A polymicrobial fungal outbreak in a regional burn center after Hurricane Sandy.

OBJECTIVE: To describe a polymicrobial fungal outbreak after Hurricane Sandy. DESIGN: An observational concurrent outbreak investigation and retrospective descriptive review. SETTING: A regional burn intensive care unit that serves the greater Baltimore area, admitting 350-450 burn patients annually. PATIENTS: Patients with burn injuries and significant dermatologic diseases such as toxic epidermal necrolysis who were admitted to the burn intensive care unit. METHODS: An outbreak investigation and a retrospective review of all patients with non-candida fungal isolates from 2009-2016 were performed. RESULTS: A polymicrobial fungal outbreak in burn patients was temporally associated with Hurricane Sandy and associated with air and water permeations in the hospital facility. The outbreak abated after changes to facility design. CONCLUSIONS: Our results suggest a possible association between severe weather events like hurricanes and nosocomial fungal outbreaks. This report adds to the emerging literature on the effect of severe weather on healthcare-associated infections.

Fat Grafting and Adipose-Derived Regenerative Cells in Burn Wound Healing and Scarring: A Systematic Review of the Literature.

BACKGROUND: There is an abundance of literature supporting the efficacy of fat grafting in aesthetic and reconstructive cases. There has been a recent emphasis on the regenerative capacity of adipose-derived stem cells and their utility in the improvement of wound healing and scarring provided by their cytokine and growth factor profiles. Despite the wealth of evidence supporting their efficacy, little attention has been paid to their utility in burn treatment. The authors' purpose was to provide an analysis of the literature regarding the use of fat grafting and regenerative cells in the treatment of burn wounds to guide surgeons and scientists on their clinical use. METHODS: A systematic review of the literature was performed by a thorough search of 12 terms using the PubMed, Medline, and Cochrane databases. Two hundred forty-one articles were subject to evaluation by predetermined inclusion and exclusion criteria. RESULTS: Six murine and 12 human studies were selected, including case-control studies, case series, and case reports. They describe histologic and clinical effects of fat grafting and regenerative cell therapy, including improvements in burn scar size and texture, enhanced angiogenesis, decreased inflammation, alleviation of pain, and return of function. CONCLUSIONS: There is a dearth of randomized controlled trials and quantitative analysis supporting the efficacy of fat grafting and adipose regenerative cells in burns. However, the subjective improvements in scars are encouraging. The authors hope that this review will be a foundation for future studies and will highlight the breadth of knowledge yet to be explored by this therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Cody.

Advances in burn management over the past 2 decades have resulted in improved survival and reduced morbidity. The treatment of a single patient following a 90% total body surface area injury illustrates the intensity of labour and coordinated hospital care required for such catastrophically injured patients. Data were extracted from the medical records and from personal recollections of the individual members of the multidisciplinary team as well as from the patient. The clinical course and management of complications are described chronologically as a series of overlapping phases from admission to discharge.

Liver disease in burn injury: evidence from a national sample of 31,338 adult patients.

OBJECTIVE: To assess mortality risk and extent of increased length of hospital stay in patients with burn injury with preexisting liver disease. METHODS: Records of 31,338 adults who were admitted with burns to 70 burn centers were reviewed from the American Burn Association National Burn Repository. Demographics, percentage burn, and medical characteristics of 180 patients with liver disease were compared with all patients without liver disease and to a propensity score-matched sample of 180 patients without liver disease. Risk of mortality as well as lengths of both intensive care and total stay were compared after matching for demographics, burn injury, and preexisting medical conditions. RESULTS: Patients with liver disease were significantly more likely to have a history of a number of medical comorbidities, including alcohol abuse, drug abuse, a psychiatric diagnosis, chronic pulmonary disease, hypertension, and diabetes. Patients with liver disease were significantly more likely to die in the hospital (27.2% vs 6.9%, odds ratio = 5.0, 95% confidence interval = 3.6-7.0, P < .01), and this held even when compared with a propensity score-matched group of patients without liver disease, but with similar demographics, burn injury, and medical profiles. Lengths of both intensive care and total hospital stay were 122.5% (P < .01) and 86.7% (P < .01) longer, respectively, among patients with liver disease than among all other patients. In a matched sample, lengths of both intensive care and total stays were longer, albeit not significantly so (41.6%, P = .12; 35.5%, P = .07). CONCLUSIONS: Liver impairment worsens the prognosis in patients with thermal injury.