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Changing flora in burn and trauma units: experience in the United Kingdom
J D Frame1, L Kangesu, W M Malik
1North East Thames Regional Plastic Surgery and Burns Unit, St. Andrew's Hospital, Billericay, Essex, England.
Abstract:
Bacterial colonization of burned and devitalized tissue is inevitable. The types of organisms that are isolated from burn wounds depend on such factors as preexisting illness, types of topical antiseptics and antimicrobials used, microbial sampling techniques, and indigenous flora that inhibit the burn unit. Among organisms that are capable of producing disease, Staphylococcus aureus remains the most common isolate in the patient with burns. The decrease in the prevalence of Pseudomonas aeruginosa, which was initiated by the advent of effective topical antiseptics, appears to have continued to the present. Acinetobacter is now a common organism in the burn unit; although the organism has developed resistance to multiple antimicrobial agents, it infrequently causes serious problems. Comparisons between burn units with intensive-care capability that practice an aggressive approach to surgical management and burn units that continue to use a more traditional approach have revealed little difference with regard to incidence of or time to acquisition of potentially pathogenic bacteria. In a recent comparison that involved a unit of each type, marked reductions in the incidence of isolation of P. aeruginosa and Streptococcus group A organisms were observed over the course of 2 years in both of the units. Significant problems with viruses, yeasts, and fungi have not yet been encountered (or identified) in burn units; further study of the potential role of such organisms in infection in the patient with burns is required.
Insights
Bacterial burn wound infections are common, with Staphylococcus aureus being the most frequent pathogen. While Pseudomonas aeruginosa is less prevalent, Acinetobacter is now common but rarely causes severe issues.
Area of Science:
- Infectious Diseases
- Burn Care
- Microbiology
Background:
- Bacterial colonization of burn wounds is unavoidable.
- Microbial isolates from burn wounds are influenced by patient health, treatments, and unit flora.
- Staphylococcus aureus is the most prevalent pathogen in burn patients.
Observation:
- Pseudomonas aeruginosa prevalence has decreased due to topical antiseptics.
- Acinetobacter is now common in burn units but infrequently causes severe infections.
- Surgical management approaches show little difference in pathogenic bacteria acquisition.
Findings:
- Both aggressive and traditional burn care units showed reduced isolation of Pseudomonas aeruginosa and Streptococcus group A.
- Further research is needed on the role of viruses, yeasts, and fungi in burn infections.
Implications:
- Effective topical antiseptics have impacted burn wound microbiology.
- Current burn care practices may not significantly alter the incidence of pathogenic bacterial acquisition.
- The role of non-bacterial pathogens in burn wound infections requires further investigation.