Antimikrobielle Therapie bei Patienten nach Verbrennungstrauma

Trupkovic, T.; Gille, Jochen; Fischer, H; Kleinschmidt, S.

doi:10.1007/s00101-012-1994-4

Cited by 13 publications

(4 citation statements)

References 45 publications

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“…We did not find that pneumonia was correlated with excessive fluid volume administered early in the hospital course, but we did find that the presence of inhalational injury increased the risk of pneumonia by more than 2-fold within the first week of injury. Several other studies have found an association between pneumonia and the presence of inhalational injuries [22][23][24][25]. We did not find a statistical correlation between TBSA and pneumonia, however, as has been seen in some of these studies [23].…”

Section: Discussioncontrasting

confidence: 62%

Evaluation of Outcomes following Reduction in Targeted Fluid Administration in Major Burns

Merchant

Cohen

et al. 2023

EBJ

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Adequate fluid resuscitation in adults with major burns is crucial to prevent or minimize burn shock, but needs to be balanced against the complications of over-resuscitation. A single-center, retrospective review of 95 ICU patients with severe burns from Jan 2014 to Aug 2021 was performed. Some 52 patients were managed with a liberal targeted fluid goal of 4 mL/kg/%TBSA, and 43 patients were managed after we incorporated a restricted fluid goal of 2 mL/kg/%TBSA into our standard resuscitation strategy. Of the 95 patients included in this analysis, 76 patients (80%) survived admission. The median age was 41 years, and the median TBSA was 36%. All patients received Ringer’s lactate as the primary fluid for resuscitation, and 40 of the 95 patients (42%) received colloids as a rescue infusion within 24 h of injury. Some 44 of the 95 patients (46.3%) had a concurrent inhalational injury. The median length of hospital stay was 37 days, and the median ICU length of stay was 18 days. A total of 17 of the 95 patients developed ARDS (17.9%), 51 of the 95 (53.7%) patients developed pneumonia, and 34 of the 95 patients (35.8%) developed AKI within the first 7 days of admission. The median fluid administered during the first day of hospitalization from 2019 onwards remained close to 4 mL/kg/%TBSA, despite transitioning to a 2 mL/kg/%TBSA formula for a 24 h fluid goal (unless there was an electrical burn, in which case the 4 cc/kg formula was utilized). Further exploratory analyses also suggested that under-resuscitation and administration of albumin may be associated with increased mortality, though this did not reach statistical significance. ARDS development was associated with increased age and TBSA as well as increased fluid intake within the first 24 h. A change in the targeted fluid goal from liberal (4 mL/kg/%TBSA) to a restricted (2 mL/kg/%TBSA) formula did not change the actual fluids administered over 24 h when guided by clinical criteria. Our review did suggest that under-resuscitation contributed to mortality, but that excessive fluid resuscitation likely contributed to ARDS risks for large TBSA patients. Our data suggest that strategies to optimize fluid administration are important to improve patient outcomes, but should focus on clinical parameters rather than calculated fluid goals.

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Section: Discussioncontrasting

confidence: 62%

Evaluation of Outcomes following Reduction in Targeted Fluid Administration in Major Burns

Merchant

Cohen

et al. 2023

EBJ

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“…PA's ability to form a biofilm enables a persistent wound infection and a significant delay in wound healing [9]. Burn wound infections can prolong the hospital stay of patients by up to 9 days or even cause major complications [34,35]. Thus, the main objective in burn wound management is prevention and effective therapy of infected burn wound sites, so that the incidence of major complications such as sepsis and death can be reduced and healing of the damaged skin can be achieved [36].…”

Section: Discussionmentioning

confidence: 99%

The Antimicrobial Efficacy of Topically Applied Mafenide Acetate, Citric Acid and Wound Irrigation Solutions Lavanox and Prontosan against Pseudomonas aeruginosa

Bagheri,

Zoric,

von Kohout

et al. 2024

Antibiotics

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Since burn wound infections caused by Pseudomonas aeruginosa (PA) lead to major complications and sepsis, this study evaluates the antimicrobial efficacy of the wound irrigation solutions Prontosan (PRT), Lavanox (LAV), citric acid (CA) and mafenide acetate (MA) using microbiology assays and an ex vivo skin wound model. In suspension assays, all the solutions showed significant reductions in bacterial number (log10 reduction: CA 5.77; LAV 4.91; PRT 4.74; MA 1.23). The biofilm assay revealed that PRT and LAV reduced biofilm formation by ~25% after a 15 min treatment, while PRT was most effective after a 24 h treatment (~68%). The number of PA in biofilms measured directly after a 15 min treatment was reduced most effectively with CA and LAV (log10 reductions ~2.5), whereas after a 24 h treatment, all solutions achieved only 1.36–1.65 log10 reductions. In the skin wound model, PRT and LAV provided the highest bacterial reduction after a 15 min treatment (log10 reduction 1.8–1.9), while MA was more effective after a 22 h treatment (log10 reduction 3.6). The results demonstrated the antimicrobial efficacy of all solutions against PA. Further investigation is needed to explore the potential clinical applications of a combination or alternating use of these solutions for infection prophylaxis and treatment of wound infections caused by PA.

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“…[56–59] For prophylaxis purpose, azole or candin agents are always used but not polyenes. Polyenes either amphotericin B or its liposome are the traditional classical antifungal agents, their broad-spectrum antifungal effects are confirmed by many doctors.…”

Section: Prophylaxis Of Bifimentioning

confidence: 99%

Guideline for diagnosis, prophylaxis and treatment of invasive fungal infection post burn injury in China 2013

et al. 2014

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Invasive fungal infection is one of the major complication of severe burns which can induce local or systemic inflammatory response and cause serious substantial damage to the patient. The incidence of fungal infection for burn victims is increasing dramatically during recent years. This guideline, organized by Chinese Society of Burn Surgeons, aims to standardize the diagnosis, prevention and treatment of burn invasive fungal infection. It can be used as one of the tools for treatment of major burn patients.

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Antimikrobielle Therapie bei Patienten nach Verbrennungstrauma

Cited by 13 publications

References 45 publications

Evaluation of Outcomes following Reduction in Targeted Fluid Administration in Major Burns

Evaluation of Outcomes following Reduction in Targeted Fluid Administration in Major Burns

The Antimicrobial Efficacy of Topically Applied Mafenide Acetate, Citric Acid and Wound Irrigation Solutions Lavanox and Prontosan against Pseudomonas aeruginosa

Guideline for diagnosis, prophylaxis and treatment of invasive fungal infection post burn injury in China 2013

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