The quality of survey research in burn care: A systematic review.

INTRODUCTION: Burn care is a relatively small, mutidisciplinary field with variability in practices between centers. Given these factors, survey studies are frequently used to better understand practice variations, establish guidelines, and direct future research. If survey research is poorly designed or reported, it limits the ability to form meaningful conclusions. This study evaluates the quality of survey studies published in burn care and determines areas of improvement to increase generalizability. METHODS: A systematic review was performed by two independent reviewers. Three databases (PubMed, Scopus, Web of Science) were queried between January 1, 2000 and March 19, 2020. Studies were included if they surveyed any member of the multidisciplinary burn team on a topic related to burn care, and surveys of non-clinicians were excluded. Data related to survey content, methodology, and quality was extracted for analysis. RESULTS: Of 247 citations, 144 met inclusion criteria. The number of published surveys increased by an average of 23% annually over the study period (p < 0.001). Studies represented a breadth of countries, scopes, themes, and disciplines. Few studies reported using reminders or incentives. The majority did not report survey development steps or validity/reliability, and half did not include the questionnaire in the publication. The median (IQR) response rate of all studies was 54% (32-83). A subgroup analysis of surveys to North American burn directors (N = 28) had a response rate of 40% (26-50). CONCLUSION: Survey reporting in the burn care literature is generally inconsistent, limiting the ability to apply this research into practice.

Enterococcus faecalis Is Associated with Anastomotic Leak in Patients Undergoing Colorectal Surgery.

Background: Anastomotic leak is among the most dreaded complications in patients undergoing colorectal surgery. We have discovered that in rodents, collagenase-producing bacteria, particularly Enterococcus faecalis, promotes anastomotic leak by degrading healing anastomotic tissue. Yet, it is unclear if these organisms play a role in humans. Patients and Methods: Patients undergoing colorectal resection at the University of Chicago from July 2014 through June 2019 who developed a post-operative infection were stratified into infections that resulted from an anastomotic leak, a Hartmann pouch stump leak, or a deep infection without an associated staple line leak. Results: Forty-two patients had available culture data. Of these patients, 19 were found to have an anastomotic leak, 7 had a stump leak, and 16 had a deep infection that was not associated with a staple line. Enterococcus faecalis was identified in 24% of all infections and was associated with the development of anastomotic leak (p = 0.029). When the organisms were classified into their known ability to produce collagenase, 74% of patients with an anastomotic leak were colonized with collagenase-producing organisms, compared with only 28% of patients with a deep infection or stump leak (p = 0.022). Antibiotic-resistant organisms were more common in patients with anastomotic leak (p = 0.01). Conclusions: Collagenase-producing and antibiotic-resistant organisms are more prevalent in anastomotic leak infections compared with other deep or organ/space infections. This lends evidence to a bacterial driven pathogenesis of leak and suggests that targeting these organisms may be a novel strategy to reduce this complication.