Referral Burn Center Research Articles

Blood transfusion in burn patients: Triggers of transfusion in a referral burn center in Iran

ObjectivesBlood and its derivatives are one of the most lifesaving products in the modern medicine practice. However, it is not an absolutely safe prescription. Many adverse effects such as infection, transfusion-related acute lung injury, immunosuppression, multi-organ dysfunction, acute respiratory syndrome, transfusion errors, transmission of infectious agents such as HIV, HBV, HCV are attributable to blood transfusion. The aim of this study was to describe how and when blood products were transfused in a referral burn center. Patients and methodsThis cross-sectional study was performed on medical records of all admitted patients in the Department of Burns and Reconstructive Surgery of Imam Reza Hospital, Mashhad, Iran during September 2014 up to August 2015. Transfusion measures such as Hb, Hct and demographic data were extracted from patient records. SPSS version 11.5 was used for data analysis. ResultsDuring the study period, 701 acute burnt patients were admitted with the mean age of 25.5±20.5 years. Sixty-four percent were male and burnt percentage of total body surface area (TBSA) was 30.9±24.3%. About one third (240) of patients received at least one blood product. Mean of the transfused packed red blood cell was 274.1±674.6mL per patient and 8.85mL per 1% of burnt TBSA. Anemia was the most common transfusion trigger. ConclusionMortality in burnt patients who received blood products was two folds more than patients who did not receive any blood products. We prescribed less blood products compared with other reviewed burn centers. However, following a written blood transfusion protocol by all clinicians may reduce blood transfusion in unnecessary situations even more significantly.

The epidemiology of burns in Indonesia’s national referral burn center from 2013 to 2015

IntroductionBurn injury is one of the leading causes of disability and death, particularly in low and middle-income countries, yet the epidemiology of burn in Indonesia is rarely reported. We aim to obtain the sociodemographic characteristics of burn patients in Cipto Mangunkusumo General Hospital’s Burn Center. MethodsA cross sectional study design was used and the medical records of patients with burns admitted to the Burn Center of Cipto Mangunkusumo Hospital between January 2013 and December 2015 were evaluated. ResultsA total of 414 subjects were involved in this study. Of these, 284 (68.6%) subjects were >18years old, while 130 (31.4%) were ≤18years old. The highest proportion of admission was from the 1 to 4years old age group. Since the pediatric population is not within the working-age population, most of the patients in the pediatric group (108 patients; 82.3%) did not have an occupation, making “Not Working” group as the most common occupational profile, while 82 (28.9%) of the adult population were laborers. Scald was the cause of burn in 66 (50.8%) subjects the pediatric group, whereas the burns in 201 (70.8%) adult subjects were caused by flame. ConclusionWe found that children below 5years of age are at the highest risk of acquiring burns. Scald was the major cause of burns in the pediatric population, while flame was the main etiology in the adult group.

Distribution of SCCmec Types in Methicillin-Resistant Staphylococcus aureus Isolated from Burn Patients

Background: Methicillin resistance Staphylococcus aureus (MRSA) isolates have been recognized as one of the most important causes of infection in burn patients that have recently shown a frequent and rapid development of antibiotic resistance. Objectives: The present study described the distribution of different SCCmec types and antibiotic resistance pattern among MRSA strains isolated from burn patients in a referral burn center in Tehran, Iran. Methods: During a 12-month study, 189 MRSA isolates were obtained from burn patients. Standard culture and biochemical tests were used for identification of MRSA isolates. The antibiotic susceptibility testing was performed using disc diffusion method and the presence of mecA, nucA, pvl, and tst encoding genes was determined using PCR method. In addition, the different SCCmec types were determined using multiplex PCR. Results: All the MRSA isolates were observed to be resistant to amoxicillin and penicillin and sensitive to linezolid, teicoplanin, and vancomycin. The rates of resistance to other antibiotics varied from 86.2% for amikacin to 17.5% for quinupristin-dalfopristin. MDR was observed in all the isolates. Six different antimicrobial resistance patterns were observed among our isolates. Based on the multiplex PCR assay, the two different SCCmec types were detected as 71.4% type III and 28.6% type IV. In total, 8.5% of isolates harbored pvl toxin encoding gene all of which belonging to SCCmec type IV. Furthermore, 33 isolates (17.5%) harbored tst encoding gene. Conclusions: The results showed low diversity of SCCmec type among circulating MRSA in the burn center with relatively high prevalence of SCCmec III. These findings support the need for more studies to elucidate distribution of different SCCmec types among MRSA isolated from burn patients.

Skin allograft procurement and transplantation in Mashhad, Iran: Are burn patients' needs being met?

Only a single donor's tissue may save or improve lives of one hundred patients. Unfortunately, low governmental and media support of tissue procurement and transplantation programs is a worldwide problem. Loss of an effective tissue procurement program in many countries like Iran, may lead to loss of many thousands valuable tissues each year. To evaluate the rate of skin donation in Mashhad in comparison to other organs and tissues, we extracted the data related to tissue and organ procurement in Mashhad from 2001. Then we evaluated the annual skin allograft needs in the Burn Department of Imam Reza Hospital as the only referral burn center in the northeast of Iran. Brain dead potential donation rate per million populations of Mashhad in the years 2007-2014 was about 33. The mean refusal rate was 51%. Of patients who have consent for donation, more than 86% have consent for skin donation. Skin allograft procured from 119 (35.5%) candidates. Average of skin retrieval per cadaveric was 1525cm2 with a gradual increase from 1400cm2 in the first year to 1800cm2 in the last year. The recipient to donor ratio was 1.14. It is estimated that about 1cm2 of skin allograft is needed for any cm2 burnt body surface area. Considering more than 700 acute burn hospitalization in our burn unit, the patients need for skin allograft would be more than 3.5 million cm2, annually. The annual amount of skin procurement in Mashhad has been currently about 20,000cm2. It shows that our patients demand is higher than supply. Skin procurement and transplantation is a simple procedure which can be as lifesaving as organ procurement and transplantation. But there isn't any national organization to regulate tissue procurement, banking and transplantation. Governmental support of skin procurement and transplantation programs especially nonprofit programs may improve skin procurement rate and save more lives of severely burnt patients.

Improved Survival of Patients With Extensive Burns: Trends in Patient Characteristics and Mortality Among Burn Patients in a Tertiary Care Burn Facility, 2004-2013.

Classic determinants of burn mortality are age, burn size, and the presence of inhalation injury. Our objective was to describe temporal trends in patient and burn characteristics, inpatient mortality, and the relationship between these characteristics and inpatient mortality over time. All patients aged 18 years or older and admitted with burn injury, including inhalation injury only, between 2004 and 2013 were included. Adjusted Cox proportional hazards regression models were used to estimate the relationship between admit year and inpatient mortality. A total of 5540 patients were admitted between 2004 and 2013. Significant differences in sex, race/ethnicity, burn mechanisms, TBSA, inhalation injury, and inpatient mortality were observed across calendar years. Patients admitted between 2011 and 2013 were more likely to be women, non-Hispanic Caucasian, with smaller burn size, and less likely to have an inhalation injury, in comparison with patients admitted from 2004 to 2010. After controlling for patient demographics, burn mechanisms, and differential lengths of stay, no calendar year trends in inpatient mortality were detected. However, a significant decrease in inpatient mortality was observed among patients with extensive burns (≥75% TBSA) in more recent calendar years. This large, tertiary care referral burn center has maintained low inpatient mortality rates among burn patients over the past 10 years. While observed decreases in mortality during this time are largely due to changes in patient and burn characteristics, survival among patients with extensive burns has improved.

Wide distribution of carbapenem resistant Acinetobacter baumannii in burns patients in Iran.

Antimicrobial resistance in carbapenem non-susceptible Acinetobacter baumannii (CNSAb) is a major public health concern globally. This study determined the antibiotic resistance and molecular epidemiology of CNSAb isolates from a referral burn center in Tehran, Iran. Sixty-nine CNSAb isolates were tested for susceptibility to antimicrobial agents using the E test methodology. Multiple locus variable number tandem repeat analysis (MLVA), Multilocus sequence typing (MLST) and multiplex PCR were performed. PCR assays tested for ambler classes A, B, and D β-lactamases. Detection of ISAba1, characterization of integrons, and biofilm formation were investigated. Fifty-three (77%) isolates revealed XDR phenotypes. High prevalence of blaOXA-23-like (88%) and blaPER-1 (54%) were detected. ISAba1 was detected upstream of blaADC, blaOXA-23-like and blaOXA51-like genes in, 97, 42, and 26% of isolates, respectively. Thirty-one (45%) isolates were assigned to international clone (IC) variants. MLVA identified 56 distinct types with six clusters and 53 singleton genotypes. Forty previously known MLST sequence types forming 5 clonal complexes were identified. The Class 1 integron (class 1 integrons) gene was identified in 84% of the isolates. The most prevalent (33%) cassette combination was aacA4-catB8-aadA1. The IC variants were predominant in the A. baumannii lineage with the ability to form strong biofilms. The XDR-CNSAb from burned patients in Iran is resistant to various antimicrobials, including tigecycline. This study shows wide genetic diversity in CNSAb. Integrating the new Iranian A. baumannii IC variants into the epidemiologic clonal and susceptibility profile databases can help effective global control measures against the XDR-CNSAb pandemic.

Nursing Actions in practicing inpatient advocacy in a Burn Unit

Understanding nursing actions in the practice of inpatient advocacy in a burn unit. A single and descriptive case study, carried out with nurses working in a referral burn center in southern Brazil. Data were collected through focus group technique, between February and March 2014, in three meetings. Data was analysed through discursive textual analysis. Three emerging categories were identified, namely: (1) instructing the patient; (2) protecting the patient; and (3) ensuring the quality of care. This study identified that the nurses investigated exercised patient advocacy and that the recognition of their actions is an advance for the profession, contributing to the autonomy of nurses and the effectiveness of patients' rights and social justice.

Prevalence of Acinetobacter baumannii harboring ISAba1/blaOXA-23-like family in a burn center

BackgroundRefractory carbapenem resistant Acinetobacter baumannii (CRAB) isolates increase mortality and morbidity rates among patients with underlying disorders, especially in patients with burns. The aim of the current study was to understand the resistant determinants of CRAB isolates and their clonal relatedness collected from referral Burn center. MethodsCRAB isolates were initially characterized and then antimicrobial susceptibility testing was assessed by E-test. Resistance determinants were investigated by PCR. Repetitive extragenic palindromic elements-PCR (REP-PCR) was used for clonality relatedness among isolates. ResultsThirty CRAB isolates were collected during the study. Colistin was the most effective antibiotic, but, all of the isolates were resistant to carbapenems. intI1 was detected in two isolates and MBLs and gene cassettes were not detected. ISAba1, blaOXA-51, blaOXA-23 and ISAba1/blaOXA23-like were detected in all, while blaOXA-24-like were present in 73% and blaOXA-58&OXA-143 were not present in isolates. REP-PCR demonstrated three clusters, with the dominant B cluster, which contained 16 subgroups. ConclusionCRAB harboring ISAba1/blaOXA-23-like family is widely disseminated in the studied Burn ward setting and the emergence of infection control measures should be regarded to limit refractory CRABs.

Burn injuries during pregnancy in Iran

Objective To report on maternal and fetal outcome in 53 pregnant women seen at a referral burn center. Methods Possible links between outcome and maternal age, level of education, marital status, percentage of total body surface area (TBSA) burned, inhalation injury, source and intentionality of the burn, and trimester of pregnancy at the time of the burn were assessed. Results Of 5497 women, 53 (1.3%) were pregnant at the time of admission. Maternal and fetal deaths occurred at significantly higher rates in cases of inhalation injury ( P = 0.001). The mean percentage of TBSA burned was significantly higher in cases of maternal or fetal death ( P < 0.001 for both), and when the burn has a suicidal intent ( P = 0.006). The maternal and fetal mortality rates were also higher when the burn was suicidal ( P = 0.001 and P = 0.005). Conclusion Inhalation injury, suicidal burn injury, and percentage of TBSA burned were correlated with a higher maternal and fetal mortality.

Prevention and Management of Infections Associated With Burns in the Combat Casualty

Burns complicate 5% to 10% of combat associated injuries with infections being the leading cause of mortality. Given the long term complications and rehabilitation needs after initial recovery from the acute burns, these patients are often cared for in dedicated burn units such as the Department of Defense referral burn center at the United States Army Institute of Surgical Research in San Antonio, TX. This review highlights the evidence-based recommendations using military and civilian data to provide the most comprehensive, up-to-date management strategies for burned casualties. Areas of emphasis include antimicrobial prophylaxis, debridement of devitalized tissue, topical antimicrobial therapy, and optimal time to wound coverage.