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Wound management in burn centres in Europe

  • European Plastic Surgery
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Abstract

Infection remains a common cause of death in burned patients. A recent survey of UK burns units showed a range of opinion on the timing of burn wound excision and the use of therapeutic and prophylactic antibiotics. The same questionnaire was sent to other European burns units to assess their practice. Answers were obtained from 96 of the 164 units contacted. A written policy on antibiotic treatment was used by 35 (36%) units, imipenem being the single most popular antibiotic, but courses often lasted more than 10 days. Excisions were covered routinely by prophylactic antibiotics in 44 (45%) units, and 10 of these covered all procedures where the wound was manipulated. All units took surface swab cultures, and 26 (27%) took punch biopsies of the wounds. Silver sulphadiazine was used in 66 (69%) of the units while others preferred sulfamylon, povidone iodine or flamacerium. In 40 hospitals (42%) reporting proven cases of toxic shock syndrome, the median number was only six cases in two years. Nineteen (20%) excised burns within 48 hours of admission. The use of very broad spectrum antibiotics for prolonged courses was the most marked difference from the UK.

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References

  1. Alexander JW MacMillan BG, Law EJ, Krummel R (1982) Prophylactic antibiotics as an adjunct for skin grafting in clean reconstructive surgery following burn injury. J Trauma 22:687–690

    Google Scholar 

  2. Armitage P, Berry G (1987) Multiple regression. Statistical methods in medical research, 2nd edn. Blackwell, Oxford, Chapter 10.1, p 306

    Google Scholar 

  3. Becker WK, Cioffi WG, McManus AT, Kim SH, McManus WF, Mason AD, Pruitt BA (1991) Fungal burn wound infection. A ten-year experience. Arch Surg 126:44–48

    Google Scholar 

  4. Bharadwaj R, Joshi BN, Phadke SA (1983) Assessment of burn wound sepsis by swab, full thickness biopsy culture — a comparative study. Burns 10:124–126

    Google Scholar 

  5. Boucher BA, Kuhl DA, Hickerson WL (1992) Pharmacokinetics of systemically administered antibiotics in patients with thermal injury. Clin Infect Dis 14:458–463

    Google Scholar 

  6. Cole RP, Shakespeare PG (1990) Toxic shock syndrome in scalded children. Burns 16:221–224

    Google Scholar 

  7. Culbertson GR, McManus AT, Conarro PA, McManus WF, Mason AD, Pruitt BA (1987) Clinical trial of imipenem/cilastatin in severely burned and infected patients. Surg Gynaecol Obstet 165:25–28

    Google Scholar 

  8. Dasco CC, Luterman A, Curreri PW (1987) Systemic antibiotic treatment in burned patients. Surg Clin North Am 67:57–68

    Google Scholar 

  9. Durtschi MB, Orgain C, Counts GW, Heimbach DM (1982) A prospective study of prophylactic penicillin in acutely burned hospitalized patients. J Trauma 22:11–14

    Google Scholar 

  10. Engrav LH, Heimbach DM, Reus JL, Harnar TJ, Marvin JA (1983) Early excision and grafting vs nonoperative treatment of burns of indeterminant depth: A randomised prospective study. J Trauma 23:1001–1003

    Google Scholar 

  11. Frame JD, Eve MD, Hackett MEJ, Dowsett EG, Brain AN, Gault DT, Wilmshurst AD (1985) The toxic shock syndrome in burned children. Burns 11:234–241

    Google Scholar 

  12. Frame JD, Kangesu L, Malik WM (1992) Changing flora in burn and trauma units: experience in the United Kingdom. J Burn Care Rehabil 13:[Suppl]281–286

    Google Scholar 

  13. Halls GA (1993) The management of infections and antibiotic therapy: a European survey. J Antimicrob Chemother 31:985–1000

    Google Scholar 

  14. Heimbach DM (1984) Cefsulodin therapy for infections due to Pseudomonas aeruginosa in patients with burns. Rev Infect Dis 6:[Suppl 3]S744-S750

    Google Scholar 

  15. Herndon DN, Barrow RE, Rutan RL, Rutan TC, Desai MH, Abston S (1989) A comparative study of conservative versus early excision: therapies in severely burned patients. Ann Surg 209:547–553

    Google Scholar 

  16. Herruzo-Cabera R, Vizcaino-Alcaide MJ, Pinedo-Castillo C, Rey-Calero J (1992) Diagnosis of local infection of a burn by semiquantitative culture of the eschar surface. J Burn Care Rehabil 13:639–641

    Google Scholar 

  17. Kahn AM, McCrady VL, Rosen VJ (1979) Burn wound biopsy: multiple uses in patient management. Scand J Plast Reconstr Surg 13:53–56

    Google Scholar 

  18. Kunst MW (1987) Ceftazidime treatment in severe burns. Scand J Plast Reconstr Surg 21:281–282

    Google Scholar 

  19. Livingstone DH, Cryer HG, Miller FB, Malangoni MA, Polk HC, Weiner LJ (1990) A randomized prospective study of topical antimicrobial agents on skin grafts after thermal injury. Plast Reconstruct Surg 86:1059–1064

    Google Scholar 

  20. McDonald WS, Deitch EA (1987) Hypertrophic skin grafts in burn patients: a prospective analysis of variables. J Trauma 27:147–150

    Google Scholar 

  21. McManus AT, Kim SH, McManus WF, Mason AD, Pruitt BA (1987) Comparison of quantitative microbiology and histopathology in divided burn-wound biopsy specimens. Arch Surg 122:74–76

    Google Scholar 

  22. Papini RPG, Wilson APR, Steer JA, McGrouther DA, Parkhouse N (1995) Wound management in burn centres in the United Kingdom. Br J Surg 82:505–509

    Google Scholar 

  23. Periti P, Stringa G, Donati L, Mazzei T, Mini E, Novelli A (1992) Teicoplanin: its role as systemic burn therapy and as prophylaxis for orthopaedic surgery. Eur J Surg S567:3–8

    Google Scholar 

  24. Piel P, Scarnati S, Goldfarb IW, Slater H (1985) Antibiotic prophylaxis in patients undergoing burn wound excision. J Burn Care Rehabil 6:422–424

    Google Scholar 

  25. Polk RE, Mayhall G, Smith J, Hall G, Kline BJ, Swensson E, Haynes BW (1983) Gentamicin and tobramycin penetration into burn eschar. Arch Surg 118:295–302

    Google Scholar 

  26. Pruitt BA (1984) The diagnosis and treatment of infection in the burn patient. Burns 11:79–91

    Google Scholar 

  27. Sasaki TM, Welch GW, Herndon DN, Kaplan JZ, Lindberg RB, Pruitt BA (1979) Burn wound manipulation-induced bacteremia. J Trauma 19:46–48

    Google Scholar 

  28. Snelling CFT, Inman RJ, Germann E, Boyle JC, Foley B, Kester DA, Fitzpatrick DJ, Warren RJ, Courtemanche AD (1991) Comparison of silver sulfadiazine 1% with chlorhexidine digluconate 0.2% to silver sulfadiazine 1% alone in the prophylactic topical antibacterial treatment of burns. J Burn Care Rehabil 12:13–18

    Google Scholar 

  29. Taddonio TE, Thomson PD, Smith DJ, Prasad JK (1990) A survey of wound monitoring and topical antimicrobial therapy practices in the treatment of burn injury. J Burn Care Rehabil 11:423–427

    Google Scholar 

  30. Theron EJ, Nel CJC (1983) Treatment of septic burns with a third generation cepbalosporin (cefatriaxon). S Afr Med J 64:816–817

    Google Scholar 

  31. Vindenes H, Bjerknes R (1993) The frequency of bacteremia and fungemia following wound cleaning and excision in patients with large burns. J Trauma 35:742–749

    Google Scholar 

  32. Volenc FJ, Clark GM, Mani MM, Humphrey LJ (1979) Burn wound biopsy bacterial quantitation: a statistical analysis. Am J Surg 138:695–697

    Google Scholar 

  33. Wasserman D, Schlotterer M, Lebreton F, Lery J, Guelfi MC (1989) Use of topically applied silver sulphadiazine plus cerium nitrate in major burns. Burns 15:257–260

    Google Scholar 

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Authors and Affiliations

  1. Departments of Plastic Surgery and Microbiology, University College Hospital, London and Mount Vernon Hospital, Northwood, Middlesex, UK

    R. P. G. Papini, A. P. R. Wilson, J. A. Steer, D. A. McGrouther & N. Parkhouse

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  1. R. P. G. Papini
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  2. A. P. R. Wilson
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  3. J. A. Steer
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  4. D. A. McGrouther
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  5. N. Parkhouse
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Papini, R.P.G., Wilson, A.P.R., Steer, J.A. et al. Wound management in burn centres in Europe. Eur J Plast Surg 18, 63–67 (1995). https://doi.org/10.1007/BF00168885

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