Successful treatment of invasive burn wound infection with sepsis in patients with major burns.
OBJECTIVE
To investigate the clinical characteristics of invasive burn wound infection with sepsis in patients with major burns and to summarize the successful experiences in the treatment of such patients.


METHODS
Eight patients with major burns, complicated by invasive burn would infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998. Among them, 6 patients developed multiple organ dysfunction syndrome (MODS) and 2 developed septic shock. The plasma concentrations of IL-6, IL-8, TNF alpha and lypopolysaccharide (LPS) were assayed before and after surgical intervention, as well as when the patient's vital signs became stable.


RESULTS
The patients' conditions usually deteriorated abruptly when extensive invasive burn wound infection emerged. While multi-microbial infection was usually found, Pseudomonas aeruginosa was the predominant bacteria isolated from the subeschar tissue. The plasma concentrations of IL-6, IL-8, TNF alpha and LPS before surgical intervention were significantly higher than those after surgical intervention (P < 0.05). The lowest levels of the inflammatory mediators were observed when the patients' conditions became stable, and the values were significantly lower than those before surgical intervention (P < 0.001).


CONCLUSIONS
Since the main cause of burn wound sepsis is the presence of a large area of infected burn wound, they should be excised and covered as early as possible. LPS and pro-inflammatory mediators play an important role in the pathogenesis of burn sepsis. Although favorable results should be attributed to comprehensive treatment, we believe that early, aggressive and thorough surgical excision of infected burn wounds, followed by sound and complete coverage of the area, play a crucial role.
Chai
J
J
Burns Institute, 304th Hospital, Beijing 100037, China.
Sheng
Z
Z
Yang
H
H
Diao
L
L
Li
L
L
D000293:Adolescent; D000328:Adult; D002056:Burns / Q000097:blood / Q000382:microbiology / Q000601:surgery*; D002648:Child; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008070:Lipopolysaccharides / Q000097:blood; D008297:Male; D008875:Middle Aged; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D018805:Sepsis / Q000382:microbiology*; D016038:Skin Transplantation; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014946:Wound Infection / Q000097:blood / Q000382:microbiology / Q000601:surgery*
D015850:Interleukin-6; D016209:Interleukin-8; D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha