title: Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-.
abstract: BACKGROUND
  Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres.
  
  
  METHODS
  Studies investigating adult hospitalised patients (2000-2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance.
  
  
  RESULTS
  Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84).
  
  
  CONCLUSIONS
  Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.
authors.affiliation: Institute of Life Science, Swansea University College of Medicine, Singleton Park, Swansea, United Kingodm; The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom.
authors.forename: Ernest A
authors.initials: EA
authors.lastname: Azzopardi
authors.affiliation: Research Institute for Health and Social Change, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, United Kingdom.
authors.forename: Elayne
authors.initials: E
authors.lastname: Azzopardi
authors.affiliation: Department of Statistics and Operations, Tal-Qroqq Campus, University of Malta, Msida, Malta.
authors.forename: Liberato
authors.initials: L
authors.lastname: Camilleri
authors.affiliation: Department of Burns and Plastic Surgery, Chelsea and Westminster Hospital NHS Trust, London, United Kingdom.
authors.forename: Jorge
authors.initials: J
authors.lastname: Villapalos
authors.affiliation: The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom.
authors.forename: Dean E
authors.initials: DE
authors.lastname: Boyce
authors.affiliation: St. Andrews Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Dziewulski
authors.affiliation: The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom.
authors.forename: William A
authors.initials: WA
authors.lastname: Dickson
authors.affiliation: Institute of Life Science, Swansea University College of Medicine, Singleton Park, Swansea, United Kingodm; The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom.
authors.forename: Iain S
authors.initials: IS
authors.lastname: Whitaker
mesh_terms: D000328:Adult; D002056:Burns / Q000150:complications* / Q000382:microbiology*; D005843:Geography; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000382:microbiology*; D006760:Hospitalization; D006801:Humans; D013223:Statistics as Topic; D014946:Wound Infection / Q000150:complications* / Q000382:microbiology*
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