Molecular characteristics and antimicrobial resistance profiles of Staphylococcus aureus isolates from burns.

BACKGROUND: Burns are a problem that affects millions of individuals around the world. OBJECTIVE: This research aimed to analyze the genetic characteristics and antibiotic resistance of Staphylococcus aureus strains isolated from patients with burns. Identifying the genetic variations of three local strains of Staphylococcus aureus isolated from burns. MATERIALS AND METHODS: Swab samples were collected from eighty sources (burns). Using sterile swabs containing media collected from patients treated at Baqubah Teaching Hospital between July 2022 and the end of September 2022, these samples were then cultured on blood agar and brain heart infusion agar. A total of twenty-four hours were spent incubating the cultured samples in an aerobic environment at 37 °C. During this time, isolated growing colonies showed characteristic growth, color, and hemolysis, while suspicious colonies were cultured for further identification. RESULTS: Our results indicated the presence of several polymorphisms that were distributed in the investigated samples. However, almost all observed variations were concentrated only in the S2 isolates. The construction of phylogenetic trees confirmed this notion by positioning these S2-based amplicons to distinct categories within Staph. aureus organisms. Furthermore, the phylogenetic tree offered additional tools for the guaranteed identity of the samples that were analyzed. Consequently, the utilization of the PCR-sequencing approach in three DNA samples belonging to these local bacterial isolates has resulted in the confirmation of the identity of this strain. However, particular emphasis should be placed on S2 isolate as it has special variants that differ from its mates, in terms of its metabolic as well as phylogenetic consequences. Therefore, S2 isolates may represent a new strain that requires a whole genome sequencing strategy to validate its identity within Staph. aureus organisms. S.aureus resistance was 100% (Augmentin and Tetracycline), and 90% (Azithromycin and Trimethoprim), while Cefotaxime and Chloramphenicol recorded (75%, and 85%) respectively.

Etiological structure and antibiotic resistance pattern of burn wound infections in hospitalized patients - a one-center study in Varna, Bulgaria.

In the present retrospective study, we have evaluated bacterial pathogens isolated from patients admitted to the Burn Care Unit at the Military Medical Academy, Varna, Bulgaria over a three-year period (January 2019 - December 2021). We also tried to summarize the corresponding antibiotic resistance pattern of the isolated infectious agents. A total of 1030 isolates were obtained from 1912 burn wound samples investigated. There were 553 Gram-positive (53.7%) and 477 Gram-negative (46.3%) isolates. The most common isolates for the study period were coagulase-negative staphylococci (CoNS) (25%), Pseudomonas aeruginosa (17.7%), Staphylococcus aureus (16.6%), Acinetobacter baumannii (7.7%), Enterobacter spp. (7.1%), Escherichia coli (4.4%), Proteus spp. (3.4%), and Klebsiella spp. (2.9%). Glycopeptide antibiotics and linezolid were the most effective drugs against gram-positive isolates, followed by amikacin (for synergistic combinations), whereas colistin, imipenem, meropenem, cefoperazon/sulbactam, and piperacillin/tazobactam were the most active drugs against Gram-negative isolates, and colistin, ampicillin/sulbactam - against A. baumannii.

Antimicrobial, Anti-inflammatory, and Wound Healing Properties of Myrtus communis Leaf Methanolic Extract Ointment on Burn Wound Infection Induced by Methicillin-Resistant Staphylococcus aureus in Rats.

Materials and Methods: In a research experiment, 48 male Wistar rats were anesthetized and second-degree burns were induced on their backs. The rats' wounds were then uniformly inoculated with MRSA. Various treatments were applied to the burn wounds daily, including Myrtus ointment, silver nanoparticles, silver nanoparticles-Myrtus ointment, silver sulfadiazine-Myrtus ointment, silver sulfadiazine 1%, mupirocin ointment, and a positive control. The study measured the antimicrobial effects, wound area, percentage of wound healing, antioxidant capacities, malondialdehyde, and nitric oxide concentrations in the serum of the rats. Data analysis was performed using GraphPad software, with one-way ANOVA and Tukey's tests used to determine the statistical significance of the results. Results: Rats treated with Myrtus ointment, silver nanoparticles-Myrtus ointment, and mupirocin had reduced bacterial growth compared to the positive control group, nanoparticle ointment, and silver sulfadiazine (P < 0.05). The wound area of the Myrtus ointment group decreased significantly on the seventh and fourteenth days, as well as the level of MDA and nitric oxide, compared to the other groups. In Myrtus and silver sulfadiazine-Myrtus ointment increased the thickness of the epidermis and dermis compared to the other groups. Conclusion: Based on the anti-inflammatory, antimicrobial, and wound healing properties of Myrtus, with further studies, an ointment of this plant may be used as a main or complementary treatment for burn wound infections caused by MRSA.

Antivirulence and antipathogenic activity of Mayan herbal remedies against Pseudomonas aeruginosa.

ETHNOPHARMACOLOGICAL RELEVANCE: The Yucatan Peninsula has a privileged wealth of vascular plants with which various Mayan herbal formulations have been developed. However, studies on their antipathogenic and antivirulence properties are scarce. AIM OF THE STUDY: Identify antivirulence properties in Mayan herbal remedies and determine their antipathogenic capacity in burn wounds infected with Pseudomonas aeruginosa. MATERIALS AND METHODS: An ethnobotanical study was conducted in Mayan communities in central and southern Quintana Roo, Mexico. Furthermore, the antipathogenic capacity of three Mayan herbal remedies was analyzed using an animal model of thermal damage and P. aeruginosa infection. Antivirulence properties were determined by inhibiting phenotypes regulated by quorum sensing (pyocyanin, biofilm, and swarming) and by the secretion of the ExoU toxin. The chemical composition of the most active herbal remedy was analyzed using molecular network analysis. RESULTS: It was found that topical administration of the remedy called "herbal soap" (HS) for eleven days maintained 100% survival of the animals, reduced establishment of the bacteria in the burn and prevented its systemic dispersion. Although no curative effect was recorded on tissue damaged by HS treatment, its herbal composition strongly reduced swarming and ExoU secretion. Through analysis of Molecular Networks, it was possible to carry out a global study of its chemical components, and identify the family of oxindole monoterpenoid alkaloids and carboline and tetrahydropyrididole alkaloids. In addition, flavonols, flavan-3-ols, and quinic acid derivatives were detected. CONCLUSIONS: The antipathogenic and antivirulence capacity of ancient Mayan remedies makes them a potential resource for developing new antibacterial therapies to treat burns infected by P. aeruginosa.

Risk factors for in-hospital acquisition of carbapenem-resistant Enterobacterales in patients with severe burns.

BACKGROUND: Although patients with severe burns are prone to severe infections with antibiotic-resistant bacteria and inevitably have some risk factors for carbapenem-resistant Enterobacterales (CRE) acquisition, risk factors for CRE infection or colonization in these patients have not been investigated. AIM: To identify the independent risk factors for CRE acquisition in patients with severe burns. METHODS: Patients admitted to the burn intensive care unit (BICU) for acute burn care were categorized based on culture results during BICU care into the CRE group and non-CRE group, which included the carbapenem-susceptible Enterobacterales (CSE) and control groups. Clinical and microbiological factors were compared between the CRE and non-CRE groups, and between the CRE and CSE groups to identify independent risk factors for in-hospital CRE acquisition. FINDINGS: Among the included 489 patients, 101 (20.7%) and 388 (79.3%) patients were classified in the CRE and non-CRE groups, respectively. The non-CRE group included 91 (18.6%) and 297 (60.7%) patients in the CSE and control groups, respectively. In multivariate analysis between the CRE and non-CRE groups, exposure to other CRE-acquired patients (P = 0.018), abbreviated burn severity index score ≥9 (P = 0.012), and mechanical ventilation (P < 0.001) were associated with CRE acquisition. In multivariate analysis between the CRE and CSE groups, exposure to other CRE-acquired patients was associated with CRE acquisition (P = 0.048). CONCLUSION: Considering the limitation of controlling the burn severity in hospitalized patients, enhanced infection control measures for preventing in-hospital CRE transmission among patients with severe burns should be emphasized.

Multidrug-Resistant Organisms: The Silent Plight of Burn Patients.

The global increasing spread of multidrug-resistant organisms (MDROs) is threatening the control of various infections in vulnerable populations and patient groups. One of the most affected groups is patients with burns, who are prone to hyperinfection as they suffer from a hypermetabolic state and weaken immune barriers. Those patients also share the infection risk of patients hospitalized for a long time, including ventilator-associated pneumonia and urinary tract infections. While some preventative and therapeutic management styles are still controversial, we discuss consensuses here. In this review, we aim to present the current knowledge on multidrug resistance with a special focus on patients with burns, discuss various causative organisms and their treatment options, and highlight the importance of antibiotic stewardship and teamwork in responding to an outbreak of MDROs.

Bloodstream infections and multidrug resistant bacteria acquisition among burns patients in Australia and New Zealand: A registry-based study.

INTRODUCTION: This study interrogates infection related data in the Burns Registry of Australia and New Zealand (BRANZ), to examine associations of multi-drug resistant organisms (MDROs) and blood stream infection (BSI). METHODS: Data between July 2016 and June 2021 were analysed to determine prevalence, risk factors and outcomes associated with BSIs and MDROs: Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Pseudomonas spp. (CRP), and carbapenem-resistant Enterobacter (CRE). Data completeness and value for quality improvement activity were assessed. RESULTS: We found a low incidence (3.4%) of the resistant organisms of interest, and no change over the study period. Fequency varied between services and increased with age and size of burn. MRSA was the commonest organism in all age groups. A positive BSI result occurred in 1.6% of patients (12.1% of cultures taken) at a median time of 10.2 days post injury. Free text identification of organisms was inconsistently documented. CONCLUSIONS: The low rate and patterns of acquisition of MDROs of interest and BSIs is comparable with reports from countries with low incidence of massive burns. Wider adoption of a standardized laboratory reporting framework would help realise the potential of clinical quality registries to provide data which supports evidence based infection prevention initiatives.

Evolution, control and success of combination therapy with Ampicilin-sulbactam/Ceftazidime-Avibactam during a Carbapenem-Resistant Acinetobacter baumannii outbreak in burn Intensive Care Unit.

We present our findings on interpatient transmission, epidemic control measures, and the outcomes of a series of ten critically ill burn patients who were either colonized or infected with carbapenem-resistant Acinetobacter baumannii (CRAB). None of the five infected patients achieved clinical cure, and all experienced relapses. Microbiological failure was observed in 40% of the infected patients. The isolated CRAB strains were found to carry blaOXA-23 and armA resistance genes. Despite the lack of clinical cure, all five infected patients survived and were discharged from the Burn Intensive Care Unit.

Recent alcohol intake impacts microbiota in adult burn patients.

Alcohol use is associated with an increased incidence of negative health outcomes in burn patients due to biological mechanisms that include a dysregulated inflammatory response and increased intestinal permeability. This study used phosphatidylethanol (PEth) in blood, a direct biomarker of recent alcohol use, to investigate associations between a recent history of alcohol use and the fecal microbiota, short chain fatty acids, and inflammatory markers in the first week after a burn injury for nineteen participants. Burn patients were grouped according to PEth levels of low or high and differences in the overall fecal microbial community were observed between these cohorts. Two genera that contributed to the differences and had higher relative abundance in the low PEth burn patient group were Akkermansia, a mucin degrading bacteria that improves intestinal barrier function, and Bacteroides, a potentially anti-inflammatory bacteria. There was no statistically significant difference between levels of short chain fatty acids or intestinal permeability across the two groups. To our knowledge, this study represents the first report to evaluate the effects of burn injury and recent alcohol use on early post burn microbiota dysbiosis, inflammatory response, and levels of short chain fatty acids. Future studies in this field are warranted to better understand the factors associated with negative health outcomes and develop interventional trials.

A novel, reverse-phase-shifting, thermoreversible foaming hydrogel containing antibiotics for the treatment of thermal burns in a swine model - A pilot study.

BACKGROUND: This study compared a novel topical hydrogel burn dressing (CI-PRJ012) to standard of care (silver sulfadiazine) and to untreated control in a swine thermal burn model, to assess for wound healing properties both in the presence and absence of concomitant bacterial inoculation. METHODS: Eight equal burn wounds were created on six Yorkshire swine. Half the wounds were randomized to post-burn bacterial inoculation. Wounds were subsequently randomized to three treatments groups: no intervention, CI-PRJ012, or silver sulfadiazine cream. At study end, a blinded pathologist evaluated wounds for necrosis and bacterial colonization. RESULTS: When comparing CI-PRJ012 and silver sulfadiazine cream to no treatment, both agents significantly reduced the amount of necrosis and bacteria at 7 days after wound creation (p < 0.01, independently for both). Further, CI-PRJ012 was found to be significantly better than silver sulfadiazine (p < 0.02) in reducing bacterial colonization. For wound necrosis, no significant difference was found between silver sulfadiazine cream and CI-PRJ012 (p = 0.33). CONCLUSIONS: CI-PRJ012 decreases necrosis and bacterial colonization compared to no treatment in a swine model. CI-PRJ012 appeared to perform comparably to silver sulfadiazine. CI-PRJ012, which is easily removed with the application of room-temperature water, may provide clinical advantages over silver sulfadiazine.

Rare multi-fungal sepsis: a case of triple-impact immunoparalysis.

Patients with burn injury and inhalation injury are highly susceptible to infectious complications, including opportunistic pathogens, due to the loss of skin cover and mucosal damage of respiratory tract as well as the disruption of homeostasis. This case report, a 34-year-old man suffered critical burns, provides the first literature description of triple-impact immunoparalysis (critical burns, inhalation injury, and SARS-CoV-2 infection), leading to a lethal multifocal infection caused by several fungi including very rare environmental representatives Metschnikowia pulcherrima and Wickerhamomyces anomalus. The co-infection by these common environmental yeasts in a human is unique and has not yet been described in the literature. Importantly, our patient developed refractory septic shock and died despite targeted antifungal therapy including the most potent current antifungal agent-isavuconazole. It can be assumed that besides immunoparalysis, effectiveness of therapy by isavuconazole was impaired by the large distribution volume in this case. As this is a common situation in intensive care patients, routine monitoring of plasmatic concentration of isavuconazole can be helpful in personalization of the treatment and dose optimization. Whatmore, many fungal species often remain underdiagnosed during infectious complications, which could be prevented by implementation of new methods, such as next-generation sequencing, into clinical practice.

Multi-resistant organisms in burn patients: an end or a new beginning.

Infections are a major cause of morbidity and mortality in burn patients, and the rise of multidrug-resistant organisms (MDROs) has made it more challenging to manage and prevent infections. This review examines the available treatment options for MDROs in burn patients and anticipates the future challenges posed by their increasing prevalence. The review covers new antibiotics, such as Eravacycline and Plazomicin, as well as non-antibiotic therapies, such as bacteriophages and nanoparticles. Future research should focus on examining the long-term efficacy, cost-effectiveness, and in vivo efficacy of different treatment modalities. The potential of alternative therapies, such as probiotics and low-frequency magnetic fields, should also be explored. Accurate and rapid diagnostic and monitoring tools for detecting MDROs in burn patients should be developed. The emergence of MDROs in burn care is a challenge and a new beginning in infection innovation and novel treatments.

Central venous catheter tip colonization and associated bloodstream infection in patients with severe burns under routine catheter changing.

BACKGROUND: Although routine changing of central venous catheters (CVCs) is commonly performed in patients with severe burns, information on pathogen colonization of the CVC tip and associated bloodstream infections (BSIs) is limited in those patients. METHODS: The medical records of 214 patients with severe burns who underwent routine CVC changing at 7-day intervals and their results of 686 pairs of CVC tips and concurrent blood cultures were retrospectively reviewed to evaluate the CVC colonization rate and associated BSI pathogens. RESULTS: Of the 686 CVCs, 137 (20.0%) were colonized by pathogens, and 81 (59.1%) of them had BSIs caused by the same pathogen. Nonflame burn (P = .002), total body surface area burn ≥30% (P = .004), femoral catheterization (P = .001), CVC changing during pre-existing BSI (P < .001), and renal replacement therapy (P = .017) were associated with catheter-related BSI in the multivariate analysis. Most BSIs were caused by Gram-negative bacteria (most commonly Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa). CONCLUSIONS: The CVC colonization rate in patients with severe burns and routine CVC changing was not high. Lengthening the CVC duration might be attempted in patients at a lower risk of catheter-related BSI although further prospective studies are necessary.

Fusariosis in burn patients: A systematic review of case reports.

Burns can cause skin damage, facilitating the entry of fungi and other microorganisms into the body, leading to infections. Fusarium is a fungus capable of infecting individuals with burn injuries. Diagnosing and treating Fusarium infections in burn patients can be challenging due to the manifestation of nonspecific symptoms. This study aims to investigate case reports and case series from published literature describing Fusarium infection in burned patients, in order to assess treatment regimens, clinical outcomes, and make recommendations for future management. We conducted searches on Web of Science, PubMed, ScienceDirect, and Medline for all case reports and case series containing keywords 'Burn', 'Burns', 'Burned', 'Fusarium', or 'Fusariosis' in the title or abstract. All burn patients who developed Fusarium fungal infections between January 1974 and March 2023 were included in the study. Demographic and clinical data were analyzed retrospectivity. The final analysis incorporates 24 case reports encompassing a total of 87 burn patients with Fusarium infection. Patient ages ranged from one to 85 years, with the majority being male (53%). The median percentage of burn surface area was 78%, and the skin in the face, upper limbs, and lower limbs were the most commonly infected sites. Fungal infections appeared around 10 days after the burn injury on average. The majority of the patients were identified through culture or histopathology. The Fusarium dimerum species complex, which was found in nine patients, was the most frequently identified Fusarium species complex. Amphotericin B was the most preferred treatment drug, followed by voriconazole, and 62% of patients underwent debridement. In our study, 23 patients (37%) died from fungal infections. Implementing early and effective treatment protocols targeting Fusarium spp. in burn treatment units can significantly reduce mortality rates. It is critical to enhance the understanding of fusariosis epidemiology and emphasize the importance of maintaining a high clinical suspicion for this condition in burn patients.

Cold atmospheric plasma is bactericidal to wound-relevant pathogens and is compatible with burn wound healing.

Burn wound healing can be significantly delayed by infection leading to increased morbidity and hypertrophic scarring. An optimal antimicrobial agent would have the ability to kill bacteria without negatively affecting the host skin cells that are required for healing. Currently available products provide antimicrobial coverage, but may also cause reductions in cell proliferation and migration. Cold atmospheric plasma is a partially ionized gas that can be produced under atmospheric pressure at room temperature. In this study a novel handheld Aceso Plasma Generator was used to produce and test Aceso Cold Plasma (ACP) in vitro and in vivo. ACP showed a potent ability to eliminate bacterial load in vitro for a number of different species. Deep partial-thickness and full-thickness wounds that were treated with ACP after burning, after excision, after autografting, and at days 5, 7, and 9 did not show any negative effects on their wound healing trajectories. On par with in vitro analysis, bioburden was decreased in treated wounds vs. control. In addition, metrics of hypertrophic scar such as dyschromia, elasticity, trans-epidermal water loss (TEWL), and epidermal and dermal thickness were the same between the two treatment groups.It is likely that ACP can be used to mitigate the risk of bacterial infection during the phase of acute burn injury while patients await surgery for definitive closure. It may also be useful in treating wounds with delayed re-epithelialization that are at risk for infection and hypertrophic scarring. A handheld cold plasma device will be useful in treating all manner of wounds and surgical sites in order to decrease bacterial burden in an efficient and highly effective manner without compromising wound healing.

Phenotypic and molecular detection of metallo-ß-lactamase-producing Pseudomonas aeruginosa isolates from patients with burns in Tehran, Iran

Abstract INTRODUCTION: Health care-associated infections caused by metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa are a significant growing concern in patients with burns worldwide. The aims of this study were to determine the antibiotic susceptibility of and detect the presence of MBLs among P. aeruginosa isolates and assess their clonal relationship using enterobacterial repetitive intergenic consensus (ERIC)-PCR. METHODS: Non-duplicated clinical isolates (160) of P. aeruginosa were collected from patients with burns at the Motahari Hospital in Tehran, Iran. All isolates were identified using standard laboratory methods and further characterized for antimicrobial susceptibility. Any carbapenem-resistant isolates were then examined for MBL production by the E-test and MBL-encoding genes were detected by PCR. The clonal relatedness of MBL-producing isolates was assessed by ERIC-PCR. RESULTS: For multidrug-resistant isolates, the highest rates of susceptibility were observed for colistin 160 (100%), polymyxin B 160 (100%), and ceftazidime 32 (20%). In total, 69 (43.7%) isolates were identified as MBL producers. Twenty-eight (17.5%) isolates were positive for the bla VIM-1 gene followed by the bla IMP-1 (15.6%) and bla SPM-1 (5.6%) genes. ERIC-PCR revealed three separate genotypes, where type A (76.8%) was the most prevalent, followed by B (20.3%), and then C (2.9%). CONCLUSIONS: Our present study found that the bla IMP-1 and bla VIM-1 genes were present at a significant frequency and also detected the bla SPM-1 gene in P. aeruginosa isolates for the first time, highlighting the need for establishing suitable infection control measures to successfully treat patients and prevent further spread of these resistant organisms among patients with burns.

Mutation and Efflux System are Responsible for Ciprofloxacin Resistance in Klebsiella pneumoniae / Las mutaciones y el sistema de eflujo son responsables de la resistencia a la ciprofloxacina en la Klebsiella pneumoniae

ABSTRACT The main mechanism of quinolone resistance in Klebsiella (K) pneumoniae is caused by mutation of porin-related proteins and efflux pumps. This study aimed to investigate the prevalence of ciprofloxacin-resistant K pneumoniae in burns patients and to understand the role of the AcrAB multidrug efflux system on minimal inhibitory concentration (MIC) of ciprofloxacin. For this reason, 52 K pneumoniae samples were collected from burns patients and evaluated for the mechanism of ciprofloxacin resistance. The results demonstrated that 40 isolates of K pneumoniae were ciprofloxacin-resistant and 35 showed the mutation on gyrA locus. By inhibition of the efflux system, the MIC yield showed a significant decrease. Therefore, it could be concluded that the high rate of mutation on the gyrA locus in combination with quinolone resistance was responsible for ciprofloxacin resistance and by inhibition of AcrA, the resistance rate showed a significant decrease in K pneumoniae isolated from burns patients.

RESUMEN El principal mecanismo de resistencia a la quinolona en las Klebsiella (K) Pneumoniae tiene como causa la mutación de las porinas y las bombas de eflujo. Este estudio tuvo por objetivo investigar la prevalencia de las K pneumoniae resistentes a la ciprofloxacina en pacientes con quemaduras, así como entender el papel del sistema de eflujo multidroga AcrAB en la concentración inhibitoria mínima (CIM) de la ciprofloxacina. Por esta razón, se recogieron 52 muestras de K pneumoniae de pacientes con quemaduras, a fin de evaluar el mecanismo de resistencia a la ciprofloxacina. Los resultados mostraron que 40 aislados de K pneumoniae eran resistentes a la ciprofloxacina y 35 mostraron la mutación en el locus gyrA. Con la inhibición del sistema de eflujo, el rendimiento de CIM tuvo una disminución significativa. Por lo tanto, se pudo concluir que la alta tasa de mutación en el locus gyrA en combinación con la resistencia a la quinolona era responsable de la resistencia a la ciprofloxacina, y por la inhibición de AcrA, la tasa de resistencia mostró una disminución significativa en las K pneumoniae aisladas de los pacientes con quemaduras.

Infecciones en niños quemados internados en el Centro Nacional de Quemados y Cirugías Reconstructivas (CENQUER) Paraguay de Enero 2017 a Enero 2018 / Infections in burned children admitted to the National Center for Burns and Reconstructive Surgery (CENQUER) Paraguay from January 2017 to January 2018

Introducción: Las infecciones juegan un rol importante en la morbilidad y mortalidad asociada a quemaduras. La experiencia en pacientes pediátricos es escasa. Objetivo: Evaluar aspectos clínicos y microbiológicos de infección intrahospitalaria en niños quemados en el Centro Nacional de Quemados y Cirugías Reconstructivas. Material y Métodos: Estudio descriptivo, observacional, retrospectivo y de corte transversal. Se incluyeron todos los niños quemados admitidos en el Servicio de Pediatría del Centro Nacional de Quemados y Cirugías Reconstructivas (CENQUER) desde enero del 2017 hasta enero del 2018. Resultados: El total de pacientes fue de 220, de los cuales fueron 161 (73%) lactantes, 24 (11%) pre escolares, 17 (8%) escolares, 13 (6%) adolescentes y 5 (2%) recién nacidos. El porcentaje de superficie corporal quemada tuvo un rango de 1 a 95% (mediana 27%). El tipo de quemadura fue A (superficial) en 78 (36%) pacientes, AB (intermedia) en 38 (17%) y B (profunda) en 104 (47%). Ciento ochenta niños (82%) tuvieron catéter venoso, 166 (75,5%) catéter arterial y 172 (78%), sonda vesical. En 150 pacientes (68%) se requirió asistencia respiratoria mecánica. Se documentaron 128 (58%) infecciones. El foco más frecuente fue la sepsis relacionada con la quemadura. Las bacterias Gram (-) Pseudomonas aeruginosa y Acinetobacter spp multirresistentes, fueron los gérmenes más frecuentemente aislados. Se fueron de alta 186(85%) pacientes y 34 (15%) fallecieron. En 28 (82%) de ellos, la causa del fallecimiento estuvo relacionada con la infección. La duración de la internación tuvo una mediana de 37 días. Conclusiones: Las infecciones en niños quemados son una importante causa de morbimortalidad y las bacterias Gram (-) multirresistentes juegan un importante rol en las mismas. La mortalidad estuvo relacionada a la infección

Introduction: Infections play an important role in the morbidity and mortality associated with burns. Experience in pediatric patients is scarce. Objective: To evaluate clinical and microbiological aspects of nosocomial infection in children burned in the National Center for Burns and Reconstructive Surgeries. Material and Methods: A descriptive, observational, retrospective and cross-sectional study. All burned children admitted to the Pediatric Service of the National Center for Burns and Reconstructive Surgery (CENQUER) from January 2017 to January 2018 were included. Results: The total number of patients was 220, of which 161 (73%) were breastfeeding, 24 (11%) pre-school, 17 (8%) schoolchildren, 13 (6%) adolescents and 5 (2%) newborns. The percentage of burned body surface area ranged from 1 to 95% (median 27%). The type of burn was A (superficial) in 78 (36%), patients, AB (intermediate) in 38 (17%) and B (deep) in 104 (47%). One hundred and eighty children (82%) had venous catheter, 166 (75.5%) arterial catheter and 172 (78%); bladder catheter in 150 patients (68%) mechanical ventilation was required. In 128(58%) patients infections were documented. The most frequent focus was sepsis related to the burn. Gramnegative bacteria Pseudomonas aeruginosa and multiresistant Acinetobacter spp were the most frequently isolated germs. 186(85%) patients were discharged and 34 (15%) died. In 28 (82%) of them, the cause of death was related to the infection. The duration of the hospitalization had a median of 37 days. Conclusions: Infections in burned children are an important cause of morbidity and mortality and multidrug resistant gram negative bacteria play an important role in them. Mortality was related to infection.

Incidencia y factores de riesgo para bacteriemia en pacientes pediátricos con quemaduras en un Centro de Atención Especializado en México / Incidence and risk factors for bacteremia on pediatric patients with burns in a specialized care center in Mexico

Background: Bacteremia events are frequent cause of mortality in burn patients and may originate from infected wounds, by bacterial translocation of endogenous microorganisms, from invasive devices or contaminated intravenous solutions. Objective: To quantify the incidence of bacteremia in pediatric patients with burns and to identify risk factors. Material and Methods: A prospective cohort study was performed in pediatric patients with burns of Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Bacteremia was diagnosed by blood cultures in patients with clinical manifestations of sepsis. Risk factors were investigated by multivariate analysis with Cox regression. Results: Were included in the cohort 260 patients, median age 3 years. The incidence of bacteremia was 9.6 events per 1,000 days patient. The most frequently isolated bacteria were Enterobacteriaceae (41.9%), Staphylococcus aureus (22.6%) and Pseudomonas aeruginosa (22.6%). Factors associated with bacteremia were: bums ≥ 20% TBSA (HR 11.06; 95% CI 4.8-25.4), deep second degree bums or higher (HR 6.9; 95% CI 2.0-23.3) and have had two or less debridement (HR 26.4; 95% CI 8.0-87.7). Conclusions: Patients with more extensive and deep burns with fewer debridement are at increased risk of bacteremia.

Introducción: Los eventos de bacteriemia son causa frecuente de mortalidad en pacientes con quemaduras y pueden originarse en heridas infectadas, por translocación bacteriana de microorganismos endógenos, por dispositivos invasores o por soluciones intravenosas contaminadas. Objetivo: Cuantificar la incidencia de bacteriemia en pacientes pediátricos con quemaduras e identificar los factores de riesgo. Material y Métodos: Estudio de cohorte prospectivo, en población pediátrica con quemaduras del Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". En pacientes con manifestaciones clínicas de sepsis se diagnosticó bacteriemia mediante cultivos de sangre. Se indagaron factores de riesgo con análisis multivariado con regresión de Cox. Resultados: Se incluyeron en la cohorte 260 pacientes, mediana de edad 3 años. La incidencia de bacteriemia fue de 9,6 eventos por 1.000 días paciente. Las bacterias más frecuentes aisladas fueron enterobacterias (41,9%), Staphylococcus aureus (22,6%) y Pseudomonas aeruginosa (22,6%). Los factores asociados a bacteriemia fueron: quemaduras ≥ 20% de superficie corporal quemada (HR 11,06; IC 95% 4,8-25,4), quemaduras de segundo grado profundo o mayores (HR 6,9; IC 95% 2,0-23,3) y haber tenido dos o menos desbridamientos (HR 26,4; IC 95% 8,0-87,7). Conclusiones: Pacientes con quemaduras más extensas y profundas, con menor número de desbridamientos presentan mayor riesgo de bacteriemia.

The effects of low level laser therapy on Staphylococcus aureus infected third-degree burns in diabetic rats

PURPOSE: To characterize the effects of low-level laser (LLL) on third-degree burn wounds which were infected with Staphylococcus aureus (S. aureus) in diabetic rats. METHODS: Thirty streptozotocin-induced diabetic rats were divided into two groups: the control and the LLL groups. Third-degree burns were induced using a heated metal rod, and then, were contaminated with S. aureus. The wounds in the LLL group were irradiated with a LLL (685nm) daily for five consecutive days, starting three days after the induction. The wound area was measured at 3, 5, 8, 14 and 21 days after burning. At the end of trial, the skin samples were harvested. RESULTS: Reduction in wound areas in the LLL and control groups were significantly different only on the 21st day (p<0.05). The mean bacterial numbers in the LLL group were significantly lower (p<0.05) than those in the control group. The number of macrophages, new blood vessels, fibroblast, and elevated collagen deposition in the LLL group significantly increased compared to the control group (p<0.05). The mean breaking strength of scars in the control group was significantly lower (p<0.05) than that of the LLL group. CONCLUSION: The low-level laser improved the healing of S. aureus third-degree burn infections in diabetic rats.