RESUMO
Burn injury remains a major global health issue. An estimated 180,000 people die annually due to burn injury, and most cases occur in low- and middle-income countries, including Indonesia. Several complications of burns may lead to mortality, and sepsis is one of the major threats, with the risk of developing multi organ dysfunction syndrome. This study applied a descriptive-retrospective method on 3-year medical records of severe burn injury patients. The data were classified according to age, etiology, outcome, antibiotic resistance, and pathogens of sepsis. There were 100 medical records of severe burn injury, and 55% of them were accompanied by sepsis. The highest number of sepsis cases was found in the age category of 40-50 years old. Nearly 80% of the cases were fire-related burns. Blood and burn wound culture of recovered patients showed 55% contamination with gram-positive bacteria, and 50% of them with Staphylococcus hominis. Contamination of blood and burn wound culture of deceased patients with gram-negative bacteria was 100%, 60% of them with Pseudomonas Aeruginosa. There is a more than 50% chance of severe burn patients falling into septic conditions. More than half of the patients were infected with gram-negative bacteria. Pseudomonas aeruginosa remains the main culprit of septic burn-related death.
Les brûlures demeurent un problème de santé publique, responsable d'environ 180 000 morts chaque année, survenant préférentiellement dans les pays à IDH bas ou moyen- bas, dont l'Indonésie. Parmi les complications pouvant conduire au décès, le sepsis en est une majeure, avec le risque de développer une défaillance multiviscérale. Nous présentons une étude descriptive et rétrospective ayant étudié cent dossiers de patients sévèrement brûlés répartis sur 3 ans, dont 55% ont développé un sepsis. Nous avons répertorié l'âge, l'étiologie de la brûlure, la bactérie en cause et son phénotype ainsi que l'évolution. Environ 80% des brûlures étaient dues à une flamme. La majorité des sepsis était observée dans la classe 40- 50 ans. Les prélèvements sanguins et cutanés de ces patients retrouvaient une bactérie à Gram positif dans 55% des cas, identifiée Staphylococcus hominis 1 fois sur 2. Ces mêmes prélèvements étaient toujours positifs à Gram négatif chez les patients décédés ; il s'agissait de Pseudomonas æruginosa dans 60% des cas. Un patient sévèrement brûlés a plus d'un risque sur 2 de développer un sepsis, plus d'une fois sur 2 à Gram positif, mais le principal responsable de la mortalité d'origine septique reste Pseudomonas æruginosa.
RESUMO
BACKGROUND: Electric burn patients usually suffer permanent injury and sequelae. Salvage of the zone of stasis is an important topic in the treatment of burn patients. N-Acetylcysteine (NAC), as an antioxidant, has effect on the saving zone of stasis and extensive rhabdomyolisis. The aim of this study was therefore to evaluate the effect of oral NAC on tissue destruction indicators in an electric burn rat model. MATERIAL AND METHODS: An experimental study was conducted with thirty six male Wistar albino rats divided into 2 groups. Group A (n=18) and group B (n=18) were electrical burn injury groups without and with NAC therapy, respectively. The extent of burn wounds were evaluated by planimetry using a digital wound measuring device. Blood samples were obtained to analyze creatine kinase (CK) levels as a marker of extensive rhabdomiolysis on the first hour after electric injury (baseline) and on the 7th day to see the antioxidant effect of NAC. RESULTS: A significant decrease in tissue destruction was seen by the necrotic area on day 7 in the NAC therapy group compared to the control group (mean 2.26±1.05cm2 versus mean 7.12±3.30cm2 respectively; p=0.001), which was confirmed by the level of serum CK (day 7: group A, mean 140±51U/L versus Group B, mean 102±6U/L; p=0.007). CONCLUSION: A decrease in electric burn necrotic area and tissue damage in the group using NAC treatment was demonstrated. NAC might have a beneficial effect in the treatment of electrical burns. Further experimental and clinical studies with NAC treatment are necessary to confirm these results.
