Septicaemia after burn injury: a comparative study
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
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