Manickavasagam, S (2008) Burns Wound Sepsis in Adults: A Prospective Study. Masters thesis, Kilpauk Medical College, Chennai.
|
Text
180300408manickvasagam.pdf Download (329kB) | Preview |
Abstract
INTRODUCTION: Although burn injuries are frequent in our society, many of these patients need hospitalization, and more than 40% die due to infections. Mortality is highest among the very young and the very old Two-thirds of all burn accidents occur at home and most commonly involve young adult females and children. Young adults are most commonly burned by flammable liquids, while toddlers are most often scalded by hot liquids while playing in the kitchen. Structural fires cause about 5% of burn accident. Inhalation injury has the biggest impact on both early and late mortality. Advances in trauma and burn management has resulted in improved survival and reduced morbidity from major burns. 50 years ago, the mortality rate of a 50% body surface area (BSA) burn in a young adult was about 50% despite treatment. Today, over 50% of these patients are surviving. Improved results are due to advancements in resuscitation, surgical techniques, infection control, nutritional and metabolic support. AIMS AND OBJECTIVES: 1. To find out the prevalence of infection in adult burn patients. 2. To find out the causative organisms and their antibiotic sensitivity. 3. To find out the most common type of infection. 4. Role of age, sex, buns percentage and general condition of the patient on the recovery. 5. To find out prevalence of drug resistant and changing pattern of microbes in burn patient. This was a prospective study which was conducted in the Departement of Burns, Plastic& Reconstructive Surgery, Kilpauk Medical College, Chennai. Two hundred and eight (208) patients with acute burns were included in this study which was conducted from January 2006 to December 2007. INCLUSION CRITERIA: 1. All patients with acute burns admitted within 12 hours of the incident, 2. Chemical , Electrical , Flame Burns, 3. Patients aged between 12 to 70 years, 4. Patients with 20-60% burns. EXCLUSION CRITERIA: 1. Patients admitted after 12 hours from the incident. 2. Admitted and treated at other hospitals and subsequently referred patient. 3. Patients aged less than 13 years and over 70 years. 4. Patients with associated systemic diseases like diabetes, Systemic hypertension, renal, hepatic disorders etc. 5. Burns more than 60%. METHOD: All patients having burns admitted via casualty to the burns department were meticulously followed up from admission to till discharge. The clinical course during the treatment was studied. DISCUSSION: This study was conducted in the Departement of Burns, Plastic & Reconstructive Surgery, Kilpauk Medical College, Chennai-10, between January 2006 & December2007. Prevalence of Infection: The prevalence of burn wound infection was found to be 59.61%. Incidence of burn wound infection on admission was 8.65%,after 48 hours it became to 43.26%,4th day it increased to 96.15% and 7th day it stabilized at 90.38%.Though burn wounds were initially sterile ,they rapidly became colonized by pathological microbes(TABLE-III). Age and Sex Distribution: In our study females in the age group of 20yrs to 40 yrs were more (66.34%) when compared to males. Changing Pattern of Microbial Organism: For all patients in the study group, after taking swabs, prophylactic antibiotic was started. Because many of the patients have dirty clothing, poor personal hygiene, they may roll on floor, and applied mud, dosa batter, ink etc.. So we decided to take culture& sensitivity on admission which is supposed to be sterile44 and we started prophylactic antibiotic. Wanted to check how each organism behaved & how early wound infection occurs so we take culture& sensitivity after 48 hours, the results of which were ready on 4th PBD, so for 4 days, the day one antibiotic had been continued. The pattern of change of flora 40 & their sensitivity were noted. If the flora changed, on 4th PBD (after 48 hours culture& sensitivity results) the antibiotic also was changed. We wanted to check if such early changes in antibiotic helped in eradication of infection or only resulted in further change in flora. Hence on 4th day, we again checked for the same. The results being received on 6th PBD, since the changed antibiotic had been on only for 3 days, we waited for one more day to have uniformity of them. On 7th PBD again swab culture and sensitivity was taken and the (4th PBD culture and sensitivity report) antibiotic change required was instituted. In the control group after starting prophylactic antibiotic, swab was taken only on the 7th post burn day. Up to 7 days the same antibiotic was continued. Swab C&S on admission found to be, sterile or showed only commensals in both groups. CONCLUSION: According to this study * More number of female patients in 20-40 years age group were admitted with burns than compared to male. * Initially all burn wounds are sterile or only has commensals * Frequent change of antibiotics results in changing pattern of infective organism. * Klebsiella is the most common infecting organism seen in our department. * MRSA infection is insignificant in our unit * Amikacin was the effective antibiotic in comparison to ampicilln,ceftriaxone,cloxacillin,ciprofloxacin, cefotaxim. But it is preferred as second line antibiotic, since the raw area was still be there (potentially infected). If amikacin is started as first line of defense, chances of developing resistant is high. * Personal hygiene of both patients & care givers, aseptic precaution during dressing, separate dressing trolley for each patients, periodical bacterial survivallence and fumigation of burns ward can significantly reduce the mortality among adult burn patients.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Burns Wound Sepsis ; Adults ; Prospective Study. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:58 |
| Last Modified: | 12 Oct 2017 01:58 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3573 |
Actions (login required)
 |
View Item |
