Plasma concentrations of tumour necrosis factor-alpha and interleukin-6 during burn wound surgery or dressing.
BACKGROUND
Clinical deterioration after burn wound manipulation may be related to the release of cytokines including tumour necrosis factor-alpha (TNF) and interleukin-6 (IL-6).


METHODS
The two cytokines were assayed by immunoenzymetric assay in blood samples taken before and during manipulation of the burn wound. An antibiotic, teicoplanin, was administered to half the patients at the start of the procedure in a randomized fashion as part of a separate trial.


RESULTS
Sixty patients with a median burn size of 8% (range 1-56%) were studied during dressing change (n = 40) or burn excision (n = 20). There was little change in TNF levels between preoperative and recovery samples but IL-6 concentrations increased three-fold, particularly in those with large recent burns or bacteraemia, and were correlated with poor clinical outcome. The presence of teicoplanin did not significantly affect the levels of either cytokine.


CONCLUSIONS
The systemic cytokine response to burn wound dressing or debridement is predominantly that of IL-6 and it is not significantly reduced by preventing Gram-positive bacteraemia during the procedure.
Papini
R P
RP
Department of Clinical Microbiology, University College London Hospitals, UK.
Wilson
A P
AP
Steer
J A
JA
Hill
G
G
McGrouther
D A
DA
Parkhouse
N
N
D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000097:blood; D001458:Bandages; D002056:Burns / Q000097:blood* / Q000601:surgery / Q000628:therapy; D004311:Double-Blind Method; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D017334:Teicoplanin / Q000494:pharmacology; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis* / Q000187:drug effects
D000900:Anti-Bacterial Agents; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D017334:Teicoplanin