Death In Burn Patients Research Articles

Evaluation of Serum Procalcitonin as a Diagnostic and Prognostic Biomarker for Sepsis in Major Burn Patients: A Prospective Study

Abstract Background Sepsis in burns worsens the patient’s prognosis and increases the risk of organ failure and death. Multiple organ dysfunction syndrome (MODS), which is a direct response to sepsis is the main reason for death in burn patients. Identifying early sepsis is very important, given that every 6 h delay in the diagnosis of sepsis reduces survival by 10%. Complexity in diagnosing sepsis in the burn is due to the systemic response to the burn itself clinically simulating sepsis. Aim of the Work The aim of this study is: To investigate the diagnostic validity of PCT in burn sepsis as an early diagnostic tool and to identify its prognostic value in major burn patients with sepsis. Patients and Methods The study was a prospective study carried out in the Burn Intensive Care Unit (ICU) of Ain Shams University Hospitals on 30 patients that were admitted from October 2021 to April 2022 with major burn (more than 20% of TBSA) were included and the Local Ethics Committee approved the study, and informed consent was obtained from all participants or their guardians. Results It had been revealed that the first 3 samples have no significant increase in PCT levels in relation to sepsis. However, the following 2 samples which had been withdrawn on day 5 show a significant increase in PCT levels, and these on day 7 on admission are highly significant with a median (IQR) range of 9 ng/dl and median (IQR) range of 13.2 ng/dl respectively. Moreover, it had been noted that the PCT level on admission was significant for the prognosis of death with a median (IQR) range of 1.65 ng/dl while in survivor patients the median was 0.45 ng/dl. Conclusion Our study demonstrated that PCT level in major burn patients is a promising diagnostic biomarker in detecting sepsis that could facilitate ideal management and initiate proper antimicrobial therapy and good prognostic value as an early predictor of mortality.

Burn Wound and Traumatic Inhalation due to Marapi Volcano Eruption

Background. Burns can be caused by various etiologies, including heat and chemicals from volcanic eruptions. Mount Marapi was a commonly visited hiking site prior to its eruption on December 3th 2023.
 Case Presentation. This case reports a 19 year old woman with severe full thickness burns, covering 40.5% of total body surface area (TBSA) with inhalation trauma caused by inhaled volcanic ash from the Mount Marapi's eruption. Airway assessment was done through bronchoscopy examination.While being treated in the burn unit, the patient's overall condition deteriorated, so the patient was moved to the intensive care unit (ICU). Severe burns usually can cause circulatory disruption and trigger systemic inflammatory responses. Meanwhile, inhalation injury and sepsis also contributes to a higher risk of death in burn patients. Burns with inhalation trauma require specific treatment procedures.
 Conclusion. This study summarizes the experience of treating victim of the Mount Marapi eruption and multidisciplinary approach to achieve optimal patient care.

The timing of death in burn patients.

When treating burn patients, some patients die in the chronic phase, even if they overcome the acute phase of the burn. To elucidate the timing of death and its underlying causes among burn patients. Patients evaluated were admitted to our burn center between January 2015, and December 2019. Patient information, time, and cause of death were retrospectively collected from their medical records. Among 342 admitted patients, 49 died. The time of death was as follows: within 24 h (n = 9), within 3 days (n = 7), within 1 week (n = 5), within 2 weeks (n = 4), within 3 weeks (n = 3), within 30 days (n = 6), within 60 days (n = 5), and after 60 days (n = 9). The causes of death within 3 days were hypoxic encephalopathy, extensive burns (>80%), severe heat stroke, and acute coronary syndrome. The causes of death after 3 days were sepsis, pneumonia, intestinal ischemia, pancreatitis, and worsening of chronic diseases. The mortality rate was similar for patients ≥65 years of age and those with a burn area of ≥20%, with both groups showing a particularly poor prognosis. The timing of death in hospitalized burn patients showed a bimodal distribution as approximately 40% of patients who survived the resuscitation period died after 30 days. Elderly patients were at particularly high risk for mortality. In burn care, treatment planning should consider not only the short-term but also the long-term prognosis.

High rate of negligence induced burns in children: A rising cause for concern of the world's burn community

One of the most important causes of death in burn patients is burn [1-10]. Accurate evaluation, timely diagnosis, and proper treatment of burn patients can reduce their mortality rate [11-21]. On the other hand, one of the most important causes of injury among children aged 1 to 15 is burns [22]. Usually, children and teenagers are more vulnerable in burn injuries than other age groups [23]. Severe burns can affect children's health both in the acute stage of burns and in the later stages of their lives [24]. Burns in children often occur due to injuries caused by hot liquids. The mechanism of burns among children can be due to exploratory behaviors without understanding the dangers in the environment [25]. Most burn injuries are due to accidental causes, but in some cases, it can be due to negligence in children [22]. It is difficult to distinguish whether the burn was accidental or caused by negligence [24]. Burn hospitalizations and deaths due to negligent burns are more than accidental burns. The interesting point is that some cases of children's burn injuries can be due to misbehavior and negligence that were not diagnosed at the time of admission. Identifying these people is important because preventive efforts by health care teams for children are necessary [22]. Hence, most negligence induced burns in children are preventable because negligence and carelessness are the main causes of burns in them [24]. The consequences of negligence induced burns in children can have physical, mental, and emotional effects on children and their families [23]. Burn scars often persist after healing and lead to functional and aesthetic problems [24]. On the other hand, psychological care after burns should be considered; because, children experience a high level of acute stress, anxiety, and depression after burns, and hospitalization can be scary for children [23]. The negative consequences of negligence induced burns in children in the long term can lead to chronic diseases in childhood and even adulthood. Therefore, special attention should be paid to the timely prevention, diagnosis, and treatment of negligence induced burns in children [22]. However, previous evidence regarding negligence induced burns in children is very limited. Hence, one study showed that 56% of burns in children were due to negligence [24].

Use of antibiograms and changes in bacterial resistance patterns in the Ross Tilley Burn Centre

BackgroundInfection is a leading cause of death in burn patients and increasing antimicrobial resistance has made management difficult. Antibiograms are a useful tool to guide empiric treatment of infections, however, inappropriate prescribing may influence resistance. The objective of this study is to describe trends in antibiotic susceptibilities and use in a Canadian burn population pre- (PrA) and post-introduction (PoA) of antibiograms. MethodsWe performed a retrospective review of patients admitted to an ABA-verified Burn Centre for two years pre- (2013–2014) and post-introduction (2016–2017) of institutional antibiograms receiving empiric broad-spectrum antibiotics (meropenem, piperacillin-tazobactam, and/or vancomycin). ResultsA total of 864 patients were admitted during the study period with 257 patients PrA and 239 patients PoA included. Average age, % total body surface area (%TBSA), and length of stay were similar between cohorts. Administration of empiric meropenem increased (43.2 % vs. 56.8 %) and piperacillin-tazobactam decreased (60.6 % vs. 39.4 %), which was significant (p = 0.002). There was a significant decrease in the overall use of empiric antibiotics (p = 0.002) and sepsis (p = 0.008) since the inception of antibiograms. There was no significant difference in use of targeted antibiotics pre- or post-antibiogram introduction. ConclusionsOur study demonstrates that since the introduction of antibiograms, there has been a decrease in overall use of empiric antibiotics, a significant decrease in administration of piperacillin-tazobactam, and improvement in sepsis rates. However, these antibiotics were not routinely targeted to the appropriate organism and therefore may contribute to multi-drug resistant organisms in a burn population.

Mortality patterns and risk factors in burn patients: A cross-sectional study from Pakistan

According to WHO, a burn is a type of tissue injury that may be caused by thermal, electric, radioactive, or chemical agents. Burns represent a critical public health concern worldwide, particularly in developing countries that experience a disproportionately high incidence of burn injuries and mortality rates. Accurate and comprehensive statistics regarding the causes of mortality and their associated factors are crucial for informed healthcare decision-making. Unfortunately, there is a notable scarcity of studies that specifically address these issues, and a significant disparity exists between clinically diagnosed causes of death and postmortem findings. This study aims to determine the causes of mortality among patients admitted to the Burns Center to improve healthcare provision and reduce the mortality rate of burn patients. This retrospective cohort study involved 262 patients, comprising 58 % (n = 152) males and 42 % (n = 110) females. The mean age of males was 34.5 years (std = 13.9) while for males was 31.9 years (std = 13.2). The data was retrieved from patients' files and autopsy reports collected from the burns centre. The chi-square test and T-test were used to identify any correlation between the variables. The causes of mortality included sepsis (48.9, n = 128), hypovolemic shock (27.5, n = 72), renal failure (22.9, n = 60), and cardiac failure (0.8, n = 2). Significant associations were observed between the causes of mortality and factors such as age, total body surface area affected (TBSA), inhalational injury, and etiology of burns (p-value < 0.05. However, no significant associations were found with gender or the degree of burns (p-value > 0.05). Our study illustrates sepsis/multiple organ failure (MOF) as the most common cause of death in burn patients, along with highlighting the risk factors having a strong correlation with the causes of mortality in individuals with burn injuries.

Antibacterial Efficacy of a Chitosan-Based Hydrogel Modified With Epsilon-Poly-l-Lysine Against Pseudomonas aeruginosa in a Murine-Infected Burn Wound Model.

Because antibiotic resistance is increasing worldwide and the leading cause of death in burn patients is an infection, an urgent need exists for nonantibiotic approaches to eliminate multidrug-resistant bacteria from burns to prevent their systemic dissemination and sepsis. We previously demonstrated the significant antibiofilm activity of a chitosan (CS) hydrogel containing the antimicrobial peptide epsilon-poly-l-lysine (EPL) against multidrug-resistant Pseudomonas aeruginosa using ex vivo porcine skin. In this study, we evaluated the in vivo antibacterial efficacy of a CS/EPL hydrogel against P. aeruginosa in a murine burn wound infection model. Full-thickness burns were created on the dorsum using a heated brass rod and were inoculated with bioluminescent, biofilm-forming P. aeruginosa (Xen41). Mice were treated with CS/EPL, CS, or no hydrogel applied topically 2 or 24 hours after inoculation to assess the ability to prevent or eradicate existing biofilms, respectively. Dressing changes occurred daily for 3 days, and in vivo bioluminescence imaging was performed to detect and quantitate bacterial growth. Blood samples were cultured to determine systemic infection. In vitro antibacterial activity and cytotoxicity against human primary dermal fibroblasts, keratinocytes, and mesenchymal stem cells were also assessed. CS/EPL treatment initiated at early or delayed time points showed a significant reduction in bioluminescence imaging signal compared to CS on days 2 and 3 of treatment. Mice administered CS/EPL had fewer bloodstream infections, lower weight loss, and greater activity than the untreated and CS groups. CS/EPL reduced bacterial burden by two orders of magnitude in vitro and exhibited low cytotoxicity against human cells. A topical hydrogel delivering the antimicrobial peptide EPL demonstrates in vivo efficacy to reduce but not eradicate established P. aeruginosa biofilms in infected burn wounds. This biocompatible hydrogel shows promise as an antimicrobial barrier dressing for the sustained protection of burn wounds from external bacterial contamination.

Multidrug-Resistant Pathogens in Burn Wound, Prevention, Diagnosis, and Therapeutic Approaches (Conventional Antimicrobials and Nanoparticles).

Multidrug-resistant pathogens are one of the common causes of death in burn patients and have a high risk of nosocomial infections, especially pneumonia, urinary tract infections, and cellulitis. The role of prolonged hospitalization and empirical antibiotics administration in developing multidrug-resistant pathogens is undeniable. In the early days of admitting burn patients, Gram-positive bacteria were the dominant isolates with a more sensitive antibiotic pattern. However, the emergence of Gram-negative bacteria that are more resistant later occurs. Trustworthy guideline administration in burn wards is one of the strategies to prevent multidrug-resistant pathogens. Also, a multidisciplinary therapeutic approach is an effective way to avoid antibiotic resistance that involves infectious disease specialists, pharmacists, and burn surgeons. However, the emerging resistance to conventional antimicrobial approaches (such as systemic antibiotic exposure, traditional wound dressing, and topical antibiotic ointments) among burn patients has challenged the treatment of multidrug-resistant infections, and using nanoparticles is a suitable alternative. In this review article, we will discuss different aspects of multidrug-resistant pathogens in burn wounds, emphasizing the full role of these pathogens in burn wounds and discussing the application of nanotechnology in dealing with them. Also, some advances in various types of nanomaterials, including metallic nanoparticles, liposomes, hydrogels, carbon quantum dots, and solid lipid nanoparticles in burn wound healing, will be explained.

Early wound excision within three days decreases risks of wound infection and death in burned patients

IntroductionIn lieu of limited studies on the timing of burn wound eschar excision for burns, a more comprehensive analysis is indicated to determine the effects of early wound excision following burns. This study aims to address the outcomes of early wound excision in burn patients. MethodsData collection were from TriNetX research database. Three groups of burn patients were stratified by the number of days in which they received burn wound excision within 14 days of injury. Five outcomes were observed: death, wound infection, sepsis, myocardial contractile dysfunction, and blood transfusion. Risk and incidence of various health outcomes were compared between the groups after propensity-matching age, sex, ethnicity, race and burn size using a z-test with p < 0.05 considered significant. ResultsWe identified 6158 burn patients with wound excision within 14 days of injury, the majority of whom (60.1%) received burn wound excision between 0 and 3 days after burn. 72.5% of patients had burns covering less than 20% of total body surface area. After propensity matching, we found a significantly lower risk of mortality in those who received burn wound excision within the first three days (3.84%) as compared to 8–14 days after burn (6.09%) (p < 0.05). Moreover, we found a decreased risk of wound infection in patients with burn wound excision within 0–3 days (37.84%) compared to those 4–7 days (42.48%) (p < 0.05). No statistical difference was detected in propensity-matched groups for myocardial contractile dysfunction, blood transfusion, or sepsis. In addition, the risk of hypertrophic scaring significantly decreased when wound excision was performed within 0–3 days (22% within 0–3 days, 28% within 4–7 days, p < 0.05). ConclusionBurn wound excision within 3 days of injury is beneficial when comparing to later treatment between 4 and 14 days, which results in a significantly lowered risk of mortality and infection in burn patient.

546 Winning the Race Against Pathogens: A Regional Burn Center Experience with a Cleansing Protocol

Abstract Introduction The skin is the first immune defense mechanism, and it functions as a barrier against various microorganisms. Burn injury will compromise this important barrier. Infections are the primary factor contributing to burn mortality, resulting in &amp;gt;50% of deaths in burn patients. In 2020, our Adult and Pediatric Burn Center instituted a pure Hypochlorous Acid (pHA) antimicrobial protocol to enhance skin barrier function. Methods We conducted a retrospective analysis on the effect of the introduction of the pHA protocol on the number of reportable infections in our Burn Center. The period of observation in this report is 2017-2021. Beginning in 2020, adults and children received topical wound care and bathing with our pHA protocol. No dilution of the product was used. The product was placed into a sterile basin and the patient was cleaned head to toe, including the genitalia and the wounds. Since invasive procedures such as placement of central venous catheters or urinary collection catheters may be a conduit of infection, the present report includes data regarding the number of patients experiencing clostridium difficile, central line-associated blood stream infection and catheter-associated urinary tract infections. Results From 2017-2021, our Burn Center admitted 2,223 patients. We computed a percent change in infections from before (2017-2019) to after (2021) the pHA protocol was implemented. We used 2021 because this was the first full year after the pHA protocol was introduced. We subtracted the total number of infections in 2021 from the average number of infections per year in 2017-2019 and divided by the average number of infections per year in 2017-2019. We found a 55% decrease in infections after the pHA protocol was introduced. There was no evidence of toxicity in adult or pediatric patients associated with care during introduction of the pHA protocol, including skin graft sites. Conclusions This analysis indicates a notable decrease in infections. The pHA procedure shows no evidence of viral, fungal or bacterial pathogens causing significant issues with the studied patient group. This analysis does not determine whether the decrease in infections is clinically or statistically significant. Applicability of Research to Practice Reducing infections in burn patients which can be life saving.

Discussion on classification and diagnostic nomenclature of burn infection

Infection is the most common complication after burn injury and one of the leading causes of death in burn patients. Thus, how to effectively prevent the occurrence and development of infection is an important task in treating burns. Till now, there are still many controversies in the clinical definition, diagnosis, and treatment of infection, especially burn infection. The authors of this article put forward their opinions and views on this subject, hoping to deepen the readers' understanding of burn infection.

Prognostic Test of Red Blood Cell Distribution Width Ratio with Platelets as a Predictor of Mortality in Burn Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Introduction: Burns is a traumatic condition with a very high mortality rate. In an effort to prevent greater mortality in burn conditions, a predictor is needed to optimize the prediction of death in burn patients. This study aimed to determine the efficacy of red blood cell distribution width ratio (RDW) to platelets (PLT) as a predictor of mortality in burn patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.&#x0D; Methods: This study was a retrospective cohort analytic observational study. A total of 51 research subjects participated in this study. Observation of clinical data and sociodemographic and laboratory evaluations were carried out. Data analysis was carried out with SPSS in univariate, bivariate, and diagnostic tests.&#x0D; Results: The RPR diagnostic test on observation ≥ 7 days is more sensitive and specific than that on observation ≥ 3 days. This study shows that both observations ≥ 3 days and observations ≥ 7 days show similarity, where the RPR value is much higher in cases of mortality than in cases of alive.&#x0D; Conclusion: RPR value ≥ 7 days has prognostic value with better sensitivity and specificity in predicting mortality in burn patients.

Comparison of open and closed burn wound dressing applications with tissue culture sampling.

Secondary infections are the leading cause of death in burn patients. The purpose of this study is to evaluate the effects of open and closed burn dressings on the development of secondary infections. Tissue cultures were obtained from the burn sites of 56 patients between the ages of 18 and 65 who were admitted to our burn unit between December 2022 and January 2023, on days 3 and 7. The impact of the demographic features of the patients, the characteristics of the burn wound, the dressing type, and the first intervention strategies given to the burn wound on the development of wound infection were evaluated. There was no statistically significant difference between the open- and closed-dressing groups in terms of cultural positiv-ity (P>0.05). A statistically significant difference (P=0.019) was found between the groups in terms of culture positivity among those whose wounds were cleansed with warm water as the initial intervention after a burn and those whose wounds were not. Even though the main impacts of the patient's variables on the development of a wound infection are recognized, it has been found that the appropriate and successful first intervention in a burn wound is also quite important.

Comparison of Abbreviated Burn Severity Index (ABSI) Score with R-Baux Score as a predictor of mortality in burn patients

Several studies regarding the mortality predictor model in burn patients have been carried out in several cities and countries. However, none have ever happened in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. This study aims to analyze the R-Baux Score and Abbreviated Burn Severity Index (ABSI) Score as a mortality predictor model in burn patients, which are relevant and useable in services at Dr. Soetomo General Academic Hospital. This study used quantitative research with a cross-sectional design and retrospective design utilizing secondary data. It was found that 263 patients met the inclusion criteria; with 73 patients died, 60.27% of whom were male, 50% with inhalation trauma, 19.18% were in the age range of 56-65 years old, 24.66% had a burn area of 61-70%, and 35.62% with a full-thickness burn. The results showed that the sensitivity value from the ABSI Score (p&lt;0.001) was 82.19%, with a specificity of 82.11%, a positive predictive value of 63.83%, and a negative predictive value of 92.31%. The R-Baux Score (p &lt;0.001) showed that the sensitivity value obtained was 80.82%, with a specificity of 80.00%, a positive predictive value of 60.83%, and a negative predictive value of 91.57%. There was no significant difference between the R-Baux Score and the ABSI Score as the predictor of mortality in burn (p&gt;0.05). Therefore, both the R-Baux Score and the ABSI Score can be used as model predictors of death in burn patients at Dr. Soetomo General Academic Hospital.

The Use of Extracorporeal Membrane Oxygenation for Burns: A Systematic Review and Meta-Analysis.

Burns are among the leading causes of trauma worldwide, and acute respiratory distress syndrome (ARDS) is a common cause of death in burn patients. Some patients develop hypoxemia refractory to conventional therapies and may be initiated on extracorporeal membrane oxygenation (ECMO) as rescue therapy. We conducted a meta-analysis for studies reporting on survival rates of patients receiving ECMO for burns or inhalation injuries, which was the primary outcome. Secondary outcomes included the hospital and intensive care unit length of stay and duration of ECMO. Random-effects (DerSimonian and Laird) were conducted. The pooled survival from 10 studies was 53.6% (95% confidence interval [CI]: 37.6-69.2%, high certainty). Survival was significantly associated with age (regression coefficient [B]: -0.0088, 95% CI: -0.0155 to -0.0021, p = 0.011) and the proportion of male patients (B: -1.0137 95% CI: -1.9695 to -0.0580, p = 0.038). Patients were cannulated on ECMO for a mean of 8.4 days (95% CI: 6.1-10.7) and remained in the ICU for a mean of 40.4 days (95% CI: 11.4-69.3). Mean hospital length of stay was 45.4 days (95% CI: 31.7-59.0). In conclusion, patients with burn and inhalation injuries who develop ARDS refractory to conservative management have a survival rate of 54% when placed on ECMO.

Antibacterial and antifungal activities in vitro of a novel silver(I) complex with sulfadoxine-salicylaldehyde Schiff base

Skin wound infections can be considered one of the most common causes of death in burned patients. The raising reports of multidrug resistant microorganisms reveals a complicated condition for the treatment of burn wound injuries, establishing urgency in the development of novel antimicrobial agents. Considering this scenario, the present work describes the synthesis, antibacterial and antifungal activities of a sulfadoxine-salicylaldehyde Schiff base (SFX-SL), and of its novel dimeric silver(I) complex (AgSFX-SL). Elemental analysis indicated a 1:1 metal:ligand molar composition for the AgSFX-SL complex, with the minimum formula AgC19H17N4O5S. Mass spectrometric (HRMS) data reveal the existence of dimeric species of the complex in solution. Infrared (FT-IR) and nuclear magnetic resonance (NMR) spectroscopic studies suggest coordination of the Schiff base to silver(I) by the nitrogen and oxygen atoms of the sulfonamide group. The structure of the SFX-SL Schiff base was determined by single crystal X-ray diffraction. Molecular modeling confirms the proposition of a dimeric structure for the AgSFX-SL complex as early indicated by mass spectrometric data. The AgSFX-SL complex showed an effective antimicrobial activity over pathogens including Gram-positive Staphylococcus aureus (multidrug resistant), S. epidermidis, Cutibacterium acnes, and Gram-negative Pseudomonas aeruginosa and Burkholderia cepacia, with minimum inhibitory concentration (MIC) values in the range 12.0–48.0 µmol·L−1. Additionally, the AgSFX-SL complex was active against Candida albicans with a MIC value of 2.8 µmol·L−1. Electrophoresis assays showed that the AgSFX-SL complex does not interact with protein models lysozyme and bovine serum albumin (BSA).

EVALUATING SEPSIS CRITERIA IN DETECTING ALTERATIONS IN CLINICAL, METABOLIC, AND INFLAMMATORY PARAMETERS IN BURN PATIENTS.

Sepsis has become the leading cause of death in burn patients. Furthermore, sepsis and septic complications result in significant morbidities and longer hospitalization, which has profound impacts on the healthcare system. Despite this, sepsis in burn patients is surprisingly poorly understood and characterized. This retrospective, single-institution cohort study aimed to increase our understanding of the septic response after burns. We hypothesized that different sepsis definitions will results in distinctive septic trajectories and biochemical patterns after injury. Sepsis was defined by our burn center-specific prospective definition, the American Burn Association criteria, Sepsis-3 criteria, and the Mann-Salinas criteria. Applying these definitions, we compared clinical, metabolic, and inflammatory markers in septic and nonseptic burn patients. We found that the Sepsis-3 criteria are the most reliable screening tool used before clinical diagnoses for detecting sepsis trajectories and biochemical patterns. Moreover, we characterized distinct temporal alterations in biomarkers during the pre- and post-septic periods in burn patients, which may be incorporated into future sepsis definitions to improve the accuracy of a sepsis diagnosis in burn patients.

700 Use of Antibiograms and Changes in Bacterial Resistance Patterns

IntroductionInfection is a leading cause of death in burn patients. With an increase in resistance patterns, management of these infections has become progressively difficult. Antibiograms, a summary of susceptibilities to bacteria in a given institution or area, are often used to guide empiric treatment of infections. However, inappropriate prescribing and use of empiric antimicrobials may greatly impact the incidence of resistance. Currently, we do not know the patterns of antibiotic use since the introduction of institutional antibiograms or associated changes in antibiotic resistance. The objective of this study is to describe trends in antibiotic susceptibilities in burn patients in Canada pre- (PrA) and post-introduction (PoA) of antibiograms.MethodsWe performed a retrospective review of patients admitted to an ABA-verified Burn Centre 2 years pre- (2013-2014) and post-introduction (2016-2017) of institutional antibiograms and started on broad-spectrum antibiotics (meropenem, piperacillin-tazobactam, and/or vancomycin).ResultsA total of 864 patients were admitted during the study period (n=420 PrA and n=444 PoA). Average age, % total body surface area (%TBSA), and length of stay were similar between cohorts. Administration of empiric meropenem increased (43.2% vs. 56.8%) and piperacillin-tazobactam decreased (60.6% vs. 39.4%), which was significant (p=0.002). The use of vancomycin was unchanged. There was a significant decrease in the overall use of empiric antibiotics (p=0.002) since the inception of antibiograms, with a significant improvement in culture and sensitivity (C&S) testing within 5 days of starting empiric antibiotics (p=0.002). There was no significant difference in use of targeted antibiotics pre- or post-antibiogram introduction.ConclusionsOur study demonstrates that since the inception of antibiograms, there has been a significant decrease in overall use of empiric antibiotics and improvement in acquiring C&S within 5 days. However, these antibiotics were not always targeted to the appropriate organism and therefore may contribute to multi-drug resistant organisms in a burn population.

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.

Application of mNGS to describe the clinical and microbial characteristics of severe burn a tanker explosion at a tertiary medical center: a retrospective study patients following

BackgroundMultiple organ dysfunction syndrome secondary to infection is the leading cause of death in burn patients. Bloodstream infection (BSI) and the prognosis of burn patients are negatively correlated. Metagenomic next-generation sequencing (mNGS) can detect many potential pathogens and may be more valuable for patients with severe burns.MethodsWe retrospectively explored the utility of mNGS in describing the clinical and microbial characteristics of severely burned patients with BSI. We compared mNGS with blood culture.ResultsFourteen patients (127 blood samples) developed 71 episodes of BSIs with 102 unique causative pathogens. The median total body surface area was 93%. The overall 90-day mortality was 43%. In total, 17 (23.9%) episodes were polymicrobial, and 61 (86.1%) episodes originated from the wound. In total, 62/71 cases (87%) showed positive findings by mNGS, while 42/71 cases (59%) showed positive findings using blood culture. We found that mNGS outperformed culture, especially in terms of fungi (27% vs. 6%, p < 0.0001).ConclusionsThe incidence of BSI and polymicrobial in patients with large-area severe burns is high. mNGS has potential value in the diagnosis of fungal infections and coinfections in such patients. In addition, mNGS may provide unique guidance for antibiotic therapy in complicated BSI.