The prevention of wound infections in burn patients

To investigate the necessity of "protective isolation" and/or gastrointestinal tract decontamination in the prevention of infections in burn patients treated under ward conditions, a bacteriological inventory of burn sites, oropharynx and faeces was made 3 times a week. The origin of bacteria isolated from the lesions was determined by typing. In addition, the effect of local protection by topical application of silver-sulphadiazine or nitrofuralum was investigated. Of potentially pathogenic bacteria known to cause infections in burn, St. aureus was found to be almost exclusively exogenous in origin. Str. pyogenes, on the other hand, appeared either to be strongly inhibited by topical treatment or else to have colonized the wounds only from endogenous sources. Endogenous (gi-tract) Enterobacteriaceae biotype-positive samples were restricted to burn sites near the mouth and the anus. Enterobacteriaceae biotypes of exogenous origin appeared to colonize wounds of about one third of the patients. It is concluded that topical protection is insufficient in the prevention of bacterial colonization of the lesions. Therefore, protective isolation (St. aureus, etc.) and selective gastrointestinal decontamination are to be considered for infection prevention.