Prophylactic Intravenous Immune Globulin and Polymixin B Decrease the Incidence of Septic Episodes and Hospital Length of Stay in Severely Burned Children

Serum immunoglobulin levels in pediatric burn patients

Infections remain the leading cause of death in burn patients. Immune responses play an important role in patient's defense mechanism against infection and decreasing morbidity and mortality associated with burn. Our goal was to determine serum immunoglobulin levels in pediatric burn patients in order to understand role of humoral immune defense in these patients. During this analytic cross sectional study from January 2011 to February 2012, all patients with burn and younger than 6 years old that were referred to Shahid Motahari burn and reconstruction center were enrolled. Patients had no inhalation injury or sepsis. Immunoglobulin levels were measured once on 3-5 days after burn. The burn size in 12 patients (24%) was less than 30%, in 30 patients (60%) were between 30% and 50% and in the remained 8 patients (16%) were more than 50%. In 45 patients (90%) depth and severity of burn were 2nd degree (superficial and deep) and in the remaining 5 patients (10%), it was 3rd or 4th degree. In 28 (56%), 1 (2%), 3 (6%), 35 (70%), 48 (96%), 19 (38%) and 6 (12%) patients IgG, IgM, IgA, IgG1, IgG2, IgG3 and IgG4 were lower than normal values, respectively. No significant correlation was seen between burn size (TBSA) and value of immunoglobulin (P>0.05). Although the drop in the serum concentration of immunoglobulins is irrespective to the burn size, more severe burn is associated with more decrease in the serum levels of IgA, IgM, IgG and its subclasses. However, further studies are needed to provide complementary data on this issue.

Bacteriology of infected burn wounds in the burn wards of a teaching hospital in Southwest Nigeria

BACKGROUND

Burns are characterized by the loss of varying proportions of the protective layers of the skin, depression of immune responses, and increased wound susceptibility to infection. Wound infection is a major cause of morbidity and mortality in burn cases. This study characterizes those factors that predispose burn wounds to infection and the bacteriology of the microorganisms in our environment.

PATIENTS AND METHODS

Prospective study of burns patients that were admitted and treated at the Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria between January 1 and May 31, 2010 was carried out. Information about the demographics, aetiology/mechanism of burns, interval between the time of injury and admission, microbial studies, and antibiotic therapy were collected and analyzed.

RESULTS

A total of 74 patients consisting of 43 males and 31 females were seen. The ages range between one week and 95 ± 22.42 years. Wound infections were confirmed in 28 patients (infection rate of 37.84 per 100 patients). Delayed presentation at LASUTH and length of hospital stay were significantly related to the development of wound infection. Pseudomonas aeruginosa and Proteus mirabilis were the most common infective organisms occurring in 53.6 and 10.7 percentages respectively. The isolated organisms were resistant to the beta-lactam antibiotics and mostly sensitive to carbapenem and aztreonam preparations.

CONCLUSION

Factors predisposing to invasive wound infections in our environment were highlighted and suggestions made on methods that could reduce the infections and thus reduce morbidity and mortality in burns.

Polymyxin B: a new strategy for multidrug-resistant Gram-negative organisms

BACKGROUND

There has been a renewed interest in using polymyxin B as a last resort therapeutic option, due to emergence of multidrug-resistant Gram-negative bacteria. Despite being available for clinical use for decades, there is still a very limited understanding on many aspects of this agent.

OBJECTIVE

To review what is known about polymyxin B and to identify missing information or gaps for future investigations.

METHODS

Pertinent information was reviewed from published literature in English.

RESULTS/CONCLUSION

For optimal use of polymyxin B, a more thorough understanding is needed on standardized susceptibility testing, serum and tissue concentrations achieved, antibacterial activity when polymyxin B is combined with other agents, and mechanisms of resistance. A more precise characterization of the relationship between drug concentration and toxicity is also required.

Targeting non-multiplying organisms as a way to develop novel antimicrobials

Increasing resistance and decreasing numbers of antibiotics reaching the market point to a growing need for novel antibacterial drugs. Most antibiotics are very inefficient at killing non-multiplying bacteria, which live side by side with multiplying ones of the same strain in a clinical infection. Although non-multiplying bacteria do not usually cause disease, they can revert to the multiplying state that leads to overt disease, at which time resistance can emerge. Here we discuss the concept of developing antibacterial drugs by targeting non-multiplying organisms. We define non-multiplying bacteria, discuss the efficacy of existing antibiotics, and assess whether targeting these bacteria might lead to new antibiotics that will decrease the rate of emergence of resistance. Lastly, we review the potential of new molecular targets and live non-multiplying bacteria as possible routes for the development of novel antimicrobial drugs.