Elsevier

Burns

Volume 28, Issue 8, December 2002, Pages 746-751
Burns

Septicaemia after burn injury: a comparative study

https://doi.org/10.1016/S0305-4179(02)00183-3Get rights and content

Abstract

Seventy-nine (8.4%) patients during June 1992–May 1996 (Group-1) and 68 (7.2%) patients from June 1996 to May 2000 (Group-2) who developed septicaemia at the burns unit of Al-Babtain Centre for Plastic Surgery and Burns, Kuwait, were retrospectively studied and compared. The mean age of 26 years, male predominance, flame burns as main aetiology and mean burn percentage of ≥40% was observed in both the groups. Both groups revealed extensive flame burn, inhalation injury, intubation and difficult resuscitation as the risk factors. The proportion of satisfactory resuscitation increased significantly (P<0.001) in Group-2. The septicaemia commonly occurred within 2 weeks postburn but the number of episodes during 5 days postburn was less in Group-2. The surface wound was found to be the likely source of entry of the organisms into the blood stream in both the groups. The gram positive organisms were dominant aetiologic factor in both groups but an increase frequency of Acnetobacter was found in Group-2. The proportion of MRSE and Pseudomonas septicaemia was significantly higher (P<0.01) in the Group-1. The rate of survivors, in both the groups was higher among operated patients but it was significantly higher (P<0.001) in the Group-1. A mortality rate 20.6% in Group-2 decreased against Group-1, which can be attributed to better resuscitation, nutritional care, early detection of septicaemia, appropriate antibiotics and early wound excision and skin grafting. MOF was the cause of death of 60.9% in Group-1 and 85.7% in Group-2. There was no role of prophylactic antibiotic in burn patients in the incidence of septicaemia and mortality.

Introduction

The better understanding of burn pathophysiology has resulted in effective fluid resuscitation in the acute period, but the morbidity and mortality of these patients are mostly linked to the burn wound consequences, once the acute initial phase is over. The burn wound is the source of virtually all ill effects, local and systemic seen in a burn patient [1]. Infection is most undesirable in burn patients but it is difficult to control because of the presence of the dead and denatured burn eschar, moist environment, dysfunction of the immune system [2], [3], [4], prolonged hospitalization and invasive diagnostic and therapeutic procedures. Wound sepsis may lead to septicaemia, which may occur at any time and systemic sepsis endangers life in burn patients [5], [6], [7].

In an earlier study, from June 1992 to May 1996, it was reported that out of 943 patients, 79 (8.4%) of burn patients had septicaemia, and in their 118 septicaemic episodes, MRSA and MRSE were the predominant microbes isolated [8]. As a further extension to that study, covering similar 4-year period from June 1996 to May 2000, the data were collected retrospectively with an objective to compare the observations regarding demographic and clinical characteristics of septicaemia patients between the two similar periods. The study was extended to evaluate the role of prophylactic antibiotics on the incidence of septicaemia and the outcome in these patients.

Section snippets

Patients and methods

During the 4-year period, from June 1996 to May 2000, 939 cases were treated as in-patients at the Burns unit of Al-Babtain Centre for Plastic Surgery and Burns, Kuwait. Of these, 68 (7.2%) patients had septicaemia either on single or multiple occasions during their stay in the hospital. The burn management, microbiological surveillance, and the diagnostic criteria for septicaemia during this period remained the same as the earlier study [8] but there was a change in the prophylactic antibiotic

Results

A total of 943 and 939 burn patients were recorded in Groups-1 and -2, respectively. Seventy-nine (8.4%) patients had septicaemia in Group-1 as compared to 68 (7.2%) patients in Group-2. The mean age in both the groups was found to be almost same (26 years). The children up to 10 years of age, comprised of 25% in contrast to 30%, and in the age group from 21 to 40 years, it was 50% compared to 40% in Group-1. Forty-four (64.7%) patients were male while this percentage was 55.7 in Group-1. Male

Discussion

The incidence of septicaemia has decreased to 7.2% as compared to 8.4% in Group-1 (8) although it did not reach the significant level. Two vulnerable age groups, up to 10 years and 21–40 years, were observed in both the periods, and they represented 50% and 20%, respectively, amongst total burn cases in an earlier epidemiological study [9]. The higher septicaemic incidence among non-Kuwaitis corresponds with heterogeneous population distribution and the nature of their work in this region.

The

References (27)

  • Williams WG, Phillips LG. Pathophysiology of the burn wound. In: Herndon DN, editor, Total burn care. London: WB...
  • J.L Ninneman

    Immunological defenses against infection: alterations following thermal injuries

    J. Burn Care Rehabil.

    (1982)
  • A.U Winkelstein

    What are the immunological alterations induced by burn injury?

    J. Trauma

    (1984)
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