Adjunctive hyperbaric oxygen therapy for chronic burn injuries complicated by MRSA and multidrug-resistant
Mendy Hatibie Oley1,2,3, Maximillian Christian Oley3,4,5, Christian Theodorus Hendra Kawengian3
1Reconstructive & Aesthetic Plastic Surgery Division, Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia.
Introduction And Importance:
Burn injuries are frequently complicated by multidrug-resistant (MDR) organisms and methicillin-resistant Staphylococcus aureus (MRSA), leading to delayed healing and increased morbidity. Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunctive modality to enhance tissue oxygenation, promote angiogenesis, and improve infection control, yet evidence for its use in chronic MDR-infected burns remains limited.
Case Presentation:
A 43-year-old male sustained lava-related burns involving 15% of total body surface area, affecting the lower back and bilateral lower extremities. Initial management included antibiotics and surgical debridement; however, persistent MDR infection developed, including MRSA and extensively drug-resistant Acinetobacter baumannii. Serial debridement was performed every 48 h, totaling 21 procedures. HBOT was initiated on day 17, delivered in a monoplace chamber at 2.4 ATA for 90 min daily over 30 sessions. Targeted intravenous antibiotics, multimodal analgesia, and structured rehabilitation were concurrently administered. Microbiological surveillance demonstrated progressive narrowing of pathogens, culminating in near-complete clearance of MRSA and Pseudomonas aeruginosa.
Clinical Discussion:
HBOT likely contributed to enhanced wound healing through increased tissue oxygenation, promotion of granulation, neutrophil activation, and disruption of bacterial biofilms. The combined approach of HBOT, repeated debridement, targeted antibiotics, pain management, and rehabilitation facilitated near-complete epithelialization (~90%) and functional recovery. Safety was ensured through rigorous monitoring, with no adverse events reported.
Conclusion:
Adjunctive HBOT may enhance infection control and accelerate healing in chronic burn injuries complicated by MDR organisms. Early integration with surgical and antimicrobial management should be considered in complex, non-healing burns, particularly when conventional therapy is insufficient.
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