Journal of Burn Care & Research最新文献

Infection is a nearly universal complication among patients with major burns, yet guidance on early empiric antibiotic therapy remains limited. Broad-spectrum antibiotics are commonly initiated in the early phase of care but carry risks of antimicrobial resistance and drug toxicities. This single-centre, retrospective study evaluated the microbiological profiles and antibiotic prescribing patterns associated with first positive cultures (FPCs) in major burn patients admitted to Canada's highest-volume adult burn centre between January 1, 2018 and May 1, 2023. A total of 114 patients with ≥20% total body surface area burns were included. Among 145 FPCs, the most commonly cultured sites were respiratory (55%) and wound (30%). The most frequently identified organisms were methicillin-sensitive Staphylococcus aureus (19%), Haemophilus influenzae (15%), Enterobacter cloacae complex (8%), Escherichia coli (7%), MRSA (7%), and Pseudomonas aeruginosa (6%). Notably, only 3% of patients who screened negative for MRSA on admission developed MRSA-positive cultures. Antibiotic therapy was initiated in 99% of patients with FPCs, most commonly with piperacillin-tazobactam (41%), vancomycin (16%), and cefazolin (14%). Dual therapy, typically piperacillin-tazobactam plus vancomycin, was used in 13% of cases. Sensitivity data demonstrated that meropenem (90%) and the combination of ciprofloxacin with cefazolin (83%) covered the highest proportion of isolates. While piperacillin-tazobactam remains effective for early empiric use, our findings indicate that targeted alternatives-such as reserving meropenem for select cases or using ciprofloxacin plus cefazolin in appropriate patients-could provide comparable coverage while adhering to antimicrobial stewardship principles. A negative MRSA screening swab on admission demonstrated a high negative predictive value (~97%), supporting the withholding of vancomycin in screen-negative patients. This study supports evidence-based antibiotic use in burn patients and underscores the need for local, data-driven stewardship.

Evaluate the effectiveness and tolerability of 0.5% and 2.0% (w/v) acetic acid on colonised burns wounds for three days after hospital admission. Burn wound infection and secondary sepsis are serious complications. Due to growing bacterial resistance worldwide, effective antimicrobial agents that do not increase the risk of resistance and are non-toxic are required. In this is phase II trial, 0.5% or 2.0% acetic acid was applied to burns colonised by specifically identifiable bacteria. Participants aged ≥16 years with burns ≥1% body surface area were randomly assigned 1:1. Efficacy was measure by change in bacterial load from swabs taken daily for four consecutive days. The study encountered two interruptions during the Covid-19 pandemic lockdown. Consequently, major protocol amendments were implemented to ensure alignment with established hospital clinical pathways. Between Feb-2018 and Oct-2021, 22 participants were randomized. Participant characteristics were balanced, except fewer full thickness burns in the 2.0% acetic acid group. Two percent acetic acid significantly decreased the bacterial load compared to 0.5% concentration (p=.0129) but also increased the pain score (p=.012). Only one serious adverse event occurred: a grade 3 urinary tract infection unrelated to acetic acid, which resolved without sequalae. Acetic acid was safe and well-tolerated. Both concentrations lowered bacterial load, with 2.0% proving more effective. The study also indicates that dressing changes every 12 hours may be required.

Burn injury is increasingly recognized as a chronic condition associated with long-term cardiovascular risk, however few studies have explored underlying mechanisms. This study aimed to evaluate cardiovascular autonomic function in individuals with chronic burn injuries. Ten adults, 3-11 years post burn injury of 10-70% total body surface area (TBSA) (mean: 34 ± 5%) underwent standard autonomic function tests: Valsalva's maneuver, paced breathing, and isometric handgrip. Heart rate (HR) and blood pressure responses were compared to either established normative values or to matched controls for each respective test. Burn survivors had significantly lower Valsalva ratios (1.32 ± 0.19) compared to age/sex normative values (1.47 ± 0.07, p<.05) and reduced heart rate variability (Root Mean Square of Successive Differences, RMSSD) compared to matched controls (31 ± 21 vs 57 ± 19 ms, p<.05), indicating impaired cardiac vagal modulation. Valsalva ratio and RMSSD were related in the burn survivors (r = 0.58, p=.079), and RMSSD but not Valsalva ratio, tended to relate to burn size (r = -0.57, p=.082). No group differences were observed in responses to isometric exercise. Chronic burn injury appears to be associated with diminished cardiac vagal control which may underlie elevated cardiovascular risk observed in this population.

Serum creatinine and protein levels have been proposed as potential biomarkers for predicting adverse outcomes in burn patients. This study aimed to investigate the prognostic utility of these markers and the serum creatinine-to-protein ratio in relation to in-hospital mortality following severe burn injuries. This retrospective cohort study included burn patients admitted within a 13-year period, with a total body surface area (TBSA) affected of ≥20%. Creatinine, serum protein levels, and the creatinine-to-protein ratio were assessed on post-burn days (PBD) 1, 3, and 7. Multivariate analysis identified independent mortality predictors, and receiver operating characteristic (ROC) curves assessed predictive accuracy. Among 283 patients, an overall mortality rate of 24.7% was noted. Neither creatinine nor protein levels independently predicted mortality. However, the creatinine-to-protein ratio was significantly elevated in non-survivors on all measured days, with the PBD 7 value emerging as an independent predictor of in-hospital mortality. Ratios measured on PBD 3 and 7 yielded an area under the ROC curve of 0.75, indicating robust predictive capability. The post-burn creatinine-to-protein ratio, particularly on PBD 7, is a reliable, accessible, and cost-effective biomarker for mortality risk in severe burn patients. Its use could enhance early prognostic evaluation in burn care.

In this review, we studied the significance of multi-omics techniques in understanding the complex processes after burns. Severe burns result in both temporary local pathophysiological changes and long-term, profound, and extensive pathophysiological abnormalities. The utilization of multi-omics approaches to identify novel treatment targets or clarify the molecular mechanisms underlying pathophysiological alterations related to burn injury has significant promise. This review encapsulates recent advancements in the utilization of omics approaches to elucidate pathophysiological alterations and biomarkers associated with inflammation, wound healing, and metabolic pathways after burn injuries, encompassing the genome, transcriptome, proteome, metabolome, and microbiome. An enhanced comprehension of the pathophysiological alterations and biomarkers associated with burn injuries can promote the creation of more efficacious and focused therapeutic approaches.

Quality improvement (QI) is essential to advancing burn care, yet most locally successful QI initiatives are not disseminated beyond individual centres. Although QI activity is common in burn care, only a small proportion of projects progress to peer-reviewed publication. This restricts shared learning and slows the spread of evidence-based, context-adaptable practices. We highlight persistent barriers to QI publication, including unclear reporting expectations and limited reviewer familiarity with improvement methodology. To address this gap, we propose three practical strategies for burn centres: intentionally developing 1-2 publishable QI projects annually, adopting SQUIRE 2.0 as a reporting scaffold, and expanding QI-trained peer reviewer capacity. We also present a 10-Point QII Scoring Framework to guide project planning and scholarly dissemination.

Cell suspension autograft (CSA) is a non-cultured, autologous cellular suspension used in partial-thickness burns or as an adjunct to widely meshed split-thickness skin grafts (STSG). While CSA has been shown to improve patient outcomes in burn care, literature is limited in highlighting its impact on mortality when used in combination with STSG. This retrospective, matched, case-control study investigates the clinical efficacy of CSA in adult burn patients admitted to a regional burn center from 2015 to 2023. Patients treated with CSA and STSG (n = 63, "CSA-treated") were compared against patients treated with STSG alone (n = 126, "non-CSA-treated"). Non-CSA-treated patients were matched in a 2:1 fashion to CSA-treated patients based on third-degree total body surface area burned (TBSA) and age. Outcomes included mortality, length of stay (LOS), intensive care unit LOS (ICU LOS), and number of procedures. Multivariate analyses revealed that CSA-treated patients had a significant reduction in mortality (p=.0445) and a 78.9% reduction in odds of death (OR: 0.211) compared to non-CSA-treated patients. CSA-treated patients displayed non-significant increases in LOS (p=.0670), ICU LOS (p=.0851), and number of procedures (p=.9084). Selection and chronology bias may partially account for the improved mortality in the CSA-treated group. The non-significant increases in LOS, ICU LOS, and number of procedures may be reflective of increased survivorship. These findings demonstrate that CSA enhances survival in burn patients when used with STSG, warranting further research to confirm these results.

Pyogenic granuloma (PG) is a benign vascular proliferation that commonly arises following trauma. Its occurrence in healing burn wounds, particularly in infants, is rare and poses diagnostic challenges. We present the case of an 11-month-old male who developed multiple rapidly growing, angiomatous nodules on the right cheek and scalp two weeks after sustaining a second-degree scald burn from boiling milk. The lesions exhibited typical bleeding and friability, prompting surgical excision and coverage with split-thickness skin grafts. Histopathological examination confirmed the diagnosis of PG. Postoperative recovery was uneventful, and follow-up at 2.5 years showed complete resolution without recurrence and minimal scarring. This case illustrates a rare but distinct manifestation of post-burn PG (PGB), emphasizing the importance of recognizing this reactive vascular phenomenon. A comprehensive review of the 38 cases reported in the literature so far underscores the variable clinical presentations and management strategies, reinforcing surgical excision as a reliable and curative intervention.

Timely closure of acute, full-thickness wounds is critical in minimizing complications such as infection, fluid loss, and impaired healing, all of which can adversely affect long-term patient outcomes. Although meshed autografting is the current standard of care, its effectiveness is limited by the need for donor skin and the re-epithelialization of expanded interstices. Prior research has shown that combining meshed autografts with skin cell suspension autograft (SCSA) enhances epidermal regeneration. In this study, we further investigate the mechanisms by which SCSA promotes re-epithelialization when applied with a widely expanded (3:1) meshed autograft in a full-thickness porcine wound model. Histological analyses demonstrate complete closure of graft interstices as early as three days post-surgery. A dual mechanism of re-epithelialization was observed, with keratinocytes migrating both from the edge of healthy skin from the interstice and within the center of interstices to form a continuous epithelial monolayer. The presence of a high number of proliferating cells in the wound bed further supports the regenerative activity of SCSA. These findings offer valuable mechanistic insight into the role of SCSA in accelerating wound closure and provide additional evidence for its use in improving outcomes for patients with acute full-thickness wounds.