Correlation of quantitative burn wound biopsy culture and surface swab culture to burn wound sepsis

The present study includes seventeen patients with second and third degree fresh burns involving 15–50 per cent total body surface area (TBSA). Surface swabs and quantitative burn wound biopsy cultures were obtained during postburn weeks 1,2 and 3 and correlation was studied. To obtain bacterial counts the technique described by Loebel et al. (1974) was used. The patients were divided in two groups depending upon burn body surface area involved. The first group includes five patients with burns between 15–29 per cent body surface area and the second group includes the rest of the twelve patients with burns between 30–50 per cent body surface area. No patient from group I showed any sign or symptom of sepsis whereas seven patients from group II developed sepsis and three died. These three patients showed positive blood culture at the time of death. Of the 48 cultures obtained in all the patients over 3 weeks, 7 cultures showed differences between swab and biopsy cultures. Genticyn was the most effective drug against Gram-negative organisms.     

Incidence of burn wound sepsis in 600 burned patients treated in a developing country

Infection is the most important problem in the treatment of burns in a developing country. A burn compromises a major body protective mechanism, namely the skin. Hence, the susceptibility to local infection increases at these sites. The incidence of burn wound sepsis is very high in south India as the socio-economic conditions and the standard of personal hygiene are poor and the hot moist climatic conditions encourage bacterial growth. These three factors are rarely present in the temperate zone countries of Europe and North America. This study was undertaken to identify more clearly the factors that are responsible for the higher incidence of burn wound infection and to formulate methods of treatment which are appropriate for our patient population living in a tropical country.     

Infection in burn patients

In a recently opened burn unit which used a semi-isolation technique to treat burn patients, burn bacteriology has shown the usual pattern of bacterial cultures i.e. Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Klebsiella and Proteus; with the first two predominating. Comparison with a similar study done in 1974 revealed that Streptococcus faecalis was absent in these cultures, E. coli and S. aureus infection had decreased, the number of sterile wounds had increased, there was slight increase in P. aeruginosa infection.A survey of burn wound, throat and stool cultures of patients and attendants over a 2-week period revealed pathogenic S. aureus in 3 out of 26 throat cultures. Phage typing of these strains did not reveal the same strain in any wound cultures. Similar phage type was grown from wounds in two different cabins on two different dates, thus indicating cross infection. Persistence of similar phage type was also seen in wounds of one patient. Similar aeruginocine typing of P. aeruginosa was seen in wound cultures of two different patients; one of these, type 15, was also grown in stool of the third patient thus indicating transmission of infection from the stool of one patient to the wound of other patient and from the wound of one patient to the wound of other patient.     

Serodiagnosis of the role of opportunistic bacteria in cases of burn wound sepsis

In the present study, the antibody titres in the serum of 21 patients with burns were analysed against various Gram-negative organisms, infecting the wounds of these patients. Antibody titre was determined on the first, fourth and tenth day of admission. The rise in antibody titre was correlated with the age of the patient, degree and area of burns and clinical status of the burn wounds.     

1981 Circus fire disaster in Bangalore,India: Causes,management of burn patients and possible presentation

The circus fire disaster claimed 92 lives and 300 others were injured. A total of 119 patients were treated in the Burns centre at Victoria Hospital. Forty-two patients were treated as outpatients and 77 cases were admitted. Fourteen patients with more than 80 per cent burns of the body surface died within 48 hours of the disaster. Three patients out of the remaining 63 cases died in the course of treatment, 32 patients were operated by escharectomy and skin grafting or flap procedures. Proper medical assessment, early fluid therapy and respiratory care saved many critical patients. Human Antitetanus toxin and Pseudomonas hyper Immune globulin seem to have a definite role in the prevention and control of infection with Clostridium tetani and Pseudomonas aeruginosa. ‘Furacin’ was found to be a valuable topical agent.     

Report on evaluation of hydron film as burn wound dressing

Hydron Burn Dressing, an amalgam of Polyethylene Glycol-400, and Polyhydroxyethyle methacrylate formed directly on the burn wound has been used in 50 cases with comparable control areas on the same patients which were managed by Polybactrin spray and exposure. The 4-layer film was found to be easily applicable in indoor patients and was pain-free during application and reduced pain after application in superficial burns. It was found to be translucent, pliable, less liable to crack and did not peel offonce dried. The rate of infection was found to be 12.5 per cent more than the controls but the healing time was shorter by 2.8 days. Patient's comfort and compliance was better than the scab of the control areas.     

Appearance of the sheep red blood cell receptor on burn T-lymphocytes after cold incubation in fetal calf serum—a possible prognostic test

In patients sustaining thermal injury, a longitudinal study was designed to evaluate total T-cells and a subpopulation of active T-cells (T₁hr). Additionally, the in vitro effect of overnight incubation at 4°C on the active T₁-cells was studied.The preliminary observations were: (1)Within 10 days of thermal injury, a marked depression of total T-cell number occurred which was paralleled with depression in T₁-cell number; (2) on follow up, although the total T-cell number showed an increase, it did not reveal any significant alteration in survivors and non survivors. In survivors, there was a gradual return of T₁-lymphocyte number to the normal range. Overnight incubation of T₁-cells in 10 per cent fetal calf serum at 4°C demonstrated a remarkable increase in survivors only. This observation suggests that incubation of cells at 4°C for 24 hours may help to modify the cell membrane resulting in an increased receptor affinity for sheep red blood cells. Though the exact mechanism remains obscure the above observation might contain some prognostic significance.     

Nailfold retraction due to burn wound contracture. A surgical procedure

Burn scar contracture on the dorsal aspect of fingers or toes often leads to retraction of the protecting nailfold, which may be extremely annoying to the patient. A surgical procedure for relocation of the nailfold is presented.     

Burns and Corynebacterium diphtheriae

The wounds of 50 burn cases were studied for the possibility of infection by Corynebacterium diphtheriae. In contrast to the study of Ayyagari et al. (1979), the present study did not reveal any case of diphtherial infection in burn wounds.     

Treatment of severe burn cases in the air-fluidized bed

During a half-year period, the air-fluidized bed was used in the treatment of severely burned patients. In most cases good results were obtained. However, in the treatment of a 31-year-old patient with second and third degree burns of 40 per cent of the total body surface area, there occurred severe hypernatraemia, hyperosmolarity of the serum, mental disorientation and decubitus ulcers. The positive and negative results of the treatment are presented. Reasons for the poor results experienced in our series and in other burn centres will be discussed.     

Control of burn wound infections by pefloxacin and its silver derivative

As might be anticipated, strains of Pseudomonas aeruginosa resistant to silver sulfadiazine have appeared. We have found an analogue of nalidixic acid (pefloxacin) which, along with its silver derivative, is highly effective against these resistant strains. In vitro the minimal inhibitory concentrations are 10 to 20 times lower than that of silver sulfadiazine against bacteria. In burned mice and rats infected with silver sulfadiazine resistant pseudomonas strains, mortality in groups receiving topical therapy with pefloxacin and silver pefloxacin is about 10 per cent compared to 80 per cent with silver sulfadiazine (100 per cent in untreated controls). There is little systemic absorption of pefloxacin and no absorption of silver from topical treatment. In addition, silver pefloxacin exhibits higher antifungal activity in vitro.     

Microcirculation of a scald burn: An in vivo experimental study of the hairless mouse ear

This experimental model using the hairless mouse ear presents a new model for microcirculatory investigation of skin. It concludes that the scald burn injury to the microcirculation is progressive during the first 48 hours post burn and that platelet microthromboembolism appears to be a major cause of this progression.     

Urine cortisol levels after burn injury

The urinary level of cortisol has been assayed in 19 patients with burn injuries of varying severity over a 10-day period. Urine cortisol was increased in all patients over the initial days post burn when compared to normal healthy volunteers. In patients with the more severe burns mean cortisol levels reached a maximum on day 2 post burn when cortisol levels correlated with the percentage body surface area of the burn. The overall pattern of cortisol excretion was similar in extent and duration to the changes in the levels of serum cortisol described in a previous study (Batstone et al., 1976). Further, urine cortisol excretion correlated with the levels of urine creatinine, magnesium, potassium and the sodium: potassium ratio lending further evidence to an important role of cortisol in peripheral tissue (particularly muscle). Cortisol output was still significantly raised at the end of the study period emphasizing the duration of the cortisol-induced catabolic drive after burn injury.     

Repigmentation after burn injury in the guinea-pig

The normal process of repigmentation of small partialand full-thickness burn wounds in the guinea-pig has been studied visually, and by light microscopy and transmission electron microscopy of biopsy material, at various stages of healing. Repigmentation proceeded apace with re-epithelialization and occurred progressively from the periphery to the centre of the wound or scar. There was an initial lag period of 1 to 2 weeks post burn during which the melanocytes and melanin content of the regenerated epithelium were below or around normal control levels. Thereafter, the melanocytes and melanin were above normal levels and correlated with hyperpigmentation of the scar epithelium.Electron microscopy at 6 and 7 weeks post burn also confirmed the increased melanogenic and cytochrine activity of the melanocytes during this phase of burn healing.     

A practical approach to the treatment of burn shock in childhood

A simple method of evaluating and treating burn shock has been used with very good results and low mortality.The amounts of fluids given in a specific time and the type of fluids given are dependent upon the evaluation of a few simple observations. We believe that shock is a treatable condition and that ‘shock kidney’ is preventable.We stress the difficulty of trying to compare the results of two different burn units.     

Histopathological and ultrastructural changes in liver tissue from burned patients

Histopathological studies were made on samples of liver and spleen tissue taken post mortem from 59 patients with severe burns. Samples from 8 patients were also studied using the transmission electron microscope. The main pathological findings were degeneration and necrosis of hepatic cells and proliferation of Kupffer cells showing active phagocytosis. Their causes in relation to the time of death after burning and severity of injury have been discussed. The proliferation of Kupffer cells may be a compensatory reaction to the severe splenic injury seen in the patients.