UNUSUAL DEVELOPMENT OF GRANULOMAS ON THE HEALING SURFACE OF BURN WOUNDS ASSOCIATED WITH MRSA INFECTIONS

Ten patients with a mean age of 14.5 years and partial skin thickness bums involving 3-5 per cent body surface areas developed rapidly proli ferating tumour-like growths on the surface of their healing wounds wi thin 10-21 days of sustaining the injuries. The number of tumours on e very patient was either single or multiple and each increased in size daily. The growths were unique in their fulminating-type fleshy mass, with a consistency varying from soft to firm, absence of purulent mate rial or head, and extension up to the fibrous layer covering the muscu lature. Histopathology was suggestive of granulomatous rather than a s uppurative nature of the lesions. Isolation of MRSA from the burn woun ds of four cases on the first day of dressing and then from the surfac e of the tumours of all of them and the excised tissues, as well as fr om the environment of the dressing room, indicated its involvement in the causation of the growths through contaminations of wounds with a h ospital endemic strain while handling or dressing. The organisms were resistant to mast antibiotics except vancomycin and teicoplanin. The g rowths in four cases subsided within 72 h with daily dressing, using a n injectable solution of either vancomycin or teicoplanin, while the r est required radical excision and immediate cover with split skin graf ts and systemic administration of either of the antiobiotics. The woun ds healed over a period of 8-10 days.