Elsevier

Burns

Volume 36, Issue 8, December 2010, Pages 1242-1247
Burns

Simple, effective and affordable approach for the treatment of burns infections

https://doi.org/10.1016/j.burns.2010.05.011Get rights and content

Abstract

Objective

The aim of the present study was to develop a simple and effective treatment modality using citric acid as a sole antimicrobial agent to control infections in burns patients not responding to conventional treatment.

Methods

Forty-six cases with 5–60% superficial to deep burns in a study group and 20 cases with 10–70% superficial to deep burns in a control group were investigated for culture and susceptibility. The isolates in study group were further tested for susceptibility to citric acid. Three percent citric acid gel was applied to burns wounds in study group; however, the control group received conventional antibiotic therapy and local wound care.

Results

In the control group, Pseudomonas aeruginosa (44.44%) and Staphylococcus aureus (33.33%) were found to be the commonest bacterial isolates and, amikacin and ciprofloxacin (40.74%) were found to be most effective antibacterial agents. In study group, P. aeruginosa (30.48%) and S. aureus (23.17%) were found to be the commonest bacterial isolates. Ceftazidime (52.43%), ciprofloxacin (47.56%) and amikacin (46.34%) were found to be most effective antibacterial agents. Application of citric acid to burn wounds resulted in complete healing in 40 (86.95%) cases in 7–25 applications (P value 0.145); however, in a control group conventional antibiotic therapy and local wound care resulted in complete healing in nine (45%) patients only.

Conclusions

Citric acid treatment was found effective in the control of burns infections as compared to conventional therapy. Complete healing in 86.95% cases as compared to 45% in a control group indicates that citric acid is nontoxic, economical and quite effective in the management of burns infections.

Introduction

The loss of the functional skin barrier after thermal injury results in increased susceptibility to infection, which is the major cause of morbidity and mortality following burns [1]. Burns have the potential to cause death, lifelong disfigurement and dysfunction [2]. Bacterial colonization and invasive bacterial infection are the major problems in the treatment of burn victims.

Infections acquired from hospital or from the patient's own endogenous flora have a significant prevalence after burns. The surface of every burn wound is contaminated to some degree by bacteria [3]. Pseudomonas aeruginosa and Staphylococcus aureus are the most frequent colonizing agents. Klebsiella spp., Proteus spp., Escherichia coli and other bacteria from Enterobacteriaceae family are also commonly isolated from burns sites [4], [5], [6], [7], [8], [9], [10].

Traditional management of the burn wound involves careful debridement of loose necrotic tissue (surgical excision of infected wounds), gentle cleansing of the wound and the application of dressings [11]. Topical antimicrobial therapy remains the single most important component of wound care in hospitalized burns patients. The goal of topical antimicrobial therapy is to control microbial colonization and prevent burn wound infection [12].

Silver sulfadiazine, the most frequently used topical prophylactic agent, has good activity against most burn pathogens but it is toxic to fibroblasts and also, it requires frequent dressing changes, delays re-epithelization and stains tissue [13]. Mafenide acetate has superior eschar penetrating characteristics, making it the agent of choice for early treatment of burn wound sepsis, but its prolonged or extensive use is associated with systemic toxicity and also it causes occasional pain on application and inhibition of epithelization [14], [15].

Systemic antibiotics are valuable therapeutic modality in burns patient when used properly. Injudicious use, however, may not only fail to be beneficial to the patient but also produces harmful effects, either through direct toxicity or by contributing to the emergence of resistant strains of microbes. Antibiotics should be used for a long enough period to produce an effect, but not long enough to allow the emergence of opportunistic or resistant organisms. In general, prophylactic systemic antibiotics are indicated in only a few clinical situations including the immediate preoperative and postoperative periods associated with excision and auto-grafting and possibly in the early phases of burns in children [16].

In the present study, an attempt was made to develop simple and effective approach for the treatment of infections in burn wounds, which otherwise difficult to mange because of compromised immunity of the host and multiple antibiotic resistance in bacteria involved in burns infections.

Section snippets

Materials and methods

The present study was carried out in consecutive hospitalized patients, with varying degree of burn injury. The study period was from January 2000 to December 2009. After obtaining institutional ethical committee approval for the study, 46 patients with 5–60% superficial to deep burns showing signs and symptoms of infection, not responding to conventional therapy for more than 2 weeks were included in the present study. The control group included 20 patients with 10–70% superficial to deep

Observations

Table 2 shows bacteria isolated from control group of patients with burns infections and susceptibility pattern. A total of 27 isolates were obtained from 20 patients. P. aeruginosa (44.44%) and S. aureus (33.33%) were found to be the commonest bacterial isolates. Majority of the isolates were found to have multiple antibiotic resistance. Amikacin and ciprofloxacin (40.74%) were found to be most effective antibacterial agents. Conventional antibiotic therapy and local wound care resulted in

Discussion

Microbial contamination of burns leading to local and systemic infections is a serious complication, which is often very difficult to control. Burn wounds provide a suitable environment for growth and multiplication of various bacteria. This colonization can lead to local invasive infection and systemic sepsis. The clinical consequences of infection in burns may be very serious; a large proportion of mortality in burned patients who survive the initial trauma and shock is due to infection [20].

Funding sources

None.

Conflict of interest

None.

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