Ceftazidime treatment in severe burns. Serious infections in patients with severe burns treated with ceftazidime

In combination with active surgical and general management, ceftazidime is a useful antibiotic for the treatment of Gram negative septic complications in patients with severe burn wounds. Against S. aureus, however, ceftazidime is not the therapy of choice.     

Clostridium difficile infections in patients with severe burns

With improved survival in burn patients, Clostridium difficile infection (CDI) remains a significant potential complication. The incidence of, risk factors for, and outcomes of CDI in severely burned patients are poorly studied and remain unclear. This study involves retrospective case control and cohort studies using electronic medical records from February 1, 2002 to January 31, 2009 at the US Department of Defense's only burn unit. Demographic, risk factor, and outcome data were collected for all C. difficile toxin positive patients in the burn, medical, and surgical intensive care units and the hospital's step down unit along with an additional analysis of a 2:1 matched control of C. difficile toxin negative to positive burn patients. In the burn intensive care unit (BICU) population there was an incidence of 7.9 cases per 10,000 patient days; less than the non-burn unit rate of 15.2 cases (p-value < 0.01). The BICU patients were young males with a median 42% total body surface area burns. There were higher frequencies of operations and prior aminoglycoside use, with longer unit stays and times until death or discharge. There was no difference in treatments, morbidity, or mortality. The comparison of patients with positive and negative C. difficile toxin among those in the BICU revealed few significant differences in risk factors or outcomes. Differences in risk factors between burn and non-burn patients were likely markers of the populations rather than independent risk factors for CDI in the burn population with overall lower rates likely reflective of younger, healthier patients in the BICU and more aggressive infection control practices.     

Polymorphonuclear leucocyte motility in patients with severe burns

Chemotaxis, chemokinesis and cellular orientation were measured for unstimulated and 10(-7) n-formyl methionyl leucyl phenylalanine (F-met-leu-phe) stimulated polymorphonuclear leucocytes (PMNS) of nine patients with recent 10-80 per cent burns using a computer-assisted image analysis technique. The technique records PMN movement, as viewed with a phase-contrast microscope on videotapes, and then uses computer programs to calculate the speed and direction of up to 50 PMNS over a 5-min period. Orientation was determined visually. Cellular adherence was also measured by attachment methods. PMNS from burn patients were slower (av. speed 16.8 microns/min), responded less well to F-met-leu-phe (av. speed 20.9 microns/min, av. McCutcheon index 0.32), were less often oriented towards the chemoattractant (av. 39 per cent) and were more adherent (av. 50 per cent) than control cells (av. speed 21.8 microns/min; av. speed F-met-leu-phe 32.2 microns/min; McCutcheon index 0.61; oriented 59 per cent adherent; 16 per cent). Thus PMNS from burn patients orient less well, are significantly slower and have less directionality in response to a chemoattractant, and are more adherent suggesting activation.     

Central nervous system infections in patients with severe burns

Background

Central nervous system (CNS) infections develop in 3–9% of neurosurgical ICU patients and 0.4–2% of all patients hospitalized with head trauma. CNS infection incidence in burn patients is unknown and this study sets out to identify the incidence and risk factors associated with CNS infections.

Methods

A retrospective electronic chart review was performed from 1 July 2003 to 30 June 2008 evaluating inpatient medical records along with cerebrospinal fluid (CSF) microbiological results for the presence of CNS infection. The presence of facial and head injuries and burns, along with intracranial interventions were reviewed for association with CNS infections.

Results

There were 1964 admissions with 2 patients (0.1%) found to have CNS infection; 1 each with MRSA and Acinetobacter baumannii. Both patients had facial burns and trauma to their head that required intracranial surgery. Of note, both patients had bacteremia with the same microorganisms isolated from their CSF and both survived. Of all patients, 29% had head or neck trauma and burns; 0.35% of those had a CNS infection. Scalp harvest for grafts or debridement of burned scalp was performed on 125 patients of which 9 had an invasive surgical procedure that involved penetration of the skull. The 2 infected patients were from these 9 intracranial surgical patients revealing a 22% infection rate.

Conclusion

The incidence of CNS infections in patients with severe burns is extremely low at 0.1%. This rate was low even with head and face burns with trauma unless the patient underwent an intracranial procedure.     

Characteristics of elderly Japanese patients with severe burns

In this study, we report the clinical characteristics of elderly Japanese patients with severe burns.     

Quality of life of adult patients with severe burns

Background

Burns are one of the most significant health problems throughout the world, leading to prolonged hospitalisation and hence increased expense for the patients, their families and society. Today, the prognosis of patients with burns is dependent, apart from adequate treatment, upon the health-care system and health-care professionals, regarding not only survival, but also lifelong quality of life. This study aims to assess quality of life of adult patients with severe burns.

Patients and methods

This study was conducted on 100 adult patients with severe burns in the burn outpatient clinic (male and female) at Mansoura University Hospital. Parameters of burn and Burn Specific Health Scale (BSHS-B) were used to assess quality of life following burns.

Results

The study revealed that burns has negative impact on most dimensions of the quality of life of patients with burns.

Conclusions

The quality of life for people who have sustained a burns should be recognised and valued by the burn team in all phases of burn care.     

Specific immunity in patients with severe burns complicated by Pseudomonas infection

The authors have studied 500 samples of blood serum in 262 patients at the age of from 17 to 70 years with thermal burns of different severity degree, depth of injury and location, which were followed by severe infective processes of pyocyanic etiology, and also in reconvalescents of the burn disease. It was established that despite the high degree of staphylococcal and pyocyanic sensibilization, the specific immune response against the background of infective process developed only in a small number of patients with severe burns.     

New tactics in the therapy of children with severe burns (author's transl)

The burns of the children could be very severe, but they can get over the first phase (shock) if suitable tactics are applied. Nowadays the second phase of the burns are dominant. The length of the second phase basically influences the developing of complications. The early (immediately) excision, the simultaneous substitution with homografting, and heterografting represents the technics which led to a fundamentally favourable prognosis.     

Value of fibrin glue in surgery of patients with severe burns]

From January 1985 to May 1986, fibrin glue was used for graft sealing in 158 cases of our 200 skin grafts performed for the treatment of burns. When the graft area was less than 200 cm2, primary and complete healing was routinely observed. In the remainder, we noticed a higher quality of healing when fibrin glue was used compared to the other grafts. In 2 patients, infection of the wound was responsible for a total graft lysis which occurred immediately in the non-sealed grafts and was delayed in the sealed ones. Fibrin glue shortens skin graft healing time while it procures a better quality of life in patients with burns during in hospital stay. However the use of this healing-facilitating compound has to be limited to well-defined indications.     

Hypnosis and pain in patients with severe burns: a pilot study

This report presents a pilot study on the effectiveness of hypnosis in the control of pain during dressing changes of burn patients. Eight patients were treated, and all evaluated the interventions as beneficial. The treatment of four patients was more closely analysed by obtaining pain and anxiety ratings daily. Results show a 50-64 per cent decrease in reported pain level for three patients and a 52 per cent increase of pain for one patient. The mean decrease for these four patients was 30 per cent (for overall as well as worst pain during dressing changes). A 30 per cent reduction of anxiety level and a modest reduction of medication use were achieved concurrently. It is concluded that hypnosis is of potential value during dressing changes of burn patients. Comparison of global evaluations and daily pain ratings shows that systematic research in some cases leads to conclusions opposite from clinical observations or follow-up evaluations. Limitations of this study are discussed and recommendations for future studies are given.