Nosocomial infections in a Brazilian Burn Unit
Introduction
Infection is the most common cause of death following burn. Burn victims are obviously at high risk for nosocomial infection due to the nature of the burn injury itself. The burn wound consisting of moist necrotic tissue represents an ideal culture medium for a wide variety of microorganisms. Furthermore, immunocompromising effects of burns, prolonged hospital stays, and intensive diagnostic and therapeutic procedures contribute significantly to nosocomial infections in these patients. Bacterial infections in burn patients are widely known. The time-related changes in the predominant flora of the burn wound from gram-positive to gram-negative recapitulate the history of burn wound infection [1], [2].
Infection rates in burn patients have been rarely reported [3], [4], [5], [6], [7]. A study conducted in Brazil which included a considerable number of infections occurring over 7 years showed that bloodstream infection was the most common infection in contrast to other countries in which there was a predominance of pneumonia [4], [7] or wound infection [3], [6].
The gains of established infection control measures are now being felt in the developed countries with a purpose-built burns unit. However, in developing countries, establishing such measures is hindered by poverty, ignorance, poor management and lack of personnel [8].
In this prospective study, we describe the results from one year of registration of infection in a consecutive series of burn patients.
Section snippets
Materials and methods
Burn patients consecutively admitted to the Burn Unit of Hospital Regional da Asa Norte during 2004 were included in this prospective study. The patients were followed to discharge or death.
The total body surface area burned (TBSAB) was calculated by Lund & Bowder chart, adding percentages of dermal and subdermal burns [9].
Since 1980, patients having partial skin thickness burns covering less than 25% of the body surface area, were not generally admitted to the Burns Unit if they were adults,
Results
Two-hundred and seventy-eight patients with burns, consecutively admitted to the Burn Unit of Hospital Regional da Asa Norte during 2004, 86 female and 160 male patients were included in the study. Median age for the 278 patients was 24 years (range 1–82). Median TBSAB was 14% (range 1–100%). One-hundred and fifty-two (54.7%) of the patients had flame injuries, 96 (34.5%) were scald injuries, 25 (9%) electrical injuries and 5 (1.8%) chemical injuries. Seven (3.9%) patients had smoke inhalation
Discussion
Despite advances in the use of topical and parenteral antimicrobial therapy, and the practice of early tangential excision, bacterial infection remains a major problem in the management of burn victims today. Few patients are as susceptible to the development of infections as burn patients. Severe dysfunction of the immune system, a large cutaneous colonization, the possibility of gastrointestinal translocation, a prolonged hospitalization and invasive diagnostic and therapeutic procedures, all
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