Early biochemical predictors of sepsis in patients with burn injury: current status and future perspectives

Erenler, Ali Kemal; Baydın, Ahmet; Ay, Mehmet Oğuzhan; Doğan, Güvenç; Yastı, Ahmet Çınar

doi:10.1097/mrm.0000000000000208

Cited by 3 publications

(1 citation statement)

References 76 publications

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“…In our study, the majority of bacterial isolates were Gramnegative, with Pseudomonas aeruginosa and Klebsiella pneumonia being the most commonly isolated pathogens. These findings are consistent with previous studies reporting that Gramnegative bacteria are the predominant pathogens in burn wound infections [11][12] . The high prevalence of Pseudomonas aeruginosa in our study is particularly concerning, as this pathogen is known to cause severe and life-threatening infections in burn patients 13 .…”

Section: Discussionsupporting

confidence: 93%

Pan-Resistance; A Rising Challenge in Burns Patients

Khan,

Shahbazi,

Imran

et al. 2023

PJMHS

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Introduction: Burn injuries by fire and hot liquids and contact with hot surfaces have been recognized as a significant and major public health problem in economically developing countries. Objectives: The main objective of the study is to find the incidence of pan-resistant strain infections, in burns Khyber teaching hospital, Peshawar. Material and methods: A retrospective observational study was conducted to determine the incidence of pan-resistant strain infections in burn patients at Khyber Teaching Hospital, Peshawar. The study was conducted over a period of 12 months, from January 1, 2022, to December 31, 2022. Khyber Teaching Hospital is a tertiary care hospital located in Peshawar, the capital city of Khyber Pakhtunkhwa province in Pakistan. Results: Table 1 presents the demographic and clinical characteristics of the study population. The table shows that the study included 100 patients with burn injuries, with a mean age of 28.5 years (SD 14.7). The majority of patients were male (70.0%) and had burn injuries covering more than 10% of their total body surface area (78.0%). The most common cause of burn injury was flame (52.0%). The mean length of hospital stay was 15.4 days. Practical Implication: This study implies and plays a role in finding the proper antibiotics which will be used for burn wounds. Conclusion: The study concludes that a significant proportion of bacterial isolates obtained from burn wound cultures were resistant to multiple antibiotics, with Acinetobacter baumannii showing a pan-resistant pattern. Keywords: Significant, Acinetobacter, Surface, Resistance, Clinical, Wound

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Section: Discussionsupporting

confidence: 93%

Pan-Resistance; A Rising Challenge in Burns Patients

Khan,

Shahbazi,

Imran

et al. 2023

PJMHS

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PCT Kinetics in the First Week Postburn for Sepsis Diagnosis and Death Prognosis—An Accuracy Study

Cabral

Fernandes

Marques

et al. 2020

Journal of Burn Care &Amp; Research

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Background Despite continuous advances in burn care, sepsis is still the main cause ofdeath in burn patients. Procalcitonin (PCT) has been reported as an accurate sepsis biomarker and also as a fair predictor of death. The aim of this study was to assess PCT kinetics in the first week post-burns regarding sepsis diagnosis and death prognosis. Material and Methods Sample included142 patients with ≥15%TBSA, admitted from January 2011 to December 2014 at Coimbra Burns Unit (CBU), Portugal. Sepsis diagnosis was done according to American Burn Association criteria. PCT range and median values in the first seven days after burns were statistically analyzed for its potential for sepsis diagnosis and death prognosis. Sub-analysis were done regarding TBSA, gender, age and inhalation injury Results First week PCT range and median were significant for sepsis diagnosis and death prognosis, but median AUC was greater in the last case. TBSA influenced PCT accuracy, which was greater for TBSA <40% either for diagnosis or prognosis. Age was inversely related with the accuracy, being better under 40 years in both cases. PCT diagnostic accuracy was not affected by gender, opposing to prognostic one which is better in women. Inhalation injury had no effect on diagnostic accuracy, but it happens with prognostic accuracy. Conclusion PCT levels’ variation is related with sepsis evolution and outcome. Its median performs better than its range. Always coupled with clinical examination, monitoring PCT levels kinetics may help early sepsis detection, potentially reducing morbidity and mortality, being also useful for death prognosis.

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Specific patterns of vital sign fluctuations predict infection and enable sepsis diagnosis in pediatric burn patients

et al. 2022

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Early recognition of the clinical signs of bloodstream infection in pediatric burn patients is key to improving survival rates in the burn unit. The objective of this study was to propose a simple scoring criteria that used readily available temperature, heart rate (HR) and mean arterial pressure (MAP) data to accurately predict bloodstream infection in pediatric burn patients. A retrospective chart review included 100 patients admitted to the pediatric burn unit for >20% total body surface area (TBSA) burn injuries. Each patient had multiple blood culture tests, and each test was treated as a separate and independent “infection event” for analysis. The time at each blood culture draw was time 0 for that event, and temperature, HR and MAP data was collected for 24 hours after the blood culture was drawn. “Infection events” included in this study had at least six complete sets of temperature, HR and MAP data entries. Median temperature, HR and MAP, as well as mean fever spikes, HR spikes and MAP dips, were compared between infection group (positive blood cultures) and control group (negative blood cultures). These vital sign fluctuations were evaluated individually and as a combination of all three as timely predictors of bloodstream infection. In addition, we tested the prediction of Gram-negative bacteria versus Gram-positive or fungi present in blood cultures. Patients in the infection group had significantly higher median temperatures (p<0.001), mean fever spikes (p<0.001) and mean HR spikes (p<0.001), compared to the control group. Using the combination scoring criteria to predict bloodstream infection, the strongest predictive values in the 24-hour timeframe had high sensitivity (93%) and specificity (81%). The predictive test metric based on vital sign spikes predicted Gram-negative bacteria, but with limited sensitivity (57%) and specificity (44%). A simple scoring criteria using a combination of fever spikes, HR spikes and MAP dips predicted bloodstream infection in pediatric burn patients, and can be feasibly implemented in routine clinical care. There is also potential to use the predictive metric to detect a few select organisms based on vital signs, however further work is necessary to enhance accuracy to levels that would allow consideration for clinical use.

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Early biochemical predictors of sepsis in patients with burn injury: current status and future perspectives

Cited by 3 publications

References 76 publications

Pan-Resistance; A Rising Challenge in Burns Patients

Pan-Resistance; A Rising Challenge in Burns Patients

PCT Kinetics in the First Week Postburn for Sepsis Diagnosis and Death Prognosis—An Accuracy Study

Specific patterns of vital sign fluctuations predict infection and enable sepsis diagnosis in pediatric burn patients

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