- Email: [email protected]
Burn wounds and microorganisms
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burns 36 (2010) 139–143
that colonization is different from infection. In this study, the skin swab method was used to isolate the causative organism of burn infection. However, the burn surface culture while helpful, sometimes it fails to predict the progression of burn wound infection. Moreover, high CNS percentage in the study result might be related with this situation. We think that if they had used wound depth biopsy specimens for culture, their results would likely to yield very important information about invasion of the infected organism. Second, this article was about infection of the burn wound. Whereas in the method section, the bacterial samples were isolated from variable sources such as the burn wound, tracheal secretions, intra-luminal catheters, however, it cannot be understood from the article how many bacteria were isolated from burn wound or how many bacteria were isolated in other sources. Third, beta hemolytic streptococci are often isolated from burn wound infections in other series [2], but such microorganisms were not isolated in this study.
references
[1] Guggenheim M, Zbinden R, Handschin AE, Gohritz A, Altintas MA, Giovanoli P. Changes in bacterial isolates from burn wounds and their antibiograms: a 20-year study (1986–2005). Burns 2009;35:553–60. [2] Taneja N, Emmanuel R, Chari PS, Sharma M. A prospective study of hospital-acquired infections in burn patients at a tertiary care referral centre in North India. Burns 2004;30:665–9.
Oguz Karabay* Sakarya Research and Education Hospital, Department of Infectious Diseases, Istanbul, Sakarya, Turkey Bahri Teker Nisa Hospital, Department of Infectious Diseases, Istanbul, Turkey *Corresponding author. Tel.: +90 2642115288 E-mail address: [email protected] (O. Karabay) 0305-4179/$36.00 # 2009 Published by Elsevier Ltd and ISBI. doi:10.1016/j.burns.2009.02.026
Response to Letter to the Editor Burn wounds and microorganisms article info Keywords: Burn wound colonization Antibacterial therapy Antibiotic susceptibility
Dear Madam or Sir, We appreciate the insightful comments on our study [1] by Dr. Karabay, as well as the opportunity to provide a response. We fully agree with Dr. Karabay in that burn wound colonization may be different from burn wound infection. As stated in the paper, our aim was to study and elucidate shifts in the bacterial spectrum colonizing burn wounds and corresponding antibiotic susceptibilities during a 20-year study period. Therefore, we aimed to include as many microbiological samples as possible, thus we analyzed results from skin swabs, tracheal secretions and intraluminal catheters. A correlation with burn wound infection was beyond the scope of the present work, particularly when considering the vast amount of data analyzed over a 20-year study period. We do, however, agree with Dr. Karabay that burn wound infection merits attention, as 75% of the mortality following thermal injuries is related directly to infections [2,3]. Our study shows and further confirms that there are shifts in the microbial spectrum and its antibiogram. These changes mandate frequent reassessment of local conditions, since, often, treatment decisions in critically ill patients must be made prior to obtaining an antibiogram, on the basis of empirical data, in order to provide timely and appropriate treatment. We therefore believe that a study on the microbiological spectrum colonizing burn wounds and its corresponding antibiogram clearly has merits. As in many other comparable studies, the majority of our data come from wound swab culture [4–8], a fact questioned by Dr. Karabay. Other than in 3rd degree burns, the use of burn wound biopsies to determine burn wound bacteriology requires local anaesthesia and may lead to unwanted scarring while not being otherwise of much practical use, as the time needed for processing limits their predictive and therapeutic value [9]. Finally, in response to the question on the frequency of ßhemolytic streptococci in our study, we would like to point out that we focused on the 12 strains making up 84.2% of all isolates (Acinetobacter sp., Escherichia coli, Enterococcus sp., Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus, methicillin-resistant S. aureus, coagulase-negative staphylococci (CNS), methicillin-resistant CNS and Stenotrophomonas maltophilia). The remaining 15.8% of the isolates comprised over 80 different bacteria, among them also b-hemolytic streptococci. DOI of original article: 10.1016/j.burns.2009.02.026
burns 36 (2010) 139–143
This is supported by several other comparable studies [4–8], where b-hemolytic streptococci where either not or only rarely found, whereas other studies [10] report isolation of Streptococcus pyogenes in 20%. Thus the point raised by Dr. Karaby once again emphazises our conclusion shared by many other authors that there are considerable local differences in the microbial spectrum of burn wounds and their antibiogram. We thank Dr. Karabay once again for his comments on our study and hope to have clarified the issues he raised.
Funding As for the study, the authors have not received any funding for this letter to the editor.
Conflict of interest statement The authors have no conflicts of interest to declare.
references
[1] Guggenheim M, Zbinden R, Handschin AE, Gohritz A, Altintas MA, Giovanoli P. Changes in bacterial isolates from burn wounds and their antibiograms: a 20-year study (1986– 2005). Burns 2009. January 23 [Epub ahead of print]. [2] Ansermino M, Hemsley C. Intensive care management and control of infection. BMJ 2004;329:220–3. [3] Vindenes H, Bjerknes R. Microbial colonization of large wounds. Burns 1995;21:575–9. [4] Agnihotri N, Gupta V, Joshi RM. Aerobic bacterial isolates from burn wound infections and their antibiograms—a five-year study. Burns 2004;30:241–3.
143
[5] Altoparlak U, Erol S, Akcay MN, Celebi F, Kadanali A. The time-related changes of antimicrobial resistance patterns and predominant bacterial profiles of burn wounds and body flora of burned patients. Burns 2004;30:660–4. [6] Nasser S, Mabrouk A, Maher A. Colonization of burn wounds in Ain Shams University Burn Unit. Burns 2003;29:229–33. [7] Revathi G, Puri J, Jain BK. Bacteriology of burns. Burns 1998;24:347–9. [8] Singh NP, Goyal R, Manchanda V, Das S, Kaur I, Talwar V. Changing trends in bacteriology of burns in the burns unit, Delhi, India. Burns 2003;29:129–32. [9] Sjo¨berg T, Mzezewa S, Jo¨nsson K, Robertson V, Salemark L. Comparison of surface swab cultures and quantitative tissue biopsy cultures to predict sepsis in burn patients: a prospective study. J Burn Care Rehabil 2003;24(November– December (6)):365–70. 10. Lawrence JC. Burn bacteriology during the last 50 years. Burns 1994;18(Suppl. 2):23–9.
Merlin Guggenheim* University Hospital Zurich, Division of Plastic and Reconstructive Surgery, 8091 Zurich, Switzerland *Tel.: +41 794160950 E-mail address: [email protected]
25 March 2009 0305-4179/$36.00 # 2009 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2009.03.010
burns 36 (2010) 139–143
that colonization is different from infection. In this study, the skin swab method was used to isolate the causative organism of burn infection. However, the burn surface culture while helpful, sometimes it fails to predict the progression of burn wound infection. Moreover, high CNS percentage in the study result might be related with this situation. We think that if they had used wound depth biopsy specimens for culture, their results would likely to yield very important information about invasion of the infected organism. Second, this article was about infection of the burn wound. Whereas in the method section, the bacterial samples were isolated from variable sources such as the burn wound, tracheal secretions, intra-luminal catheters, however, it cannot be understood from the article how many bacteria were isolated from burn wound or how many bacteria were isolated in other sources. Third, beta hemolytic streptococci are often isolated from burn wound infections in other series [2], but such microorganisms were not isolated in this study.
references
[1] Guggenheim M, Zbinden R, Handschin AE, Gohritz A, Altintas MA, Giovanoli P. Changes in bacterial isolates from burn wounds and their antibiograms: a 20-year study (1986–2005). Burns 2009;35:553–60. [2] Taneja N, Emmanuel R, Chari PS, Sharma M. A prospective study of hospital-acquired infections in burn patients at a tertiary care referral centre in North India. Burns 2004;30:665–9.
Oguz Karabay* Sakarya Research and Education Hospital, Department of Infectious Diseases, Istanbul, Sakarya, Turkey Bahri Teker Nisa Hospital, Department of Infectious Diseases, Istanbul, Turkey *Corresponding author. Tel.: +90 2642115288 E-mail address: [email protected] (O. Karabay) 0305-4179/$36.00 # 2009 Published by Elsevier Ltd and ISBI. doi:10.1016/j.burns.2009.02.026
Response to Letter to the Editor Burn wounds and microorganisms article info Keywords: Burn wound colonization Antibacterial therapy Antibiotic susceptibility
Dear Madam or Sir, We appreciate the insightful comments on our study [1] by Dr. Karabay, as well as the opportunity to provide a response. We fully agree with Dr. Karabay in that burn wound colonization may be different from burn wound infection. As stated in the paper, our aim was to study and elucidate shifts in the bacterial spectrum colonizing burn wounds and corresponding antibiotic susceptibilities during a 20-year study period. Therefore, we aimed to include as many microbiological samples as possible, thus we analyzed results from skin swabs, tracheal secretions and intraluminal catheters. A correlation with burn wound infection was beyond the scope of the present work, particularly when considering the vast amount of data analyzed over a 20-year study period. We do, however, agree with Dr. Karabay that burn wound infection merits attention, as 75% of the mortality following thermal injuries is related directly to infections [2,3]. Our study shows and further confirms that there are shifts in the microbial spectrum and its antibiogram. These changes mandate frequent reassessment of local conditions, since, often, treatment decisions in critically ill patients must be made prior to obtaining an antibiogram, on the basis of empirical data, in order to provide timely and appropriate treatment. We therefore believe that a study on the microbiological spectrum colonizing burn wounds and its corresponding antibiogram clearly has merits. As in many other comparable studies, the majority of our data come from wound swab culture [4–8], a fact questioned by Dr. Karabay. Other than in 3rd degree burns, the use of burn wound biopsies to determine burn wound bacteriology requires local anaesthesia and may lead to unwanted scarring while not being otherwise of much practical use, as the time needed for processing limits their predictive and therapeutic value [9]. Finally, in response to the question on the frequency of ßhemolytic streptococci in our study, we would like to point out that we focused on the 12 strains making up 84.2% of all isolates (Acinetobacter sp., Escherichia coli, Enterococcus sp., Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus, methicillin-resistant S. aureus, coagulase-negative staphylococci (CNS), methicillin-resistant CNS and Stenotrophomonas maltophilia). The remaining 15.8% of the isolates comprised over 80 different bacteria, among them also b-hemolytic streptococci. DOI of original article: 10.1016/j.burns.2009.02.026
burns 36 (2010) 139–143
This is supported by several other comparable studies [4–8], where b-hemolytic streptococci where either not or only rarely found, whereas other studies [10] report isolation of Streptococcus pyogenes in 20%. Thus the point raised by Dr. Karaby once again emphazises our conclusion shared by many other authors that there are considerable local differences in the microbial spectrum of burn wounds and their antibiogram. We thank Dr. Karabay once again for his comments on our study and hope to have clarified the issues he raised.
Funding As for the study, the authors have not received any funding for this letter to the editor.
Conflict of interest statement The authors have no conflicts of interest to declare.
references
[1] Guggenheim M, Zbinden R, Handschin AE, Gohritz A, Altintas MA, Giovanoli P. Changes in bacterial isolates from burn wounds and their antibiograms: a 20-year study (1986– 2005). Burns 2009. January 23 [Epub ahead of print]. [2] Ansermino M, Hemsley C. Intensive care management and control of infection. BMJ 2004;329:220–3. [3] Vindenes H, Bjerknes R. Microbial colonization of large wounds. Burns 1995;21:575–9. [4] Agnihotri N, Gupta V, Joshi RM. Aerobic bacterial isolates from burn wound infections and their antibiograms—a five-year study. Burns 2004;30:241–3.
143
[5] Altoparlak U, Erol S, Akcay MN, Celebi F, Kadanali A. The time-related changes of antimicrobial resistance patterns and predominant bacterial profiles of burn wounds and body flora of burned patients. Burns 2004;30:660–4. [6] Nasser S, Mabrouk A, Maher A. Colonization of burn wounds in Ain Shams University Burn Unit. Burns 2003;29:229–33. [7] Revathi G, Puri J, Jain BK. Bacteriology of burns. Burns 1998;24:347–9. [8] Singh NP, Goyal R, Manchanda V, Das S, Kaur I, Talwar V. Changing trends in bacteriology of burns in the burns unit, Delhi, India. Burns 2003;29:129–32. [9] Sjo¨berg T, Mzezewa S, Jo¨nsson K, Robertson V, Salemark L. Comparison of surface swab cultures and quantitative tissue biopsy cultures to predict sepsis in burn patients: a prospective study. J Burn Care Rehabil 2003;24(November– December (6)):365–70. 10. Lawrence JC. Burn bacteriology during the last 50 years. Burns 1994;18(Suppl. 2):23–9.
Merlin Guggenheim* University Hospital Zurich, Division of Plastic and Reconstructive Surgery, 8091 Zurich, Switzerland *Tel.: +41 794160950 E-mail address: [email protected]
25 March 2009 0305-4179/$36.00 # 2009 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2009.03.010