Pseudomonas aeruginosa septicaemia in burns

Out of 1415 patients treated as inpatients at Al-Babtain Center for Burns a nd Plastic Surgery, Ibn Sina Hospital, Kuwait spanning over a period of 6 y ears from June 1992 to June 1998, 102 developed clinically and microbiologi cally proven septicaemia. Only 15 out of them had either single or multiple episodes of septicaemia due to Pseudomonas aeruginosa and were studied dur ing their stay in the hospital. Five of them were males and 10 females, wit h a mean age of 26 years (range 3-51 years) and mean total body surface are a of burns (TBSA) of 66% (range 25-90%). All of them had flame burns and re suscitation was found to be difficult in eight patients either due to delay ed hospitalization or accompanied inhalation injury. Seven patients were in tubated, four due to inhalation injury and three for septicaemic complicati ons. Among the 15 patients under study, a total of 36 septicaemic episodes were detected of which 21 were due to P. aeruginosa. This organism was foun d in the first episodes in nine patients, in second episodes in six, in thi rd episodes in three and fourth, fifth and sixth episodes in one patient, e ach at a variable postburn day. Ten patients had 38 sessions of excision an d skin grafting, six of them survived. Nine of the 15 patients under study died due to septicaemia, but only six of them had P. aeruginosa as the last isolate. Except for one, all patients had >40% TBSA burn, two had difficul t resuscitation and four were intubated. The day of death varied between 3 to 52 days postburn (mean 19 days). This study showed that females with fla me burns are susceptible to P. aeruginosa septicaemia. Difficult resuscitat ion and intubation also proved to be important risk factors. Septicaemia co uld occur quite early in the postburn days and the mortality due to this or ganism was quite high. Early excision and grafting with other effective man agement may result in a better outcome. (C) 1999 Elsevier Science Ltd and I SBI. All rights reserved.