BURN SEPTICEMIA - AN ANALYSIS OF 79 PATIENTS

Out of 943 patients treated from June 92 to May 96 at the burns unit o f the Al-Babtain Centre for Plastic Surgery and Burns, Kuwait, 280 (30 %) required admission to the burns intensive care unit (ICBU) and were studied retrospectively. Seventy-nine (28.2%) developed clinically an d microbiologically proven septicaemia. Forty-four (56%) were males, 3 5 (44%) females with a mean age of 26 years (range 45 days to 75 years ) and mean total body surface area burn (TBSA) of 46% (range 10-90%). Sixty-two had flame burns, 16 a scald and one had an electric burn. Th ese 79 patients had a total of 118 septicaemic episodes. Sixty (76%) h ad only one and 19 (24%) had multiple episodes of septicaemia. Fifty-f our (68%) had their first episode within 2 weeks, though the maximum n umber of episodes was between 6 and 10 days postburn. Septicaemia was also observed in 13% of patients within 3 days postburn. Out of the 11 8 episodes, 48 were due to methicillin resistant Staphylococcus aureus (MRSA), 17 due to methicillin resistant Staphylococcus epidermidis (M RSE), 15 to Pseudomonas, 12 to Acinetobacter, four to Streptococcus, a nother four to Enterococci, two to Klebsiella, one due to Serratia and 15 to more than one organism. Once the septicaemia was diagnosed appr opriate therapy was instituted. Fifty-six (71%) patients had 143 sessi ons of skin grafting and the mortality was low in operated patients. T wenty-three (29.1%) patients died. The low mortality rate was probably due to factors such as continuous clinical and microbiological survei llance leading to quick detection of aetiology, appropriate antibiotic therapy, care for nutrition and early wound cover. This study suggest s that flame burn patients are more vulnerable to sepsis. Onset of sep ticaemia may be as early as 3 days and commonly within 2 weeks. A surf ace wound is the likely source of entry to the blood stream. Gram posi tive organisms are dominant in the aetiology. Early detection and appr opriate treatment including wound coverage result in a better outcome. (C) 1998 Elsevier Science Ltd for ISBI. All rights reserved.