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Mackow NA, Yahav D, Williams FN, van Duin D. Which trial do we need? Evaluation of systemic antibiotics as primary prophylaxis in mechanically ventilated patients with burn injuries. Clin Microbiol Infect 2023; 29:1107-1109. [PMID: 37059223 DOI: 10.1016/j.cmi.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023]
Affiliation(s)
- Natalie A Mackow
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Center, Faculty of Medicine, Tel-Aviv University, Ramat-Gan, Israel
| | - Felicia N Williams
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA; North Carolina Jaycee Burn Center, Chapel Hill, NC, USA
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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Nițescu B, Pițigoi D, Tălăpan D, Nițescu M, Aramă SȘ, Pavel B, Streinu-Cercel A, Rafila A, Aramă V. Etiology and Multi-Drug Resistant Profile of Bacterial Infections in Severe Burn Patients, Romania 2018-2022. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1143. [PMID: 37374347 DOI: 10.3390/medicina59061143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/29/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
Infections in severe burns and their etiology are and will remain a big concern for the medical field. The multi-drug resistant strains of bacteria are a challenge of today's medicine. The aim of our study was to identify the etiological spectrum of bacterial infections in severe burn patients in Romania and their multi-drug resistant patterns. We performed a prospective study that included 202 adult patients admitted to the intensive care unit (ICU) of the Clinical Emergency Hospital of Plastic, Reconstructive Surgery and Burns, Bucharest, Romania (CEHPRSB), from 1 October 2018 to 1 April 2022, a period which includes the first 2 years of the outbreak of COVID-19. From each patient, wound swabs, endotracheal aspirates, blood for blood culture, and urine were collected. The most frequently isolated bacterium was Pseudomonas aeruginosa (39%), followed by Staphylococcus aureus (12%), Klebsiella spp. (11%), and Acinetobacter baumannii (9%). More than 90% of Pseudomonas aeruginosa and Acinetobacter baumannii were MDR, regardless of the clinical specimen from which they were isolated.
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Affiliation(s)
- Bogdan Nițescu
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Emergency Hospital of Plastic, Reconstructive Surgery and Burns, 010761 Bucharest, Romania
| | - Daniela Pițigoi
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- "Prof. Dr. Matei Balș" National Institute of Infectious Diseases, 021105 Bucharest, Romania
| | - Daniela Tălăpan
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- "Prof. Dr. Matei Balș" National Institute of Infectious Diseases, 021105 Bucharest, Romania
| | - Maria Nițescu
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- "Prof. Dr. Matei Balș" National Institute of Infectious Diseases, 021105 Bucharest, Romania
| | - Sorin Ștefan Aramă
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Bogdan Pavel
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Emergency Hospital of Plastic, Reconstructive Surgery and Burns, 010761 Bucharest, Romania
| | - Adrian Streinu-Cercel
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- "Prof. Dr. Matei Balș" National Institute of Infectious Diseases, 021105 Bucharest, Romania
| | - Alexandru Rafila
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- "Prof. Dr. Matei Balș" National Institute of Infectious Diseases, 021105 Bucharest, Romania
| | - Victoria Aramă
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- "Prof. Dr. Matei Balș" National Institute of Infectious Diseases, 021105 Bucharest, Romania
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3
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Nitsani Y, Michael T, Halpern D, Hasidim AA, Sher M, Givoli Vilensky R, Krieger Y, Silberstein E, Shoham Y. Blood Stream Infections in Burns: A 14-Year Cohort Analysis. Life (Basel) 2023; 13:1357. [PMID: 37374139 DOI: 10.3390/life13061357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Blood stream infections are a significant cause of morbidity and mortality in burns, and pathogen identification is important for treatment. This study aims to characterize the microbiology of these infections and the association between the infecting pathogen and the hospitalization course. METHODS We conducted a cohort study that included records of burn patients treated at the Soroka University Medical Center between 2007-2020. Statistical analysis of demographic and clinical data was performed to explore relationships between burn characteristics and outcomes. Patients with positive blood cultures were divided into four groups: Gram-positive, Gram-negative, mixed-bacterial, and fungal. RESULTS Of the 2029 burn patients hospitalized, 11.7% had positive blood cultures. The most common pathogens were Candida and Pseudomonas. We found significant differences in ICU admission, need for surgery, and mortality between the infected and non-infected groups (p < 0.001). Pathogen groups differed significantly mean TBSA, ICU admission, need for surgery, and mortality (p < 0.001). Multivariate analysis showed flame (OR 2.84) and electric burns (OR 4.58) were independent risk factors for ICU admission and surgical intervention (p < 0.001). Gram-negative bacterial infection was found to be an independent predictor of mortality (OR = 9.29, p < 0.001). CONCLUSIONS Anticipating specific pathogens which are associated with certain burn characteristics may help guide future therapy.
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Affiliation(s)
- Yarden Nitsani
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Tal Michael
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Dor Halpern
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Ariel Avraham Hasidim
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Maayan Sher
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Rotem Givoli Vilensky
- Clinical Research Center, Soroka University Medical Center, Beer-Sheba 8410101, Israel
| | - Yuval Krieger
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Eldad Silberstein
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Yaron Shoham
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
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Shah NR, Palackic A, Brondeel KC, Walters ET, Wolf SE. The Burn Wound. Surg Clin North Am 2023; 103:453-462. [PMID: 37149381 DOI: 10.1016/j.suc.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Skin serves as a protective barrier against infection, prevents excessive fluid and electrolyte losses, performs crucial thermoregulation, and provides tactile feedback of surroundings. The skin also plays an essential role in human perception of body image, personal appearance, and self-confidence. With these many diverse functions, understanding normal anatomic composition of skin is pivotal to evaluating the extent of its disruption from burn injury. This article discusses the pathophysiology, initial evaluation, subsequent progression, and healing of burn wounds. By delineating the various microcellular and macrocellular alterations of burn injury, this review also augments providers' capacity to deliver patient-centered, evidence-based burn care.
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Affiliation(s)
- Nikhil R Shah
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Kimberley C Brondeel
- John Sealy School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Elliot T Walters
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
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De Rose DU, Pugnaloni F, Martini L, Bersani I, Ronchetti MP, Diociaiuti A, El Hachem M, Dotta A, Auriti C. Staphylococcal Infections and Neonatal Skin: Data from Literature and Suggestions for the Clinical Management from Four Challenging Patients. Antibiotics (Basel) 2023; 12:antibiotics12040632. [PMID: 37106994 PMCID: PMC10135205 DOI: 10.3390/antibiotics12040632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Staphylococcal infections in neonates might be associated with skin blistering since early antibiotic therapy has been shown to limit infection spread and positively influence outcomes; therefore, neonatologists should be aware of these conditions. This review examines the recent literature on the management of Staphylococcal infections that involve neonatal skin, discussing the most appropriate clinical approach to four cases of neonatal blistering diseases with Staphylococcal infections: a case of Staphylococcal bullous impetigo, a case of Staphylococcal scalded skin syndrome (SSSS), a case of epidermolysis bullosa with overlapping Staphylococcal infection, and a case of burns with overlapping Staphylococcal infection. In treating Staphylococcal infections involving skin in neonates, the presence or absence of systemic symptoms should be considered. In the lack of evidence-based guidelines in this age category, treatment should be individualized according to several factors including the extension of the disease or further skin comorbidities (such as skin fragility), with a multidisciplinary approach.
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Affiliation(s)
| | - Flaminia Pugnaloni
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Ludovica Martini
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Iliana Bersani
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Maria Paola Ronchetti
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - May El Hachem
- Dermatology Unit and Genodermatosis Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
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6
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Rogers AD, Amaral A, Cartotto R, El Khatib A, Fowler R, Logsetty S, Malic C, Mason S, Nickerson D, Papp A, Rasmussen J, Wallace D. Choosing wisely in burn care. Burns 2022; 48:1097-1103. [PMID: 34563420 DOI: 10.1016/j.burns.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/15/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Choosing Wisely Campaign was launched in 2012 and has been applied to a broad spectrum of disciplines in almost thirty countries, with the objective of reducing unnecessary or potentially harmful investigations and procedures, thus limiting costs and improving outcomes. In Canada, patients with burn injuries are usually initially assessed by primary care and emergency providers, while plastic or general surgeons provide ongoing management. We sought to develop a series of Choosing Wisely statements for burn care to guide these practitioners and inform suitable, cost-effective investigations and treatment choices. METHODS The Choosing Wisely Canada list for Burns was developed by members of the Canadian Special Interest Group of the American Burn Association. Eleven recommendations were generated from an initial list of 29 statements using a modified Delphi process and SurveyMonkey™. RESULTS Recommendations included statements on avoidance of prophylactic antibiotics, restriction of blood products, use of adjunctive analgesic medications, monitoring and titration of opioid analgesics, and minimizing 'routine' bloodwork, microbiology or radiological investigations. CONCLUSIONS The Choosing Wisely recommendations aim to encourage greater discussion between those involved in burn care, other health care professionals, and their patients, with a view to reduce the cost and adverse effects associated with unnecessary therapeutic and diagnostic procedures, while still maintaining high standards of evidence-based burn care.
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Affiliation(s)
- A D Rogers
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - A Amaral
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - R Cartotto
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - A El Khatib
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - R Fowler
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - S Logsetty
- Manitoba Firefighters Burn Unit, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - C Malic
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - S Mason
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - D Nickerson
- Calgary Firefighters' Burn Treatment Centre, Foothills Medical Centre, Department of Surgery, University of Calgary, Alberta, Canada
| | - A Papp
- BC Professional Firefighters' Burn Unit, Vancouver General Hospital, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Rasmussen
- Queen Elizabeth II Health Sciences Centre Burn Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - D Wallace
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Antibiotic Prophylaxis in Plastic Surgery: From Systematic Review to Operative Algorithm. World J Plast Surg 2022; 11:24-36. [PMID: 36117892 PMCID: PMC9446112 DOI: 10.52547/wjps.11.2.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/10/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We aimed to provide a single, viable and user-friendly operative protocol for preoperative antibiotic prophylaxis that meets the needs of all plastic surgery practitioners. METHODS The research was conducted through the abstract and citation databases of peer-reviewed literature Pubmed® (National Center for Biotechnology Information), Medscape® (General Surgery) and Scopus® (Elsevier), comparing existing data from 2010 to 2020. A separated and dedicated research was accomplished for each of 8 macroareas such as: skin and soft tissue, hand, breast, aesthetics, head and neck, trauma, burns and miscellaneous. RESULTS The findings for each macroareas included the choice of the antibiotic, the route and timing of administration and the clinical applications. Finally, the review has been condensed in an operative algorithm for antibiotic use to apply in each field of plastic surgery. CONCLUSION We could provide plastic surgeon an effective, easy-to-use operative protocol for antibiotic prophylaxis in daily activity.
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8
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Maurer K, Renkert M, Duis M, Weiss C, Wessel LM, Lange B. Application of bacterial nanocellulose-based wound dressings in the management of thermal injuries: Experience in 92 children. Burns 2022; 48:608-614. [PMID: 34303573 DOI: 10.1016/j.burns.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/11/2021] [Accepted: 07/06/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Management of pediatric thermal injuries involves a high standard of care in a multidisciplinary setting. To avoid physical and psychological sequelae, wound dressings should minimize hospitalization time and anesthesia while maximizing patient comfort. PATIENTS AND METHODS 190 children with thermal injuries of the torso, arms and legs were treated with polyurethane foam dressings or bacterial nanocellulose sheets. Data were analyzed retrospectively regarding hospitalization, procedures with general anesthesia, scar formation, rate of infection and need for skin grafting. RESULTS The groups did not differ significantly concerning age, gender distribution or percentage of injured total body surface area. Statistical analysis showed that length of hospitalized care and procedures undergoing anesthesia were significantly reduced in the nanocellulose group (each p < 0.0001). There was no significant difference in rate of complications, wound healing and rate of skin grafting between the two subgroups. DISCUSSION Acting as a temporary epidermal substitute, bacterial nanocellulose enables undisturbed reepithelialization without further wound dressing changes. In children, no additional topical antimicrobial agents are indicated for unimpaired wound healing. CONCLUSIONS Bacterial nanocellulose is superior to polyurethane foam regarding length of hospitalization and number of interventions under anesthesia. It offers a safe, cost-effective treatment option and provides excellent comfort in pediatric patients.
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Affiliation(s)
- Kristina Maurer
- Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
| | - Miriam Renkert
- Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Malte Duis
- Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Christel Weiss
- Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Medical Statistics and Biomathematics, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Lucas M Wessel
- Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Bettina Lange
- Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
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9
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Pediatric major burns: a monocentric retrospective review of etiology and outcomes (2008–2020). EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Background
Burns are one of the most common causes of mortality and morbidity among children. This study aims to assess the epidemiology of pediatric major burns in a third level hospital in Spain to evaluate demographics, etiology, and outcomes.
Methods
A retrospective study was held by the Plastic, Reconstructive and Burn Surgery department of the hospital. We included 147 patients under 18 admitted to hospital between January 2008 and December 2020 who meet the inclusion criteria: partial thickness burns > 10% total body surface area (TBSA) in patients < 18 years old. Clinical data extracted included age, gender, date of admission, %TBSA, burn types, severity and sites of burn, length of stay, length of ventilator support, intensive care admission, blood transfusion, surgical interventions, and complications.
Results
Three groups of age were analyzed. The average %TBSA was 18.7 (SE 0.9). Scalds were the main mechanism of injury (70.1%) and upper extremity was the most frequent location affected (68%). The 28.6% of patients suffered some complication, but the mortality rate was low (0.7%). In our series, the group aged 13–18 showed significantly higher %TBSA, more number of surgeries and blood transfusions.
Conclusions
Scald burns are the most frequent mechanism of injury in pediatric burns. However, teenagers suffer more severe burns and complications, usually caused by flame. Despite the low mortality rates, more measures of prevention should be taken to increase children security.
Level of evidence: Level IV, Risk/Prognostic.
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10
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Cicuttin E, Sartelli M, Scozzafava E, Tartaglia D, Cremonini C, Brevi B, Ramacciotti N, Musetti S, Strambi S, Podda M, Catena F, Chiarugi M, Coccolini F. Antibiotic Prophylaxis in Torso, Maxillofacial, and Skin Traumatic Lesions: A Systematic Review of Recent Evidence. Antibiotics (Basel) 2022; 11:antibiotics11020139. [PMID: 35203743 PMCID: PMC8868174 DOI: 10.3390/antibiotics11020139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 02/04/2023] Open
Abstract
Use of antibiotic prophylaxis (AP) in trauma patients is a common practice. However, considering the increasing rates of antibiotic resistance, AP use should be questioned and limited only to specific cases. We performed a systematic review of recent literature (from year 2000), aiming to summarize the state of the art on efficacy and appropriateness of AP in patients with traumatic injuries of torso, maxillofacial complex and skin (including burns). Twenty-six articles were selected. In thoracic trauma, AP could be useful in reducing infective complications in tube thoracostomy for penetrating trauma. In maxillo-facial trauma, AP could find a role in the peri-operative trauma setting in the case of a graft or prosthetic implant. In abdominal trauma, there is a lack of consensus on the definition of contamination, infection, antibiotic therapy, and prophylaxis. In burned patients, routine AP is not suggested. In the case of human bites to the extremities, AP could find an indication. Future studies should focus on the subcategories of patients at higher risk of infection, identifying those who would benefit from AP. Attention to antimicrobial stewardship and guidelines focused on AP in trauma are required, to reduce antibiotic abuse, and increase quality research.
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Affiliation(s)
- Enrico Cicuttin
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | | | - Emanuele Scozzafava
- Unit of Maxillo-Facial Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.S.); (B.B.)
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | - Camilla Cremonini
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | - Bruno Brevi
- Unit of Maxillo-Facial Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.S.); (B.B.)
| | - Niccolò Ramacciotti
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | - Serena Musetti
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | - Silvia Strambi
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | - Mauro Podda
- Department of General and Emergency Surgery, Cagliari University Hospital, 09123 Cagliari, Italy;
| | - Fausto Catena
- General and Emergency Surgery Department, Bufalini Hospital, 47521 Cesena, Italy;
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | - Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
- Correspondence:
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11
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McAlister P, Hagan G, Lowry C, Mullen S. Fifteen-minute consultation: Management of paediatric minor burns. Arch Dis Child Educ Pract Ed 2022:archdischild-2021-323229. [PMID: 35063949 DOI: 10.1136/archdischild-2021-323229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/15/2021] [Indexed: 11/04/2022]
Abstract
Burn injuries are a common presentation to the paediatric emergency department (PED) and are painful, distressing and may have long-term sequelae. In adhering to the first aid principles of burns management, we aim to alleviate pain, prevent bacterial contamination and minimise the extent of injury. First aid involves cooling the burn and covering with an appropriate material while simultaneously providing analgesia. Assessing the severity (depth and total body surface area) of the burn are important for prognostication with implications for management. It is imperative to consider non-accidental injury in burns, which be present in 10% of cases .
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Affiliation(s)
- Peter McAlister
- Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Gary Hagan
- Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Christopher Lowry
- Paediatric Emergency Department, Royal Belfast Children's Hospital, Belfast, UK
| | - Stephen Mullen
- Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK .,Faculty of Medicine, Health and Life Sciences, Queen's University, Belfast, UK
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12
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Cirks BT, Rajnik M, Madden KB, Otollini M. Pediatric Infectious Diseases Encountered During Wartime Part II: Infectious Diseases Complications in the Individual Pediatric Patient. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00771-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Barsuk AL, Nekaeva ES, Lovtsova LV, Urakov AL. Selective Intestinal Decontamination as a Method for Preventing Infectious Complications (Review). Sovrem Tekhnologii Med 2021; 12:86-95. [PMID: 34796022 PMCID: PMC8596238 DOI: 10.17691/stm2020.12.6.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Indexed: 11/14/2022] Open
Abstract
Infectious complications are the most common cause of death in patients with severe burns. To date, there is no generally accepted method for preventing such complications in burn injury. One of the possible prevention options is selective intestinal decontamination (SID). This method is based on the enteral administration of non-absorbable antimicrobial agents. The preventive effect of SID involves inhibition of intestinal microflora translocation through the mucous membranes, inasmuch as studies demonstrate that endogenous opportunistic microorganisms are a common cause of infectious complications in various critical conditions. The SID method was originally developed in the Netherlands for patients suffering from mechanical injury. Antimicrobial drugs were selected based on their high activity in relation to the main endogenous opportunistic pathogens and minimal activity against normal intestinal microflora components. The combination of polymyxin (B or E), tobramycin, and amphotericin B with intravenous cefotaxime was chosen as the first SID regimen. Other regimens were proposed afterwards, and the application field of the method was expanded. In particular, it became the method of choice for prevention of infectious complications in patients with severe burn injury. Clinical studies demonstrate efficacy of some SID regimens for preventing infectious complications in patients with thermal injury. Concomitant administration of SID and systemic preventive antibiotics and addition of oropharyngeal decontamination increases the method efficacy. SID is generally well-tolerated, but some studies show an increased risk of diarrhea with this preventive option. In addition, SID increases the risk of developing antibiotic resistance like any other antibiotic regimens.
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Affiliation(s)
- A L Barsuk
- Associate Professor, Department of General and Clinical Pharmacology; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - E S Nekaeva
- Head of Admission and Consultation Department, Clinical Pharmacologist, University Clinic; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - L V Lovtsova
- Associate Professor, Head of the Department of General and Clinical Pharmacology; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A L Urakov
- Professor, Head of the Department of General and Clinical Pharmacology; Izhevsk State Medical Academy, 281 Kommunarov St., Izhevsk, 426034, Udmurt Republic, Russia; Leading Researcher, Department of Modeling and Synthesis of Technological Processes Udmurt Federal Research Center, Ural Branch of the Russian Academy of Sciences, 34 Tatyany Baramzinoy St., Izhevsk, 426067, Udmurt Republic, Russia
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14
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Kelava L, Nemeth D, Hegyi P, Keringer P, Kovacs DK, Balasko M, Solymar M, Pakai E, Rumbus Z, Garami A. Dietary supplementation of transient receptor potential vanilloid-1 channel agonists reduces serum total cholesterol level: a meta-analysis of controlled human trials. Crit Rev Food Sci Nutr 2021; 62:7025-7035. [PMID: 33840333 DOI: 10.1080/10408398.2021.1910138] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abnormal cholesterol level is a major risk factor in the development of atherosclerosis, which is a fundamental derangement in cardiovascular diseases. Any efforts should be undertaken to lower blood cholesterol levels. Among dietary interventions, capsaicinoid supplementation is also considered as a novel cholesterol-lowering approach, but human studies concluded contradictory results about its effectiveness. The present meta-analysis aimed at determining the effects of capsaicinoids on serum lipid profile in humans. We searched the PubMed, EMBASE, and CENTRAL databases from inception to February 2021. We included 10 controlled studies, which involved 398 participants. We found that dietary capsaicinoid supplementation alone or in combination with other substances significantly (p = 0.004 and 0.001, respectively) reduced serum total cholesterol level compared to controls with an overall standardized mean difference of -0.52 (95% confidence interval: -0.83, -0.21). Capsaicinoids also decreased low-density lipoprotein level significantly (p = 0.035), whereas no effect was observed on serum levels of high-density lipoprotein and triglycerides. Our findings provide novel quantitative evidence for the efficacy of dietary capsaicin supplementation in lowering serum total cholesterol and low-density lipoprotein levels in humans. To validate our conclusion, further randomized controlled trials in a diverse population of adult humans receiving dietary capsaicinoid supplementation are warranted.
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Affiliation(s)
- Leonardo Kelava
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - David Nemeth
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Peter Hegyi
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.,Szentagothai Research Centre, University of Pecs, Pecs, Hungary.,Department of Translational Medicine, First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Patrik Keringer
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Dora K Kovacs
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Marta Balasko
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Margit Solymar
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Eszter Pakai
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Zoltan Rumbus
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Andras Garami
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
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15
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Putra O, Saputro I, Nurrahman N, Herawati E, Dewi L. Effects of empirical antibiotic administration on the level of C-Reactive protein and inflammatory markers in severe burn patients. ANNALS OF BURNS AND FIRE DISASTERS 2020; 33:20-26. [PMID: 32523491 PMCID: PMC7263725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 01/19/2020] [Indexed: 06/11/2023]
Abstract
Severe burns lead to a high level of inflammation and high risk of infection. Inflammatory biomarkers are usually used to predict the severity of inflammation or infection and to assess the efficacy of antibiotics. The use of antibiotics in burns is still controversial. The aim of this study is to assess the effects of empirical antibiotics on level of C-reactive protein (CRP) and other inflammatory markers (leucocytes, neutrophils, lymphocytes, and ratio of neutrophils-lymphocytes) in severe burn patients. This cohort study was conducted in the burn unit of Dr. Soetomo Hospital between April and November 2019. CRP and other inflammatory markers were measured on admission, day 5, and day 7 after the administration of empirical antibiotics. Fifteen severe burn patients were enrolled in this study. All patients received Ceftazidime, 3x1 gram during seven days of hospitalization. CRP level reduced from 15,78±7,5 mg/dl to 14,98±10,29 mg/dl (p=0,705) by paired-t-test. There were no significant differences in mean decline of CRP between day 0-5 and 0-7. There was no decrease in inflammatory markers, including leucocytes, neutrophils, lymphocytes and ratio of neutrophils-lymphocytes during seven days of empirical antibiotic administration. Our conclusions are that the administration of ceftazidime as an empirical antibiotic lowers CRP level, although not significantly, while there is no decrease in several inflammatory markers.
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Affiliation(s)
- O.N. Putra
- Study Program of Pharmacy, Faculty of Medicine, Hang Tuah University, Indonesia
| | - I.D. Saputro
- Faculty of Medicine, Airlangga University, Indonesia
| | - N.D. Nurrahman
- Study Program of Pharmacy, Faculty of Medicine, Hang Tuah University, Indonesia
| | - E.D. Herawati
- Study Program of Pharmacy, Faculty of Medicine, Hang Tuah University, Indonesia
| | - L.K. Dewi
- Study Program of Pharmacy, Faculty of Medicine, Hang Tuah University, Indonesia
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