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Infection with resistant strains of Staphylococcus aureus
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of intrapulmonary right to left shunt (Qs/Qt) from Pao2/F~o 2 were obtained only when arteriovenous oxygen content differences were between 3 and 5 m l / 1 0 0 ml. As over one-third of the measurements were outside these limits Pao2/F~o 2 did not reliably reflect changes in Qs/Qt. Martyn J. A. J,, Aikawa N., Wilson R. S. et al. (1979) Extra-pulmonary factors influencing the ratio of arterial oxygen tension to inspired oxygen concentration in burn patients. Crit. CareMed. 7,492.
Infection with resistant strains of Staphylococcus aureus Over a 22-month period, strains of S. aureus resistant to methicillin and multiple aminoglycosides were recovered from 108 patients, 66 in the burns unit and 42 from other hospital wards. Among the burned patients these resistant strains of S. aureus were recovered from the burned wounds of 64 per cent of the patients, 32 per cent of whom had septicaemia with these organisms. Patients with these antibioticresistant organisms had a longer mean stay in hospital (79"6 days v. 36'9 days, P < 0"01), developed infection later (26'5 days v. 13-5 days, P < 0"01) and had received antibiotic therapy before infection more often (81 per cent v. 38 per cent, P < 0"01) than in the non-burned patients. The types of infection and incidence of death and bacteraemia were similar in the two groups of patients. Crossley K., Loesch D., Landesman B. et al. (1979) An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. I. Clinical studies. J. Infect. Dis. 139, 273. Epidemiology of resistant strains of Staphylococcus aureus The epidemiological behaviour of strains of S. aureus resistant to methicillin and various aminoglycosides was studied after isolating these organisms from 201 patients. Seventy-eight per cent of the patients with these organisms had been in the burns unit. Within the burns unit these resistant organisms could be recovered from the air, from the hair and hands of personnel and from inanimate objects. Nasal (72 per cent) and rectal (66 per cent) colonization were common among burned patients with infected burn wounds, but occurred in only 6 of 74 burn unit personnel. When compared with control periods when no antistaphylococcal agents were used on patients, the use of these agents markedly increased the incidence of the resistant organisms. Of the 45 patients without burns from whom resistant strains ofS. aureus were isolated, 93 per cent were surgical patients. The source of these resistant organisms could not be determined since they were not in the air or on other objects within the surgical wards. None of 334 non-burn unit hospital staff was found to be a carrier of the resistant strains. Four phage types (83A, 6/75/85, 29/52/80 and 92) were recovered during the outbreak,
Burns VoL 6/No. 4
Crossley K., Landesman B. and Zaske D. (1979)An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. II. Epidemiologic studies. J. Infect. Dis. 139, 280.
Blood glucose and septicaemia In a series of 214 patients with septicaemia the mean blood glucose level in patients with Gram-positive organisms was 165 mg per cent compared with 101 mg per cent for patients with Gram-negative organisms. In 'non-diabetic' patients the difference was aIso marked--138 mg per cent in the Gram-positive septicaemias and 97-5 mg per cent in the Gram-negative septicaemias. Of all the patients with septicaemia having a blood glucose of less than 110 mg per cent, over 80 per cent showed Gram-negative organisms in their blood cultures. Of all those patients whose blood glucose concentrations were greater than 130 mg per cent over 80 per cent showed Gram-positive organisms in the cultures. When there was clinical evidence of septicaemia, and the body temperature exceeded 38-5 °C the blood glucose level was measured in the blood taken for blood culture. If the blood glucose level was above 130 mg per cent a Gram-positive septicaemia was presumed and appropriate antimicrobial therapy was instituted without waiting for the blood culture results. Similarly if the blood glucose level was below 110 mg per cent a Gram-negative septicaemia was presumed and treated accordingly. The presumption of the type of septicaemia, based on blood glucose levels, was correct in 80 per cent of the septicaemias. Kucan J. O., Hegger J. P. and Robson M. C. 0979) Blood glucose level as an aid in the diagnosis of septicaemia. B u r n s 6 , 111.
Treatment of stress ulceration A prospective randomized, double-blind, endoscopic study is described in which the efficacy of cimetidine (13 patients) is compared to that of various antacids (14 patients) in the prevention of stress ulceration following severe burns. Each method of treatment was equally effective in the prevention of acute gastroduodenal disease and its associated complications. Both cimetidine and antacids produced a near elimination of duodenal disease and markedly reduced the severity of gastric disease when compared with that of untreated historical controls. Lack of major side effects and ease of administration make cimetidine an attractive alternative to antacid therapy in the prophylaxis of stress-induced gastroduodenal disease in burned patients. McElwee H. P., Sirinek K. R. and Levine B. A. (1979) Cimetidine affords protection equal to antacids in prevention of stress ulceration following thermal injury. Surgery86, 620.
Freeze-dried plasma versus plasma protein fraction A controlled trial conducted in 24 children and 13 adults with burns covering between 10 and 80 per cent
of intrapulmonary right to left shunt (Qs/Qt) from Pao2/F~o 2 were obtained only when arteriovenous oxygen content differences were between 3 and 5 m l / 1 0 0 ml. As over one-third of the measurements were outside these limits Pao2/F~o 2 did not reliably reflect changes in Qs/Qt. Martyn J. A. J,, Aikawa N., Wilson R. S. et al. (1979) Extra-pulmonary factors influencing the ratio of arterial oxygen tension to inspired oxygen concentration in burn patients. Crit. CareMed. 7,492.
Infection with resistant strains of Staphylococcus aureus Over a 22-month period, strains of S. aureus resistant to methicillin and multiple aminoglycosides were recovered from 108 patients, 66 in the burns unit and 42 from other hospital wards. Among the burned patients these resistant strains of S. aureus were recovered from the burned wounds of 64 per cent of the patients, 32 per cent of whom had septicaemia with these organisms. Patients with these antibioticresistant organisms had a longer mean stay in hospital (79"6 days v. 36'9 days, P < 0"01), developed infection later (26'5 days v. 13-5 days, P < 0"01) and had received antibiotic therapy before infection more often (81 per cent v. 38 per cent, P < 0"01) than in the non-burned patients. The types of infection and incidence of death and bacteraemia were similar in the two groups of patients. Crossley K., Loesch D., Landesman B. et al. (1979) An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. I. Clinical studies. J. Infect. Dis. 139, 273. Epidemiology of resistant strains of Staphylococcus aureus The epidemiological behaviour of strains of S. aureus resistant to methicillin and various aminoglycosides was studied after isolating these organisms from 201 patients. Seventy-eight per cent of the patients with these organisms had been in the burns unit. Within the burns unit these resistant organisms could be recovered from the air, from the hair and hands of personnel and from inanimate objects. Nasal (72 per cent) and rectal (66 per cent) colonization were common among burned patients with infected burn wounds, but occurred in only 6 of 74 burn unit personnel. When compared with control periods when no antistaphylococcal agents were used on patients, the use of these agents markedly increased the incidence of the resistant organisms. Of the 45 patients without burns from whom resistant strains ofS. aureus were isolated, 93 per cent were surgical patients. The source of these resistant organisms could not be determined since they were not in the air or on other objects within the surgical wards. None of 334 non-burn unit hospital staff was found to be a carrier of the resistant strains. Four phage types (83A, 6/75/85, 29/52/80 and 92) were recovered during the outbreak,
Burns VoL 6/No. 4
Crossley K., Landesman B. and Zaske D. (1979)An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. II. Epidemiologic studies. J. Infect. Dis. 139, 280.
Blood glucose and septicaemia In a series of 214 patients with septicaemia the mean blood glucose level in patients with Gram-positive organisms was 165 mg per cent compared with 101 mg per cent for patients with Gram-negative organisms. In 'non-diabetic' patients the difference was aIso marked--138 mg per cent in the Gram-positive septicaemias and 97-5 mg per cent in the Gram-negative septicaemias. Of all the patients with septicaemia having a blood glucose of less than 110 mg per cent, over 80 per cent showed Gram-negative organisms in their blood cultures. Of all those patients whose blood glucose concentrations were greater than 130 mg per cent over 80 per cent showed Gram-positive organisms in the cultures. When there was clinical evidence of septicaemia, and the body temperature exceeded 38-5 °C the blood glucose level was measured in the blood taken for blood culture. If the blood glucose level was above 130 mg per cent a Gram-positive septicaemia was presumed and appropriate antimicrobial therapy was instituted without waiting for the blood culture results. Similarly if the blood glucose level was below 110 mg per cent a Gram-negative septicaemia was presumed and treated accordingly. The presumption of the type of septicaemia, based on blood glucose levels, was correct in 80 per cent of the septicaemias. Kucan J. O., Hegger J. P. and Robson M. C. 0979) Blood glucose level as an aid in the diagnosis of septicaemia. B u r n s 6 , 111.
Treatment of stress ulceration A prospective randomized, double-blind, endoscopic study is described in which the efficacy of cimetidine (13 patients) is compared to that of various antacids (14 patients) in the prevention of stress ulceration following severe burns. Each method of treatment was equally effective in the prevention of acute gastroduodenal disease and its associated complications. Both cimetidine and antacids produced a near elimination of duodenal disease and markedly reduced the severity of gastric disease when compared with that of untreated historical controls. Lack of major side effects and ease of administration make cimetidine an attractive alternative to antacid therapy in the prophylaxis of stress-induced gastroduodenal disease in burned patients. McElwee H. P., Sirinek K. R. and Levine B. A. (1979) Cimetidine affords protection equal to antacids in prevention of stress ulceration following thermal injury. Surgery86, 620.
Freeze-dried plasma versus plasma protein fraction A controlled trial conducted in 24 children and 13 adults with burns covering between 10 and 80 per cent