J.S. Cason

MORTALITY AND INFECTION IN EXTENSIVELY BURNED PATIENTS TREATED WITH SILVER-NITRATE COMPRESSES

Abstract 46 patients with extensive burns were treated with silver-nitrate compresses, which had been found highly effective in prophylaxis against Pseudomonas aeruginosa ( pycoyanea ). The expected mortality in these patients was 21 and the observed mortality was 16; separate analyses in children under thirteen years (27) and in adults (19) showed a reduced mortality only in children. Survival-time of adults was sometimes very prolonged. Only 1 patient died with Ps. aeruginosa septicaemia. The use of silver-nitrate compresses and some other improvements in antibacterial prophylaxis was associated with a large reduction in Ps. aeruginosa in burns and in blood-cultures of patients in the unit.

EVALUATION OF PHENOXETOL-CHLORHEXIDINE CREAM AS A PROPHYLACTIC ANTIBACTERIAL AGENT IN BURNS

A controlled clinical trial was conducted to compare the value of a cream containing 2% phenoxetol and 0.2% chlorhexidine as a prophylactic agent against wound infection in patients with burns affecting up to 15% total body surface area. The acquisition of bacteria was similar in the two treatment groups but the incidence of Staphylococcus aureus in the burns treated with phenoxetol-chlorhexidine cream significantly lower. The incidence of gram-negative bacilli was low in the two treatment groups, and no wound yielded Pseudomonas aeruginosa. Unlike preparations containing silver, phenoxetol-chlorhexidine does not cause electrolyte imbalance or stain materials with which it comes into contact, and it did not produce adverse effects during this trial.

Somatomedin activity in plasma from burned patients with observations on plasma cortisol

Abstract The somatomedin activity (SMA) was assayed in 108 plasma samples from 12 patients with burns which varied in surface area from 10 to 51 per cent. The plasma SMA was greatly reduced or eliminated within 2 days post burn and remained reduced for a period of 1–9 days. The activity then slowly increased in the patients who recovered. The duration of depression of SMA significantly correlated with the area of the burns and with the volume of fluids transfused relative to the patients blood volume. Four patients died and their plasma had little or no SMA in the days, or weeks before death. The plasma cortisol concentrations were elevated in all but one patient within 2 days of burning and remained high for between 1 and 4 days. By mixing plasma taken soon after burning with normal human serum it was shown that the low SMAs were unlikely to be due to an inhibitor(s) of somatomedins (SMs). Some of these plasmas lacked SMA, possibly due to the degradation of SMs and/or the binding of SMs to damaged tissues. Others showed ‘latent SMA’, suggesting that these plasmas lacked a ‘permissive agent(s)’ required for SMs to act on the cartilage.

Staphylococcal sepsis in a burns unit

An outbreak of staphylococcal sepsis in a burns unit occurred between January 1976 and May 1978. Many patients and members of staff had boils, and a number of patients also developed septicaemia. Most of the boils in the early period of the trial and a large proportion of boils in patients during the later period yielded Staphylococcus aureus resistant to penicillin, tetracycline and erythromycin only (PTE), and were shown to be of phage type 95 in the early period while strains were phage typed. From blood cultures, most strains in the early period were of resistance pattern PTE and phage type 95, but in the later period other resistance patterns were predominant. Strains from burns were usually multiresistant (PTEKNML) and of the phage pattern 29/77, which had been endemic in the Unit, but during the early period of the outbreak there was an increased proportion of strains in burns with the resistance pattern PTE and of phage type 95. Staphylococcal sepsis has for many years been very infrequent in the burns unit. This outbreak seems to have been initiated by a strain of phage type 95 and resistance pattern PTE, but during the course of the outbreak the endemic strain of type 29/77 and some other staphylococci seem to have developed enhanced ability to cause clinical infections, conceivably by transduction from the epidemic strain of phage type 95.

Trial of a laminar air-flow enclosure for the control of infection in a burns operating theatre

A series of 22 patients with full-skin thickness burns had skin grafting operations in a Piekenrood-Vinitex BV open-topped laminar air-flow enclosure, and a parallel control series of 18 patients were grafted in the same operating room without the use of the laminar flow unit; the operating room in which both series of operations were performed had standard plenum ventilation with 20 air changes per hour. None of the patients acquired on their burns Staph. aureus of phage types and antibiotic sensitivity patterns corresponding with those isolated from carriers who were in the theatre at the time of the operation; 16 patients acquired on their burns strains of types corresponding with those of strains isolated from burns of other patients in the ward. Settle plates exposed during operations showed a relatively small reduction in bacterial counts associated with the use of the laminar flow enclosure.

Topical chemoprophylaxis with cerium (cerous) nitrate cream

Summary In a controlled trial, burns of 28 patients dressed with a cream (SNC) containing 0·5 per cent silver nitrate and 0·2 per cent chlorhexidine gluconate, the control series, acquired Pseudomonas aeruginosa less often (9 of 270 swab samplings, 3·3 per cent) than did a comparable series of burns in 33 patients dressed with a cream (CeN) containing 1·74 per cent cerium nitrate (58 of 370 swab samplings, 16 per cent). No bacterial growth or very scanty growth (in liquid medium only) was found in 122 of 270 (45 per cent) swabs from burns in the SNC cream series and in 62 of 370 (17 per cent) swabs from burns in the CeN cream series.