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Perineal Diagnostic Microbial Swabs As A Predictive Parameter In Pediatric Burn Injury
S Bohr1,2,3, T Mammadli4,2
1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, EKM Clinics, Germany.
Insights
Perineal diagnostic microbial swabs (PDMS) can predict wound infections in infants with scald burn injuries. This method identifies an enteric reservoir, aiding in early intervention and preventing complicated infections.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Microbiology
Background:
- Infants with scald burn injuries face a significant risk of secondary wound infections.
- The enteric tract can serve as a reservoir for pathogens causing these infections, even after initial wound care.
Purpose of the Study:
- To assess the predictive value of perineal diagnostic microbial swabs (PDMS) for identifying enteric reservoirs.
- To determine if PDMS can predict clinically relevant microbial burn wound colonization and subsequent infections in infants.
Main Methods:
- Perineal swabs were collected from infants upon admission with scald burn injuries.
- Clinical data including fever, white blood cell count (WCC), C-reactive protein (CRP), and need for surgical revision were recorded.
- Statistical analysis, including odds ratios (OR), was used to correlate PDMS results with wound infection outcomes.
Main Results:
- PDMS proved to be an independent predictor of clinically relevant microbial wound colonization in pediatric patients.
- For burns exceeding 5% total burn surface area (TBSA), initial PDMS results predicted infections requiring intervention with approximately 10-fold odds.
- A significant risk of infection from the enteric reservoir was observed, even with sterile protocols.
Conclusions:
- PDMS is a valuable tool for characterizing the enteric microbial reservoir in infants with scald burns.
- Incorporating PDMS can guide therapeutic strategies, such as antibiotic therapy and wound management, to prevent complicated infections.
Abstract:
The aim is to evaluate the predictive usefulness of perineal diagnostic microbial swabs (PDMS) which will identify an enteric reservoir as possible source of concomitant wound infection following scald burn injury in infants. Perineal swabs were taken on admission of infants presenting with scald burn injury along with a standardized protocol of initial sterile surgical field cleansing and dressing. Complicated (CC) and uncomplicated (UC) clinical cases were discriminated based on parameters of significant microbial burn wound colonization, such as onset of fever, white blood cell count (WCC), C-reactive protein (CRP) and a concomitant need for surgical wound revision with/without guided antibiotic therapy. Relative risks (RR) / odds ratios (OR) based on microbial swab results were calculated related to anticipated wound infection. We found PDMS to be an independent predictive parameter for clinically relevant microbial wound colonization in pediatric patients (n=274; age 2.81±2.69). Most importantly, we show that in patients with initial total burn surface area (TBSA) >5%, clinically relevant burn wound infection requiring intervention can be predicted from initial perineal swab results with ORs ~10fold. Infants presenting with scald burn injury are exposed to a relevant risk of wound infection emanating from a unique microbial enteric reservoir, even with initial surgical decontamination and sterile dressing protocols, warranting further hospitalization. Based on our findings we suggest PDMS as a useful additional predictive parameter to (i) characterize the relevant enteric microbial reservoir and (ii) direct further therapeutic measures with the aim of preventing complicated wound infections, including preemptive aseptic wound dressings, guided antibiotic therapy and surgical wound revision.
