The role of quantitative bacteriology on burn wound management

Abstract

Background:Severe burn wound infection and sepsis is associated with high mortality. Early diagnosis of infection or sepsis is of utmost importance on burn wound management.  Evaluation of the burn wound by a surface swabbing has been the principle method in most of the institutions. This study emphasizes a method of quantitative bacterial count by a tissue biopsy technique for a more accurate way of assessing the burn wounds. Surface swabbing gives surface colonization while a count of 105 CFU/gm. of tissue in the quantitative assay predicts sepsis, skin graft survival and burn wound healing.

Methods: 83 surface swabs and 246 tissue biopsy specimens were collected from a total number of 83 patients. Tissue biopsy was taken, weighed and homogenized in a lab blender stomacher 80. Four fold dilutions of the homogenate were made. Then they were inoculated in MacConkey and blood agar plates and colonies were counted.                                                    Statistical analysis used: SPSS version.

Results:Out of 83 patients, 54.22% were females and 45.78% were males. The most common age group affected was 16-30 years (51.81%) and 31.33% acquired 10-20% TBSA burns. Bacterial counts of <105 yielded a graft take of 95-100%, while graft loss occurred with bacterial counts of >105.

Conclusions:Mortality due to acute burn infections is about 5%. Quantitative bacteriology by the above method is simple and provides an exact bacterial count and reliable data in predicting burn wound sepsis. This should be employed in all centres to reduce burn related deaths due to sepsis.