Successful treatment of invasive burn wound infection with sepsis in patients with major burns

Objective To investigate the clinical characteristics of invasive burn woun d infection with sepsis in patients with major burns and to summarize the s uccessful experiences in the treatment of such patients. Methods Eight patients with major burns, complicated by invasive burn wound infection and sepsis were consecutively admitted to our hospital from Sept ember 1997 to October 1998. Among them, 6 patients developed multiple organ dysfunction syndrome (MODS) and 2 developed septic shock. The plasma conce ntrations of IL-6, IL-8, TNF alpha and lypopolysaccharide (LPS) were assaye d before and after surgical intervention, as well as when the patient's vit al signs became stable. Results The patients' conditions usually deteriorated abruptly when extensi ve invasive burn wound infection emerged. While multi-microbial infection w as usually found, Pseudomonas aeruginosa was the predominant bacteria isola ted from the subeschar tissue. The plasma concentrations of IL-6, IL-8, TNF alpha and LPS before surgical intervention were significantly higher than those after surgical intervention ( P < 0.05). The lowest levels of the inf lammatory mediators were observed when the patients' conditions became stab le, and the values were significantly lower than those before surgical inte rvention (P < 0.001). Conclusion Since the main cause of burn wound sepsis is the presence of a l arge area of infected burn wound, they should be excised and covered as ear ly as possible. LPS and pro-inflammatory mediators play an important role i n the pathogenesis of burn sepsis. Although favorable results should be att ributed to comprehensive treatment, we believe that early, aggressive and t horough surgical excision of infected burn wounds, followed by sound and co mplete coverage of the area, play a crucial role.