INCIDENCE OF BACTEREMIA AFTER BURN WOUND MANIPULATION IN THE EARLY POSTBURN PERIOD

Background: Transient bacteremia associated with burn wound manipulati on is considered a frequent occurrence and is commonly cited as an ind ication for perioperative antibiotic prophylaxis in burn patients. Met hods: In a prospective clinical setting, blood cultures (BC) were obta ined from 19 burn patients at the following intervals: 30 minutes befo re wound cleansing (WC) or wound excision (WE), 30 minutes after the s tart of WC or WE, hourly until procedure completion, and 1 hour after completion. Burn wound biopsy for histologic grading and microbial cul ture was performed after the first BC. Results: Twenty-two WC and 20 W E episodes were evaluated by 67 and 76 BC sets, respectively. Patients had a mean age of 42.8 years and mean burn size of 50% of the body su rface area. Three WC episodes (13.6%) and four WE procedures (20.0%) w ere associated with postprocedure bacteremia. Two patients had both pr eprocedure and postprocedure bacteremia later attributed to nonburn wo und infections, Excluding these cases, the bacteremia rate was 12.5% ( 9.5% from WC and 15% from WE). Wound biopsy culture and histologic ana lysis did not predict the occurrence of bacteremia. Conclusion: Curren t therapy is associated with a lesser incidence of burn wound manipula tion-induced bacteremia than reported in prior series, The discordance between wound biopsy and BC results, the absence of positive histolog y, and the similarity of bacteremia occurrence rates with WC and WE co nfirm the effectiveness of current techniques of microbial control in burn wounds and question the need for perioperative antibiotic therapy in patients with burns involving less than 40% of the total body surf ace during the first 10 postburn days.