Speciation and amphotericin B sensitivity studies on blood isolates of Candida from burned patients.

Methods of speciating Candida isolates from clinical specimens are described and the necessity of speciation is emphasized. Differences in susceptibility of C. albicans and C. tropicalis to amphotericin B were observed and the implications of this in relation to treatment with amphotericin B and the development of resistance are discussed.

Tibial compartment syndromes in burn patients. A report of four cases.

Anterior and posterior motor compartment syndrome have been observed in four burn patients. Recognition was difficult because of multiple concurrent problems, including burns and thrombophlebitis of the involved extremities. Early fasciotomy was performed in one case, with good return of function. Muscle necrosis occurred in two patients in whom diagnosis was delayed. Electromyography is of benefit in confirming the diagnosis and providing follow-up management. It is important to maintain a high index of suspicion of this syndrome in patients with overlying burns.

Experience with amphotericin-B in the treatment of systmeic candidiasis in burn patients.

Systemic candidiasis has emerged as a major cause of death in burn patients. An increase both in the incidence of systemic candidiasis and its increase as a cause of death has been observed. Treatment with systemic amphotericin-B prior to 1971 at our institution was rarely successful. This was felt to be in part due to lack of sufficiently early recognition of the infection and to delay in the initiation of appropriate systemic therapy. From 1971 to 1975, fifteen patients have been treated with systemic amphotericin-B with one death. There have been no fatalities from candidiasis since 1972. No serious complications attributed to the use of amphotericin-B were observed. Prompt initiation of therapy with intravenous amphotericin-B is advised for burn patients in whom systemic candidiasis is present.

Primary excision of the burn wound.

Early excision of burn eschar and wound closure significantly improves survival following major burn injury. Immediate primary excision performed by burn-experienced surgeons in dedicated burn care facilities can reduce further morbidity and mortality, length of hospital stay and medical costs. Burn care at the millennium is evolving rapidly into a subcategory of trauma surgery, with burn patients increasingly being viewed as victims of major trauma who benefit most from immediate and definitive surgical correction of their injuries.

Trichosporon beigelii septicaemia in a burn patient.

A patient with Trichosporon beigelii sepsis secondary to a 31 per cent burn is reported. Good results were obtained by treatment with amphotericin B. No other reports of septicaemia due this organism in burn patients have been found by us, although the organism has been reported as a cause of sepsis in cancer patients.

Experience with polymicrobial sepsis in a regional burn unit.

A 2-year review of 795 patients admitted to a regional burn unit was carried out to determine the incidence of polymicrobial sepsis. Of 38 bacteraemic patients, 21 (55 per cent) had polymicrobial sepsis in 1990. Of 38 cases in 1991, 12 patients (31.6 per cent) had polymicrobic infections. Of 36 deaths in 1990, 13 were attributed to sepsis, 12 of 29 (31.6 per cent) in 1991. Of the patients who died in 1990, eight (21 per cent) were polymicrobic septic deaths and six (15.8 per cent) in 1991. The problem has been reported in immunocompromised patients, especially those with terminal malignancies, but has rarely been noted in burn patients. Recognition of the seriousness of the problem and the aggressive antibiotic therapy appropriate to the organisms in question is advised.

Management of candida septicaemia in a regional burn unit.

Sepsis due to candida infection is a major cause of mortality and morbidity on our unit. Over a period of 3 years and 4 months, 29 cases of candida septicaemia, diagnosed by blood cultures, were encountered at the burn unit at Augusta Regional Medical Center. Factors known to predispose to fungal sepsis were present in all cases. All patients had large burns (14-98 per cent total body surface (TBSA) with a mean of 48.3 per cent). All but one patient had at least one central venous line. Respiratory problems requiring ventilator support were present in 24 patients. Sixteen patients had Candida albicans sepsis, two in association with another fungal sepsis. Candida parapsilosis was encountered in nine patients, one in combination with another species. Four patients had Candida tropicalis. Amphotericin B was prescribed therapeutically in 25 patients, in seven together with fluconazole. Two patients received fluconazole only and two received no antifungal therapy. There were eight deaths all attributed to sepsis and all of whom had multiple organ failure. Five of those who died had completed a course of amphotericin B therapy, two were receiving treatment at the time of death, and one patient died before culture data became available. Early and aggressive therapy is advised and amphotericin B appears to be the drug of choice.

Massive haemorrhage due to rectosigmoid ulcers in a patient with extensive burns.

A 36-year-old white-skinned male was admitted with 45.5 per cent burns, mostly of full skin thickness. Severe rectal bleeding from rectal ulcerations developed on postburn day 12. Various conservative attempts at management failed, and after multiple transfusions, abdominoperineal resection was carried out with eventual complete recovery. Complications during his acute phase included Pseud. aeruginosa sepsis and Clostridium difficile diarrhoea. Extensive skin grafts were required. The cause of the rectal ulcerations is unclear.

The use of erythropoietin in two burned patients who are Jehovah's Witnesses.

Recombinant-human erythropoietin was given to two burn patients who are Jehovah's Witnesses and hence refused transfusion. Anaemia developing postburn was corrected in both patients. Serum erythropoietin levels were found to be elevated prior to initiation of therapy in both patients.

Caecal perforation due to colonic ulcer in a burn patient.

Non-specific ulcers of the colon are occasionally reported as a cause of perforation of the colon. No previous cases have been reported in burn patients as a cause of perforation, although cases of haemorrhage have been cited. A 42-year-old black-skinned female with a 26 per cent TBSA burn developed a caecal perforation from this cause. Treatment with caecostomy patient recovered successfully.