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Treatment of post-burn candidiasis
74
Burns Vol. ~/NO.
similar to those recorded before treatment with silver sulphadiazine was introduced. This was associated with a large reduction in the incidence of resistance of certain Gram-negative organisms (especially species of klebsiella) to several antibiotics. Transferable resistance to sulphadiazine, shown by conjugation experiments with Escherichia co/i K12, was found in a majority of the strains of klebsiella species tested and in some other species. A pattern of transferable resistance to tetracycline, cephaloridine, chloramphenicol, ampicillin, carbenicillin and sulphadiazine was found in 4 of the 22 strains of klebsiella tested and closely related patterns were transferred by 5 other strains. These patterns of resistance were commonly found in species of klebsiella isolated from burns in the period before the withdrawal of sulphonamides from the ward but were found in none of the klebsiella strains isolated in the first 6 months after that period. Strains of acinetobacter and proteus, in which transferable resistance was not found, showed no appreciable fall or rise in sulphadiazine resistance; there was no fall in resistance of these organisms to tetracycline, cephaloridine, chloramphenicol, ampicillin or carbenicillin on withdrawal of sulphonamides from use on the ward, but there were substantial falls in resistance of acinetobatter to kanamycin, gentamicin, trimethoprim and tetracycline which were probably not caused by the withdrawal of sulphonamides. Bridges K. and Lowbury E. J. L. (1977) Drug resistance in relation to use of silver sulphadiazine cream in a burns unit. J. Clin. Puthol. 30, 160.
Evaluation
of burn care
Studies are reported from 73 of the 220 hospitals in the state of Florida in an attempt to determine whether additional facilities were required for the care of burned patients. Data were collected over a period of 12 months, indicating that 1656 patients with burns were admitted to the hospitals during this time. With due allowance for mortality probabilities there was no evidence that any particular hospital, whether it had a special burns unit or not, gave a better standard of treatment. Considerable evidence was obtained that additional education was needed for improvement in the care of burned patients. Many hospital records were poor, some admissions were inappropriate, some patients with minor burns stayed too long in hospital. Some patients with more severe burns received inadequate early fluid therapy resulting in a prolonged period of raised morbidity. Linn B. S., Stephenson S. E. and Smith J. (1977) Evaluation of burn care in Florida. N. Et&. J. Med. 296, 311.
Treatment
of post-burn
candidiasis
Systemic candidiasis has become a major cause of death in burn patients. Before 1971 treatment of systemic candidiasis with systemic amphotericin B was rarely successful, partly owing to a lack of sufficiently early recognition of the infection and
1
partly to a delay in the initiation of appropriate systemic therapy. Between 1971 and 1975, 15 patients were treated with systemic amphotericin B, only 1 of whom died. No fatalities from candidiasis have been observed since 1972. No serious complications attributable to the use of amphotericin B were observed. Prompt initiation of therapy with intravenous amphotericin B is advised for burn patients in whom systemic candidiasis is present. Gauto A., Law E. J., Holder I. A. et al. (1977) Experience with amphotericin B in the treatment of systemic candidiasis in burn patients. Am. J. Surg. 133, 174.
Studies
of leucocyte
function
Various polymorphonuclear leucocyte functions were studied in a group of 7 adult patients with burns covering lo-27 per cent of the body surface and in another group of 9 adult patients with burns covering 34-66 per cent of the body surface. The studies were made twice a week during the first 3-4 weeks after burning. Bactericidal capacity was impaired in 12 of the 16 patients. Chemotaxis was decreased in 7 of the 9 patients with burns covering more than 30 per cent but increased in 5 of the 7 patients with less extensive burns. Random migration was decreased in 12 of the 16 patients. The maximum disturbances in polymorphonuclear functions occurred during the second week after burning, coinciding with maximal bacterial growth on the burn wounds. Ransjo U., Forsgren A. and Arturson G. (1977) Neutrophil leucocyte functions and wound bacteria in burn patients. Burns 3, 171.
Scalds with
hot coffee
A report which indicates the number of patients treated in Denmark for scalds due to hot coffee during three 12-month periods commencing 1 January 1971 (112 burned patients), 1 April 1973 (38 burned patients) and 1 April 1974 (65 burned patients). The reduction in the number of burns from this cause during the year 1973-74 followed an intensive advertising campaign stating the hazards of the various methods of making coffee. During the subsequent year the number of accidents increased considerably, suggesting that the advertising campaign had little prolonged effect. Attempts are now being made to ensure that a safer design of coffee maker is produced. Sorensen B., Werner H. and Asmussen C. F. (1977) Coffee scalds-pursuant prophylaxis. Burns 3, 166.
Measurements loss
of evaporative
water
The evaporative water loss from burns, granulating wounds and skin donor sites was calculated from measurements of the vapour pressure gradient of the air layer close to the skin. Soon after burning the mean rate of evaporation from partial thickness burns
Burns Vol. ~/NO.
similar to those recorded before treatment with silver sulphadiazine was introduced. This was associated with a large reduction in the incidence of resistance of certain Gram-negative organisms (especially species of klebsiella) to several antibiotics. Transferable resistance to sulphadiazine, shown by conjugation experiments with Escherichia co/i K12, was found in a majority of the strains of klebsiella species tested and in some other species. A pattern of transferable resistance to tetracycline, cephaloridine, chloramphenicol, ampicillin, carbenicillin and sulphadiazine was found in 4 of the 22 strains of klebsiella tested and closely related patterns were transferred by 5 other strains. These patterns of resistance were commonly found in species of klebsiella isolated from burns in the period before the withdrawal of sulphonamides from the ward but were found in none of the klebsiella strains isolated in the first 6 months after that period. Strains of acinetobacter and proteus, in which transferable resistance was not found, showed no appreciable fall or rise in sulphadiazine resistance; there was no fall in resistance of these organisms to tetracycline, cephaloridine, chloramphenicol, ampicillin or carbenicillin on withdrawal of sulphonamides from use on the ward, but there were substantial falls in resistance of acinetobatter to kanamycin, gentamicin, trimethoprim and tetracycline which were probably not caused by the withdrawal of sulphonamides. Bridges K. and Lowbury E. J. L. (1977) Drug resistance in relation to use of silver sulphadiazine cream in a burns unit. J. Clin. Puthol. 30, 160.
Evaluation
of burn care
Studies are reported from 73 of the 220 hospitals in the state of Florida in an attempt to determine whether additional facilities were required for the care of burned patients. Data were collected over a period of 12 months, indicating that 1656 patients with burns were admitted to the hospitals during this time. With due allowance for mortality probabilities there was no evidence that any particular hospital, whether it had a special burns unit or not, gave a better standard of treatment. Considerable evidence was obtained that additional education was needed for improvement in the care of burned patients. Many hospital records were poor, some admissions were inappropriate, some patients with minor burns stayed too long in hospital. Some patients with more severe burns received inadequate early fluid therapy resulting in a prolonged period of raised morbidity. Linn B. S., Stephenson S. E. and Smith J. (1977) Evaluation of burn care in Florida. N. Et&. J. Med. 296, 311.
Treatment
of post-burn
candidiasis
Systemic candidiasis has become a major cause of death in burn patients. Before 1971 treatment of systemic candidiasis with systemic amphotericin B was rarely successful, partly owing to a lack of sufficiently early recognition of the infection and
1
partly to a delay in the initiation of appropriate systemic therapy. Between 1971 and 1975, 15 patients were treated with systemic amphotericin B, only 1 of whom died. No fatalities from candidiasis have been observed since 1972. No serious complications attributable to the use of amphotericin B were observed. Prompt initiation of therapy with intravenous amphotericin B is advised for burn patients in whom systemic candidiasis is present. Gauto A., Law E. J., Holder I. A. et al. (1977) Experience with amphotericin B in the treatment of systemic candidiasis in burn patients. Am. J. Surg. 133, 174.
Studies
of leucocyte
function
Various polymorphonuclear leucocyte functions were studied in a group of 7 adult patients with burns covering lo-27 per cent of the body surface and in another group of 9 adult patients with burns covering 34-66 per cent of the body surface. The studies were made twice a week during the first 3-4 weeks after burning. Bactericidal capacity was impaired in 12 of the 16 patients. Chemotaxis was decreased in 7 of the 9 patients with burns covering more than 30 per cent but increased in 5 of the 7 patients with less extensive burns. Random migration was decreased in 12 of the 16 patients. The maximum disturbances in polymorphonuclear functions occurred during the second week after burning, coinciding with maximal bacterial growth on the burn wounds. Ransjo U., Forsgren A. and Arturson G. (1977) Neutrophil leucocyte functions and wound bacteria in burn patients. Burns 3, 171.
Scalds with
hot coffee
A report which indicates the number of patients treated in Denmark for scalds due to hot coffee during three 12-month periods commencing 1 January 1971 (112 burned patients), 1 April 1973 (38 burned patients) and 1 April 1974 (65 burned patients). The reduction in the number of burns from this cause during the year 1973-74 followed an intensive advertising campaign stating the hazards of the various methods of making coffee. During the subsequent year the number of accidents increased considerably, suggesting that the advertising campaign had little prolonged effect. Attempts are now being made to ensure that a safer design of coffee maker is produced. Sorensen B., Werner H. and Asmussen C. F. (1977) Coffee scalds-pursuant prophylaxis. Burns 3, 166.
Measurements loss
of evaporative
water
The evaporative water loss from burns, granulating wounds and skin donor sites was calculated from measurements of the vapour pressure gradient of the air layer close to the skin. Soon after burning the mean rate of evaporation from partial thickness burns