Epidemiological retrospective analysis in major burn patients: single centre medical records from 2009 to 2019.

Burns cause a loss of skin barrier function, rendering it prone to infection. The prevention of infection comprises a focus on the treatment of patients with burns. Therefore, we analysed the results of microbiological tests of patients with severe and extremely severe burns to provide a basis for the prevention and treatment of infection in patients with burns. The results of microbiological tests of patients with severe and extremely severe burns admitted to our burn centre between 2009 and 2019 were retrospectively reviewed. The overall positive rate of microbial detection was 40.67% and did not significantly decline over the 10-year study period. The most common positive sites were wounds, sputum, and urine. The most common bacterial species causing the infections were Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Furthermore, the predictors of a positive detection, overall and at various sites, mainly included the burn area and depth, inhalation injury, and length of the hospital stay. Positive detection was an important predictor of the prognosis. In particular, a positive blood culture and Klebsiella pneumoniae had better predictive strength for mortality than other sites and strains. This study analysed the microbiological testing results at a single burn centre over a period of 10 years. The results provide information regarding the predictors of a positive detection and the influence of a positive detection on prognosis, and can be used as a basis for the development of clinical infection prevention and treatment strategies, as well as the selection of treatment measures.

Characterization of Bacterial Community Structure Dynamics in a Rat Burn Wound Model Using 16S rRNA Gene Sequencing.

Burns destroy the skin barrier and alter the resident bacterial community, thereby facilitating bacterial infection. To treat a wound infection, it is necessary to understand the changes in the wound bacterial community structure. However, traditional bacterial cultures allow the identification of only readily growing or purposely cultured bacterial species and lack the capacity to detect changes in the bacterial community. In this study, 16S rRNA gene sequencing was used to detect alterations in the bacterial community structure in deep partial-thickness burn wounds on the back of Sprague-Dawley rats. These results were then compared with those obtained from the bacterial culture. Bacterial samples were collected prior to wounding and 1, 7, 14, and 21 days after wounding. The 16S rRNA gene sequence analysis showed that the number of resident bacterial species decreased after the burn. Both resident bacterial richness and diversity, which were significantly reduced after the burn, recovered following wound healing. The dominant resident strains also changed, but the inhibition of bacterial community structure was in a nonvolatile equilibrium state, even in the early stage after healing. Furthermore, the correlation between wound and environmental bacteria increased with the occurrence of burns. Hence, the 16S rRNA gene sequence analysis reflected the bacterial condition of the wounds better than the bacterial culture. 16S rRNA sequencing in the Sprague-Dawley rat burn model can provide more information for the prevention and treatment of burn infections in clinical settings and promote further development in this field.

The direct hospitalisation costs of paediatric scalds: 2-year results of a prospective case series.

OBJECTIVE: To reveal the characteristic and distribution of length of hospital stay (LOS) and direct hospitalisation costs of paediatric scald. METHODS: A prospective case series observation was performed from January 2005 to December 2006 at the Burn Center, Changhai Hospital, Shanghai, China. The information, such as demographics, clinical diagnosis and treatments since admission, of the paediatric scald patients included in the series was recorded. The direct cost of a treatment event was recorded into the price system when it was incurred. All cost data were summarised on completion of the study. The distribution of LOS and the hospitalisation costs were recorded by gender, age, total burn area, depth of burn, blood transfusion and patterns of treatment. Mann-Whitney signed-rank test was used to assess the differences between continuous, non-normally distributed variables, and multiple linear regression was used to model LOS and direct hospitalisation costs. Statistical analyses were undertaken with SPSS 15.0 statistical software. RESULTS: Patients aged 3 years or less accounted for more than half of the total LOS and hospitalisation costs, patients with burn area less than 10%TBSA (total burn surface area) accounted for more than 70% of the total LOS and more than half of the hospitalisation costs and patients with second-degree burn accounted for more than 78% of the total LOS and hospitalisation costs. Depth of burn, area of burn, patterns of treatment and blood transfusion were independent predictors of LOS; whereas LOS, area of burn and blood transfusion were independent predictors of hospitalisation costs. CONCLUSION: Paediatric scalds have particular characteristics in terms of distribution of LOS and direct hospitalisation costs and the factors influencing them. The data presented in this study should assist burn care practitioners and hospital epidemiologists estimate and compare the economic burden of paediatric burns at other institutions; it may also be useful in resource allocation and cost-effectiveness analysis of treatment versus prevention strategies.