Perineal Diagnostic Microbial Swabs As A Predictive Parameter In Pediatric Burn Injury.

PubMed, vol. 33, pp. 224–232

Abstract

The aim is to evaluate the predictive usefulness of perineal diagnostic microbial swabs (PDMS) which will identify an enteric reservoir as possible source of concomitant wound infection following scald burn injury in infants. Perineal swabs were taken on admission of infants presenting with scald burn injury along with a standardized protocol of initial sterile surgical field cleansing and dressing. Complicated (CC) and uncomplicated (UC) clinical cases were discriminated based on parameters of significant microbial burn wound colonization, such as onset of fever, white blood cell count (WCC), C-reactive protein (CRP) and a concomitant need for surgical wound revision with/without guided antibiotic therapy. Relative risks (RR) / odds ratios (OR) based on microbial swab results were calculated related to anticipated wound infection. We found PDMS to be an independent predictive parameter for clinically relevant microbial wound colonization in pediatric patients (n=274; age 2.81±2.69). Most importantly, we show that in patients with initial total burn surface area (TBSA) >5%, clinically relevant burn wound infection requiring intervention can be predicted from initial perineal swab results with ORs ~10fold. Infants presenting with scald burn injury are exposed to a relevant risk of wound infection emanating from a unique microbial enteric reservoir, even with initial surgical decontamination and sterile dressing protocols, warranting further hospitalization. Based on our findings we suggest PDMS as a useful additional predictive parameter to (i) characterize the relevant enteric microbial reservoir and (ii) direct further therapeutic measures with the aim of preventing complicated wound infections, including preemptive aseptic wound dressings, guided antibiotic therapy and surgical wound revision.

Authors 2

1. Stefan Bohr Aachen Department of Plastic and Hand Surgery - Burn Centre

   RWTH Aachen University · Universitätsklinikum Aachen · Harvard University · Massachusetts General Hospital · Shriners Hospitals for Children - Boston

   Affiliation as printed

   Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, EKM Clinics, Germany

   Department of Plastic and Hand Surgery - Burn Centre, University Clinics RWTH Aachen, Germany

   Centre for Engineering in Medicine/Surgical Services, Massachusetts General Hospital, Harvard Medical School, and Shriners Hospitals for Children, Boston, USA

2. Toghrul Mammadli Aachen Department of Plastic and Hand Surgery - Burn Centre

   RWTH Aachen University · Universitätsklinikum Aachen · Klinikum Darmstadt

   Affiliation as printed

   Department of Plastic, Reconstructive and Aesthetic Surgery, Darmstadt-Dieburg Clinics, Germany

   Department of Plastic and Hand Surgery - Burn Centre, University Clinics RWTH Aachen, Germany