the basis of the data obtained. Univariate and multivariate regression analyses were used to investigate the association between mFI-5 and medical complications and in-hospital mortality. A total of 617 burn patients were included in this study. Increasing mFI-5 scores were significantly associated with increased in-hospital mortality (p < 0.0001), myocardial infarction (p=0.03), sepsis (p=0.005), urinary tract infections (p=0.006), and perioperative blood transfusions (p=0.0004). They were also associated with an increase in the length of hospital stay and the number of surgical procedures, albeit without statistical significance. An mFI-5 score of ≥ 2 was a significant predictor of sepsis (odds ratio [OR]=2.08; 95% confidence interval [CI]: 1.03 to 3.95; p=0.04), urinary tract infection (OR=2.82; 95% CI: 1.47 to 5.19; p=0.002), and perioperative blood transfusions (OR=2.61; 95% CI: 1.61 to 4.25; p=0.0001). Multivariate logistic regression analysis revealed that an mFI-5 score of ≥ 2 was not an independent risk factor for in-hospital mortality (OR=1.44; 95% CI: 0.61 to 3.37; p=0.40). mFI-5 is a significant risk factor for only a few select complications in the burn population. It is not a reliable predictor of in-hospital mortality. Therefore, its utility as a risk stratification tool in the burn unit may be limited.

Complications in Burn Patients Following Fluid Over-Resuscitation

Background/Objective: Over-resuscitation of burn patients leads to dangerous edema-related sequelae. The Parkland formula is commonly used to predict fluid requirements in the 24 hours following burn injury, yet studies report widely varying resuscitation rates. This study aims to assess fluid resuscitation practices at Lutheran Hospital and evaluate correlations between resuscitation rates and fluid-overload complications.Methods: A retrospective chart review assessed fluid resuscitation of 36 adult patients withburns affecting at least 15% total surface body area (TBSA) between May 2020-May 2022 atLutheran Hospital. Intravenous fluid rates and urine output (UO) were recorded for the first 24 hours of each patient’s hospital stay. Complications and mortality were recorded for the entirety of a patient’s hospital stay. Patients who received volumes exceeding those recommended by the Parkland formula were placed in the high-volume group whereas patients who received a lesser volume were placed in the low-volume group. Statistical analyses were performed using Microsoft Excel (α = 0.05).Results: The study included 36 patients with an average fluid resuscitation of 4.13 ±2.14mL/kg/%TBSA in the first 24 hours following hospital admission. Average UO in the high-volume group (n=14) was 1.33 ±0.76 mL/kg/hr compared to 0.75 ±0.47 mL/kg/hr in the low-volume group (n=22). Fluid complications were more common in the high-volume group (41.7%)compared to the low-volume group (19.0%), but this difference was not statistically significant (p=0.230). No difference in mortality was observed (p=1.000).Conclusion: The high-volume group had an average UO exceeding the recommended range(0.5-1.0 mL/kg/hr) and experienced greater rates of fluid-overload complications (pulmonaryedema, compartment syndromes, etc.). Due to the small sample size and limited power of this study, the difference in fluid-related complications was not statistically significant.Clinical Impact and Implications: Physicians should limit fluid volumes exceeding theParkland formula when resuscitating burn patients to avoid fluid overload sequelae.

The Protective Role of Strong Antioxidant Astaxanthin on Burn Wound and Burn-Induced Early Acute Kidney Injury through Abilities to Relieve Oxidative Stress and Inhibit Apoptosis by Modulating Mitochondrial-Apoptotic Pathways

Summary: Burns are skin damage caused by heat trauma or cold trauma (frost bite). Causes include fire, hot water, electricity, chemicals, radiation, and cold (frostbite). This damage may involve subcutaneous tissue. Burn injuries are associated with high incidence and prevalence, high risk of morbidity and mortality, resource-intensive, and costly. One of the most common complications in burn patients is acute kidney injury (AKI). The mechanism of early AKI after burn injury is multifactorial, and previous studies have mainly focused on oxidative stress injury, tubular apoptosis, and systemic or local inflammation. Previous results (from our group and others) suggested that ROS-induced oxidative stress damage and apoptosis play an important role in the development of early AKI due to burn injury, and that 24 h after burn injury are useful for observing changes in burn injury. It shows that it provides an important timeframe. Kidney function and levels of oxidative stress and apoptosis. Astaxanthin (ATX) is a naturally occurring carotenoid that is readily obtained from marine organisms and stronger antioxidant effects than other carotenoids. Given the critical role of oxidative stress and secondary renal inflammation in severe burn-induced early AKI, a protective role of ATX through its anti-inflammatory effects and potential mechanisms of action in early post-burn AKI is reasonable.

Research progress on risk factors of delirium in burn patients: A narrative review.

Delirium, an acute brain dysfunction, is a common and serious complication in burn patients. The occurrence of delirium increases the difficulty of patient treatment, is associated with various adverse outcomes, and increases the burden on the patient's family. Many scholars have studied the factors that cause delirium, but the causes, pathogenesis, and treatment of delirium in burn patients have not been fully revealed. There is no effective pharmacological treatment for delirium, but active preventive measures can effectively reduce the incidence of delirium in burn patients. Therefore, it is necessary to study the relevant factors affecting the occurrence of delirium in burn patients. This study was conducted on December 20, 2021 by searching the PubMed database for a narrative review of published studies. The search strategy included keywords related to "burns," "delirium," and "risk factors." We reviewed the characteristics of delirium occurrence in burn patients and various delirium assessment tools, and summarized the risk factors for the development of delirium in burn patients in terms of personal, clinical, and environmental factors, and we found that although many risk factors act on the development of delirium in burn patients, some of them, such as clinical and environmental factors, are modifiable, suggesting that we can estimate the exposure of burn patients to risk factors by assessing their likelihood of delirium occurring and to make targeted interventions that provide a theoretical basis for the prevention and treatment of burn delirium.

A bibliometric analysis of publications on burn sepsis using VOSviewer.

BackgroundSepsis is one of the most common complications in burn patients and causes high morbidity, especially in those with severe burns. Nevertheless, there are no formal criteria for diagnosing and treating burn sepsis. Therefore, this bibliometric analysis is applied to reveal research trends in this field and predicts its possible hot spots.MethodsWe screened relevant literature on burn sepsis that met the inclusion criteria of the Web of Sciences (WOS) database and analyzed publication trends and research hot spots in related fields using VOSviewer software.ResultsFrom 1981 to 2022, we screened 2,486 documents that met the requirements and analyzed them bibliometrically. The American scholar Herndon DN had a much higher h-index [47] than other authors. Most published, cited, and h-indexed publications are from the USA (Np: 1193, Nc: 42154, H: 98). The second most publishing country is China, but the second most cited and h-indexed country is Germany. Burns also outperforms other journals in this field (Np: 376, Nc: 8019, H: 46). “Biomarkers” is a newly emerging keyword (cluster “clinical research,” APY was 2018.16), and clinically relevant research in burn sepsis maybe a future research trend.ConclusionsSepsis in burn patients has unique pathophysiological characteristics and the general diagnostic criteria for sepsis lack specificity. Consequently, we must establish a database and construct an intelligent predictive model to help achieve a more individualized and precise early diagnosis and treatment of burn sepsis. This may also be an important development direction for future research in this field.

115 Analyzing Temporal Trends and Outcomes Associated with High Prevalence Bacterial Infections in Burn Patients

IntroductionBacterial infections are a leading cause of complications in burn patients. However, ambiguity remains around the most common infectious etiologies and their resulting complications. Our study identifies which bacterial infections will lead to specific complications and tracks infection rates of these bacteria over time.MethodsBurn patients diagnosed with a bacterial infection within 6 months of burn were identified in the TriNetX database using ICD-10 codes; those with bacterial infections prior to injury were excluded. Occurrence of the following outcomes within 12 months of injury were compared for those with bacterial infections and those without, including acute kidney injury (AKI), congestive heart failure (CHF), hypertrophic scarring, sepsis, and death. The top 4 bacterial infections, by incidence, were then identified and analyzed for the outcomes. Lastly, infection rates were stratified by year from 2010-2020. Data was analyzed using chi-square with p < .05 considered significant, and regressions.ResultsWe identified 457,383 burn patients, of whom 4,688 (1.0%) were diagnosed with a bacterial infection within 6 months of injury. The bacteria that constituted the highest proportion of infected patients were Staph aureus (51.1%), E. Coli (20.2%), Pseudomonas (17.6%), and Enterococcus (9.6%). When outcomes were stratified by bacteria, Enterococcus infection was associated with the highest incidence of AKI (23.1%), sepsis (25.2%), and mortality (16.03%). E. Coli was associated with the highest incidence of CHF (17.7%) and Pseudomonas was associated with the highest incidence of hypertrophic scarring (13.3%). All data was found to be statistically significant (p< .05). Time trend data from 2010 to 2020 stratified by bacterial infection is displayed in Figure 1. Of note, Pseudomonas infection rates increased by 90% (r2 = 0.6717) while E. Coli infection rates increased by 33%. (r2 = 0.7223). In contrast, Staph Aureus infection rates have decreased since 2013. Lastly, Enterococcus infection rates displayed a fluctuating pattern with an increasing trend since 2017.ConclusionsSpecies identification of a post-burn bacterial infection is an important step in outcome management. Despite its low incidence, Enterococcus infection was associated with the highest incidence of AKI, sepsis, and mortality, and has displayed recent increases in infection rates. Pseudomonas has shown a similar increasing trend and is notable for hypertrophic scar formation.

Acute Colonic Pseudo-Obstruction: A critical complication in burn patients

Acute Colonic Pseudo-Obstruction (ACPO) is a rare diagnosis characterized by gross dilation of the large bowel in the absence of an obstruction in burn patients, traditional management of ACPO may not be successful in fully resolving the bowel distention without recurrence, necessitating a more aggressive management course. We present five such patients from our Regional Burn Center and their clinical course. This case series aims to raise awareness for this rare yet significant complication of burn trauma, with recommendations for adjusted management algorithms.

A multicenter study analyzing the association of vitamin D deficiency and replacement with infectious outcomes in patients with burn injuries

Vitamin D (25OHD) deficiency is associated with poor outcomes in intensive care populations. The primary objective of this 7-center study was to determine if 25OHD deficiency is associated with infectious outcomes in adult burn patients. Generalized linear mixed modeling was used to control for center effect, percent total body surface area burn (% TBSA), age, and presence of inhalation injury. A total of 1147 patients were initially included (admitted January 2016 through August 2019). After exclusions, 234 (56.8%) in the deficient (25OHD<20 ng/mL) and 178 in the non-deficient group (25OHD ≥ 20 ng/mL) remained, surpassing a priori power requirements. The non-deficient group had their concentration drawn earlier (p < 0.001), were more likely to be male (p = 0.006), Caucasian (p < 0.001), have lower body mass index (p = 0.009), lower % TBSA (p = 0.002), and taking a 25OHD supplement prior to admission (p < 0.001). Deficient patients were more likely to have an infectious outcome (52.1% vs 36.0%, p = 0.002), acute kidney injury with renal replacement therapy (p = 0.009), less ventilator free days in the first 28 days (p < 0.001), and vasopressors (p = 0.01). After controlling for center, % TBSA, age, and inhalation injury the best model also included presence of deficiency (OR 2.425 [CI 1.206–4.876]), days until 25OHD supplement initiation (OR 1.139 [CI 1.035–1.252]), and choice of cholecalciferol over ergocalciferol (OR 2.112 [CI 1.151–3.877]). To the authors' knowledge, this is the first multicenter study to evaluate the relationship between 25OHD and infectious complications in burn patients.

Effect of extracorporeal shock wave therapy on keratinocytes derived from human hypertrophic scars

Hypertrophic scars represent a common complication in burn patients. In addition to cosmetic defects, they may cause serious sensory abnormalities such as pain and itching, severe dysfunction depending on the site, and emotional disorders such as anxiety and depression. The present study aimed to identify the molecular mechanisms underlying the use of extracorporeal shock wave therapy in keratinocytes. Keratinocytes derived from hypertrophic scar tissue were cultured and expression of proliferation markers (keratin 5 and 14), activation markers (keratin 6 and 17), differentiation markers (keratin 1, 10, and involucrin), apoptosis factors (Bax, Bcl2, and Caspase 14), and proliferation/differentiation regulators (p21 and p27) was investigated to compared with that of those in keratinocytes derived from normal skin tissue. Scar-derived keratinocytes were treated with extracorporeal shock waves under 1000 impulses at 0.1, 0.2, and 0.3 mJ/mm2. Shock waves altered the molecular pattern of proliferation, activation, differentiation, and apoptosis, as well as proliferation/ differentiation regulators, including Bax, Bcl2, ASK1, p21, p27, and Notch1. In summary, we show that extracorporeal shock wave therapy regulates the proliferation and differentiation of keratinocytes derived from hypertrophic scar to maintain normal epidermal integrity.

529 Acute Colonic Pseudo-Obstruction: A Critical Complication in Burn Patients

Abstract Introduction Acute Colonic Pseudo-Obstruction (ACPO) is a rare clinical condition characterized by gross dilation of the large bowel in the absence of an obstruction. It presents a particularly complex challenge in diagnosis and management in the context of burn trauma. We followed five burn patients who developed ACPO that did not respond to conservative treatments. These patients ultimately required surgical intervention to resolve their ACPO. Through our study, we propose that traditional management may not be successful in fully treating ACPO in burn patients without recurrence and that complete resolution necessitates a more aggressive management course, often in the form of surgical intervention. Methods We studied the clinical course of all burn patients who developed ACPO in the past 2 years at our burn center. Using Electronic Health Records, we collected patient demographic data, percent total burn surface area (%TBSA), hospital length of stay, cecal diameter, bowel regimen for catharsis, and vital sign measurements. Abdominal CT scans and X-rays were used to monitor the progression of cecal diameter. Results We have noted that burn patients who are at a high risk of developing ACPO tend to either be obese, have large TBSA burns (&amp;gt;20%), or have a combination of both. Furthermore, patients who had a greater percentage of 3rd degree burns had worse outcomes. All patients received acetylcholinesterase inhibitors (AChEi’s), but ultimately underwent some manner of further intervention for complete resolution of ACPO. Two patients were treated solely with decompression: one via NGT suction, the other via colonoscope. Three patients received surgical intervention through hemicolectomy, subtotal colectomy, and cecostomy. The former two subsequently expired, one due to direct ACPO complications; the latter three survived and remain well today. Conclusions ACPO is a rare but serious complication in burn patients that may easily be missed by the diagnosing clinician. In the treatment of ACPO in burn patients, one should consider a more aggressive approach, as traditional medical therapy may not be enough to resolve the original distention or prevent a recurrence. In our review of five burn patients that subsequently developed ACPO, surgical intervention was universally the mechanism by which definitive resolution of the condition was achieved.

Effects of Robot-Assisted Gait Training in Patients with Burn Injury on Lower Extremity: A Single-Blind, Randomized Controlled Trial

This study investigated the effects of robot-assisted gait training (RAGT) on gait function in burn patients. Briefly, 40 burn patients were randomly divided into an RAGT group or a conventional training (CON) group. SUBAR® (Cretem, Korea) is a wearable robot with a footplate that simulates normal gait cycles. The RAGT group underwent 30 min of robot-assisted training using SUBAR® with 30 min of conventional physiotherapy once a day, 5 days a week for 12 weeks. Patients in the CON group received 30 min of overground gait training and range-of-motion (ROM) exercises twice a day for 5 days a week for 12 weeks. The RAGT group and the CON group underwent 60 min of training per day. The intervention frequency and duration did not differ between the RAGT group and the CON group. The main outcomes were functional ambulatory category (FAC); 6-min walking test (6MWT); visual analogue scale (VAS) during gait movement; ROM; and isometric forces of bilateral hip, knee, and ankle muscles before and after 12 weeks of training. The results of the VAS, FAC, and 6MWT (8.06 ± 0.66, 1.76 ± 0.56, and 204.41 ± 85.60) before training in the RAGT group improved significantly (4.41 ± 1.18, 4.18 ± 0.39, and 298.53 ± 47.75) after training (p < 0.001, p < 0.001, and p < 0.001). The results of the VAS, FAC, and 6MWT (8.00 ± 1.21, 1.75 ± 0.58, and 220.94 ± 116.88) before training in the CON group improved significantly (5.00 ± 1.03, 3.81 ± 1.05, and 272.19 ± 110.14) after training (p < 0.001, p < 0.001, and p = 0.05). There were differences in the improvement of results of the VAS, FAC, and 6MWT between groups after training, but they were not statistically significant (p = 0.23, p = 0.14, and p = 0.05). The isometric strengths of the right hip extensor (p = 0.02), bilateral knee flexor (p = 0.04 in the right, and p = 0.001 in the left), bilateral knee extensor (p = 0.003 in the right, and p = 0.002 in the left), bilateral ankle dorsiflexor (p = 0.04 in the right, and p = 0.02 in the left), and bilateral ankle plantarflexor (p = 0.001 in the right, and p = 0.008 in the left) after training were significantly improved compared with those before training in the RAGT group. The ROMs of the right knee extension (p = 0.03) and bilateral ankle plantarflexion (p = 0.008 in the right, and p = 0.03 in the left) were significantly improved compared with measurements before training in the RAGT. There were no significant differences of the isometric strengths and ROMs of the bilateral hip, knee, and ankle muscles after training in the CON group. There were significant improvements in the isometric strengths of the left knee flexor (p = 0.01), left ankle dorsiflexor (p = 0.01), and left ankle plantarflexor (p = 0.003) between the two groups. The results suggested that RAGT is effective to facilitate early recovery of muscles strength after a burn injury. This is the first study to evaluate the effectiveness of RAGT in patients with burns compared with those receiving conventional training. The absence of complications in burn patients provides an opportunity to enlarge the application area of RAGT.

Bacterial infection profile and predictors among patients admitted to a burn care center: A retrospective study

BackgroundInfection is the main cause of mortality and complications in burn patients. The present study was the first to examine the local profile and antecedents of bacterial infections among patients admitted to a Lebanese burn care center. MethodsThe present study was a retrospective analysis of the occurrence and recurrence of infection, its characteristics as well as antimicrobial susceptibility among 475 patients admitted to the Burn Centre at the Lebanese Geitaoui Hospital between January 2014 and December 2018. Results55% of patients contracted at least one infection during their hospitalization. Length of stay (LOS), sepsis, wound dressing under anesthesia, blood transfusion and female sex independently and positively predicted infection in burn patients. Infection was predominately caused by Staphylococcus aureus (48.7%), followed by Pseudomonas aeruginosa (22.6%) and Acinetobacter baumannii (15.7%). Bacterial isolates were predominately multi-drug or extensively drug resistant and showed variable antimicrobial susceptibility patterns. Recurrent infections occurred in 44.1% of infected burn patients, and were independently predicted by LOS (p = 0.004), sepsis (p = 0.001), surgery (p = 0.003), burn excision and skin grafting (p = 0.019), and central line insertion (p = 0.004). ConclusionExisting burn management and infection control measures must be revised in order to reduce the incidence and improve the treatment of infections in burn patients.