[Timing of bacterial colonization in severe burns: is strict isolation necessary?].
BACKGROUND
Infection is still one of the main causes of mortality in severe burn patients. Strict isolation has been used for the prevention of infection, but the efficacy of this measure is debatable. The aim of this study was to determine the timing of bacterial colonization in these patients and to ascertain whether strict isolation is indicated.


METHODS
Thirty consecutive children with severe burns were studied. Patients were only barrier-nursed during dressing changes. On admission and twice weekly over the entire hospital stay, burn, sputum, gastric aspirates, feces, and blood samples were obtained for culture. All isolates were tested for specific biotypes. Results were studied with linear regression and repeated measures ANOVA to determine the timing of colonization and cross-colonization between patients.


RESULTS
On admission, normal cutaneous flora were isolated from burn cultures of all patients. The remaining cultures were negative. After one week, gastric aspirates were found to be colonized by gram-negative bacteria and fungi. This was followed by colonization of feces, burn, and sputum cultures. Biotype identification showed unidirectional colonization from the gastrointestinal tract to burns and upper airway. There were no cross infections between patients.


CONCLUSIONS
Microbial colonization in severe burn patients was endogenous in nature and there were no cross infections. Thus, strict isolation is not necessary in burn centers, except during outbreaks of multi-resistant microorganisms.
Barret
Juan P
JP
St. Andrew's Centre for Plastic Surgery & Burns. Broomfield Hospital. Chelmsford. Essex. United Kingdom. BCONSJB@meht.nhs.uk
D001419:Bacteria / Q000302:isolation & purification*; D002056:Burns / Q000382:microbiology*; D002648:Child; D006801:Humans; D015601:Injury Severity Score; D011446:Prospective Studies; D013997:Time Factors