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An epidemiological profile and trend analysis of wound flora in burned children: 7 years' experience
Insights
This study on pediatric burn patients found Staphylococcus aureus predominant in smaller burns, while Pseudomonas dominated larger ones. Silver sulfadiazine remains effective, but antibiotic resistance necessitates strict usage controls.
Area of Science:
- Infectious Diseases
- Burn Care
- Microbiology
Background:
- Understanding burn wound infections is critical for patient outcomes.
- Antibiotic resistance poses a significant challenge in managing burn patients.
- Identifying common pathogens and their resistance patterns informs treatment strategies.
Purpose of the Study:
- To analyze wound flora and invasive organisms in pediatric burn patients.
- To identify trends in antibiotic resistance patterns.
- To evaluate the effectiveness of topical antimicrobial agents and inform infection control practices.
Main Methods:
- Retrospective chart review of 5418 culture and sensitivity reports.
- Analysis of data from 93 pediatric burn patients.
- Trend analysis of microbial isolates and antibiotic susceptibility.
Main Results:
- Coagulase-positive Staphylococcus was the predominant pathogen in burns <60% body surface area (BSA).
- Pseudomonads were the predominant invasive organism in burns ≥60% BSA.
- Silver sulfadiazine demonstrated sustained efficacy; however, multi-drug resistant Pseudomonads were frequent, especially with silver sulfadiazine-cerium nitrate treatment.
Conclusions:
- Increasing burn size correlates with higher incidence of Gram-negative and invasive organisms.
- Strict antibiotic stewardship and environmental controls in burn units can reduce nosocomial infections and resistance.
- Regular monitoring of burn wound flora and adherence to wound care protocols are effective in preventing sepsis.
Abstract:
A retrospective chart review was conducted of 5418 culture and sensitivity reports from 93 paediatric burn patients to determine profiles of wound flora and invasive organisms, trend analysis and patterns of antibiotic resistance. Coagulase-positive Staphylococcus was the predominant burn wound pathogenic isolate and the predominant invasive organism for burns less than 60 per cent BSA. Pseudomonads were the predominant invasive organism for burn wounds greater than or equal to 60 per cent BSA. Only 7 per cent of all pathogenic isolates were fungi. A significant association was demonstrated between increasing burn size and an increasing incidence of Gram-negative and invasive organisms. Silver sulphadiazine remains a very effective topical agent for the control of bacterial and fungal growth in burn wounds after 10 years of intensive use in this burn unit. Pseudomonad isolates were routinely multi-drug resistant. Pseudomonad isolates from wounds treated topically with a silver sulphadiazine-cerium nitrate mixture were frequently resistant to aminoglycosides, colistin and carbenicillin. It is concluded from this review that severe restrictions on antibiotic usage within burn units, and strict internal environmental control within burn units may help to decrease the incidence of nosocomial resistant strains and cross infection. Regular monitoring of burn wound flora, and the protocol for wound care used in treating these patients have been effective in preventing septic episodes and death due to sepsis.