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ISSN 2007-5294 (Print)
Confederación Nacional de Pediatría de México, A. C. (CONAPEME)

2009, Number 1

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Pediatr Mex 2009; 11 (1)

Sepsis in burn children: Clinical and microbiologic characteristics in a retrospective series

Loaiza-Guzmán JJ, Pérez-Hernández V

Language: Spanish
References: 37
Page: 24-28
PDF size: 69.09 Kb.


ABSTRACT

Introduction: Burns in children represent a serious problem of public health in all over the world. Sepsis as a complication is the main cause of death. The goal of this study is to know the clinical course and bacteriological features in burn children with sepsis. Methods: Based on observational, descriptive, retrospective, crossover study we studied 19 patients during a period of 17 months. We use a descriptive statistics to show the results. Results: The most common cause of burns was due to scalding (84.2%). The body surface percentage affected was 23.4%. The most of children sustained partial thickness burns. Early disturbances of sepsis were increase of breathing and gastrointestinal abnormalities (94.7%). A sudden increase of temperature was also a common feature (89.4%). Sepsis was present between 6 to 15 days after burn. Gram-negative germs were isolated in 72.4%. Klebsiella sp., coagulase-negative Staphylococcus and Citrobacter sp., were the most common germs in blood cultures. Five children died. Conclusions: We must have a high index of suspicion to identify as soon as possible sepsis in burn children in order to begin specific antimicrobial therapy. It is important to take peripheral culture samples before starting antibiotics.


REFERENCES

  1. Mason AD Jr, McManus AT, Pruitt BA Jr. Association of burn mortality and bacteremia. Arch Surg 1986; 121: 1027-1031.

  2. Shelby J, Merrell SW. In vivo monitoring of postburn immune response. J Trauma 1987; 27: 213-216.

  3. Gang RK, Bang RL, Sanyal SC, Mokaddas E, Lari AR. Pseudomonas aeruginosa septicaemia in burns. Burns 1999; 25: 611-616.

  4. Sparkes BG. Immunological responses to thermal injury. Burns 1997; 23: 106-113.

  5. Jones WG, Minei JP, Barber AE, Rayburn JL, Fahey TJ, Shires GT Jr, Shires GT. Bacterial translocation and intestinal atrophy after thermal injury and burn wound sepsis. Ann Surg 1990; 211: 399-405.

  6. Winkelstein AU. What are the immunological alterations induced by burn injury? J Trauma 1984; 24 (Suppl): S72-S83.

  7. Alexander JW. Control of infection following burn injury. Arch Surg 1971; 103: 435-441.

  8. Bang RL, Gang RK, Sanyal SC, Mokaddas EM, Lari ARA. Beta-haemolytic Streptococcus infection in burns. Burns 1999; 25: 242-246.

  9. Lesseva MI, Hadjiiski OG. Staphylococcal infections in the Sofia Burn Centre, Bulgaria. Burns 1996; 22: 279-282.

  10. Nagoba BS, Gandhi RC, Wadher BJ, Deshmukh SP, Gandhi SP. Citric acid treatment of severe electric burns complicated by multiple antibiotic resistant Pseudomonas aeruginosa. Burns 1998; 24: 481-483.

  11. Pruitt BA, McManus AT. The changing epidemiology of infection in burn patients. World J Surg 1992; 16: 57-67.

  12. García-Bernal FJ, Torrero V, Regalado J, Gabilondo FJ. Bacteriology in burn patients undergoing mechanical ventilation. Burns 2000; 26: 731-736.

  13. Wisplinghoff H, Pergbix W, Seifert H. Risk factors for nosocomial bloodstream infections due to Acinetobacter baumannii: a case-control study of adult burn patients. Clin Infect Dis 1999; 28: 59-66.

  14. Richardson SE, Bannatyne RM, Summerbell RC, Milliken J, Gold R, Weitzman SS. Disseminated fusarial infection in the immunocompromised host. Rev Infect Dis 1988; 10: 1171-1181.

  15. Levenson C, Wohlford P, Djou J, Evans S, Zawacki B. Preventing postoperative burn wound aspergillosis. J Burn Care Rehabil 1991; 19: 765-767.

  16. Walton MA, Villarreal C, Herndon DN, Heggers JP. The use of aztreonam as an alternate therapy for multi-resistant Pseudomonas aeruginosa. Burns 1997; 23: 225-227.

  17. Gang RK, Sanyal SC, Mokaddas E, Lari AR. Rifampicin as an adjunct to vancomycin therapy in MRSA septicaemia in burns. Burns 1999; 25: 640-644.

  18. Cone JB, Wallace BH, Lubansky HJ, Caldwell FT. Manipulation of the inflammatory response to burn injury. J Trauma 1997; 43: 41-46.

  19. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992; 20: 864-874.

  20. Carvajal HF, Feinstein R, Traber AL, Parks DH, Kiker R, Larson DL, Whorton EB. An objective method for early diagnosis of Gram-negative septicaemia in burned children. J Trauma 1981; 21: 221-227.

  21. Lavrentieva A, Kontakiotis T, Lazaridis L, Tsotsolis N, Koumis J, Kyriazis G, Bitzani M. Inflammatory markers in patients with severe burn injury. What is the best indicator of sepsis? Burns 2007; 33: 189-194.

  22. Pruitt BA, McManus AT, Kim SH, Goodwin CW. Burn wound infections: current status. World J Surg 1998; 22: 135-145.

  23. Barlow Y. T lymphocytes and immunosuppression in the burned patient: a review. Burns 1994; 20: 487-490.

  24. Bang RL, Gang RK, Sanyal SC, Mokaddas E, Ebrahim MK. Burn septicaemia: an analysis of 79 patients. Burns 1998; 24: 354-361.

  25. Gang RK, Sanyal SC, Bang RL, Mokaddas E, Lari AR. Staphylococcal septicaemia in burns. Burns 2000; 26: 359-366.

  26. Hayden WR. Sepsis terminology in pediatrics. J Pediatr 1994; 124: 657-658.

  27. Barret JP, Jeschke MG, Herndon DN. Selective decontamination of the digestive tract in severely burned pediatric patients. Burns 2001; 27: 439-445.

  28. Sheridan RL, Weber JM, Peterson HF, Tompkins RG. Central venous catheter sepsis with weekly catheter change in paediatric burn patients: an analysis of 221 catheters. Burns 1995; 21: 127-129.

  29. Dijkstra HM, Manson WL, Blaauw B, Klasen HJ, de Smet B. Bacterial translocation in D-galactosamine-treated rats in a burn model. Burns 1996; 22: 15-21.

  30. Taylor GD, Kibsey P, Kirkland T, Burroughs E, Tredget E. Predominance of Staphylococcal organisms in infections occurring in a burn intensive care unit. Burns 1992; 18: 332-335.

  31. Wolf S, Jeschke M, Rose K, Desai M, Herndon D. Enteral feeding intolerance. Arch Surg 1997; 132: 1310-1314.

  32. Ong YS, Song MSC. Meta-analysis of early excision of burns. Burns 2006; 32: 145-15.

  33. Atiyeh BS, Costagliola M, Hayek SN, Dibo SA. Effect of silver on burn wound infection control and healing: review of the literature. Burns 2007; 33: 139-148.

  34. Luterman A, Dacso CC, Curreri PW. Infections in burn patients. Am J Med 1986; 81 (Suppl 1A): S45-S52.

  35. Monafo WW, Freedman B. Topical therapy for burns. Surg Clin North Am 1987; 67: 133-145.

  36. Neely AN, Holder IA. Antimicrobial resistance. Burns 1999; 25: 17-24.

  37. Al-Qattan MM. «Late» multiorgan failure in major burns: a «three-event» construct rather than a «two-event» construct. Burns 2007; 33: 268-270.




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