QUANTITATIVE MICROBIOLOGY IN THE MANAGEMENT OF BURN PATIENTS .2. RELATIONSHIP BETWEEN BACTERIAL COUNTS OBTAINED BY BURN WOUND BIOPSY CULTURE AND SURFACE ALGINATE SWAB CULTURE, WITH CLINICAL OUTCOME FOLLOWING BURN SURGERY AND CHANGE OF DRESSINGS

The use of quantitative bacteriology in the barns unit has been though t to be efficient in predicting sepsis or graft loss. To examine the r elationship between clinical outcome and bacterial densities on and in the burn wound 69 biopsy/surface swab pairs were collected from 47 pa tients on 64 occasions, either immediately prior to excision and graft ing, or at routine change of dressings. The mean per cent TBSA barn wa s 16 (range 1-65). There was a significant correlation between log fet al bacterial count by biopsy with total white cell count and age (P=0. 028), and a significant negative correlation between total bacterial c ount by swab with per cent TBSA (P=0.006). There was no significant di fference in bacterial counts between patients judged to be a clinical success or clinical failure (72 h follow-up), either after undergoing excision and grafting, or change of dressings, and no difference in co unts between patients with perioperative bacteraemia and those without . With bums > 15 per cent TBSA, a relationship between bacterial count s and subsequent sepsis or graft loss still was not demonstrated. It i s suggested that quantitative bacteriology by burn wound biopsy or sur face swab does not aid the prediction of sepsis or graft loss.