SUMMARY. The most frequent and serious complication after burn injury is infection. Bacteriological monitoring of patients after burn injury is part of complex care. The algorithm of bacteriological checkups is set. Burned areas are microbiologically monitored by semi quantitative imprint method. Colonization is proportional to the length of patient's hospital stay.Resistance of the bacteria to antibiotics is usually higher in burn units than in other departments. That is why it is important to consider antibiotic treatment and strictly observe sensitivity by obtaining bacteriological results and current epidemiological situation. Burned patients are in danger of infection from the burned areas, respiratory tract. urinary tract and central venous catheters.Attending doctor should daily be in contact with the bacteriological laboratory..
Infektion stellt eine schwere Komplikation bet verbrannten Patienten dar. Bakteriologische Untersuchung gehort zur komplexen Therapie von Patienten mit einem Verbrennungstrauma. Algorithmus der bakteriologischen Untersuchungen wird genau festgestellt, Mikrobiologische Untersuchung der Brandwunden kann durch eine semiquantitative Abdruckmethode durchgeführt werden. Die Kolonisation der verbrannten Oberfläche entspricht der Zeitdauer des Aufenthalts des Patienten im Krankenhaus. Antibiotika-Resistenz der Bakterien wird an den Kliniken für Verbrennungen gewöhnlich höher als in anderen Abteilungen. Deshalb es ist immer notwendig die AntibiotikaTherapie abwägen and die Ergebnisse der aktuellen bakteriologischen Untersuchungen beachten. Verbrannten Patienten werden nicht nur von der Infektion der Brandwunden, sondern von den Respirationswege and der durch invasive Eingriffe verursachten Infektion bedroht. Der alltägliche Kontakt des Arztes mit dem bakteriologischen Labor ist von Bedeutung.
Key words: burn wound infection, bacteriological examination, print method, frequency of bacteria, antimicrobial resistance
Burn wound infection is a serious complication ìn burn victims. The surface of a burn, which contains a large amount of necrotic tissue and protein-rich wound exudate, provides a rich growth medium for many bacteria. Burns are also associated with a generalised reduction in immunocompetency. General conditions necessary for the occurrence of infection are as follows:
Another possible source of infection is respiratory tract (due to artificial ventilation), urinary tract and blood vessels due to catheterization through infected body surface. Regular microbiological surveillance of burn patients is a necessary condition. Admission specimens for bacteriological examination are routinely taken not only from the burn wound, but also from the respiratory tract, urine and rectum of each admitted patient.
Bacteriological examination algorithm includes the burn surface, colonisation of endotracheal tube, i.v. and urinary catheters, urine and another specimens according to clinical status.
Bacteriological surveillance of the burn wound may be performed by:
Figures 1, 2, and 3 describe consecutive surface colonisation by S. aureus.
<% immagine "Fig. 1","gr0000007.jpg","Consecutive sui face colonisation by Staphylococcus aureus ",230 %> <% immagine "Fig. 2","gr0000008.jpg","Consecutive sui face colonisation by Staphylococcus aureus ",230 %> <% immagine "Fig. 3","gr0000009.jpg","Consecutive sui face colonisation by Staphylococcus aureus ",230 %>Usually non-invasive bacteria persist in devitalized tissue, crusts and necrosis. They can invade live tissue.
The initial bacterial colonisation depends on the first treatment or resuscitation. On the burn surface there are present at first G+ cocci, then G- rods, pseudomonas and candidas. Figure 4 shows time dependence of bacterial colonisation.
The character of bacterial strains depends on the epidemiological situation and changes not only during years but also during months.
Figure 5 represents the occurrence of S. aureus in years 1997 and 2002 and Figure 6 displays the prevalence of P. aeruginosa during single years.
<% immagine "Fig. 4","gr0000010.jpg"," Time dependence of bacterial colonisation ",230 %> <% immagine "Fig. 5","gr0000011.jpg"," Occurrence of Staphylococcus aureus m years 1995 and 2002 ",230 %> <% immagine "Fig. 6","gr0000012.jpg"," Prevalence of Pseudomonas aeruginosa in selected years ",230 %>Antimicrobial resistance is usually higher at the department of burn medicine compared to other departments in the same hospital (Fig. 7, 8).
There is an indisputable role of microbiologist in the multidisciplinary treatment of burn patients: he provides daily bacteriological reports on patients, follows possible epidemiological correlations, occurrence of unusual resistance to antimicrobial agents and performs microbial environmental monitoring.
<% immagine "Fig. 7","gr0000013.jpg"," Oxacillin resistance of Staphylococcus aureus at the Burn Centre (BC) as compared to the Teaching Hospital (TH) ",230 %> <% immagine "Fig. 8","gr0000014.jpg","Antimicrobial resistance of Pseudomonas aeruginosa at the Burn Centre (BC) as compared to the Teaching Hospital (TH): TAZ -tazocin, IMI = imipenem,CTZ = ceftadizin, OFLO = ofloxacin ",230 %>Address for correspondence: