Blot, Stijn

Brusselaers, Nele

Hoste, Eric

Monstrey, Stan

snoeij, t

Vogelaers, Dirk

English

Ghent University Academic Bibliography

( 2 0S4 Burns 3 5 STestosterone serum levels were higher in non-survivors women than in survivors(p=0.001) regardless of thepostmenopausal state,whereas they resulted reduced inburn men without a signiﬁcant difference considering the outcome. Plasma levelsof prolactin were signiﬁcantly lower as well in men as in women who died than inthose who survived (p=0.029 and p<0.001, respectively). No signiﬁcant differencebetween survivors and non-survivors was found in plasma FSH and LH levels.Conclusion: Gonadic setting in our population of burn patients resulted only inpart consistent with well-known pathophysiological mechanisms. Prolactin lev-els’ reduction can be partly explained by the early dopamine infusion, but the lackof stress-induced hyperprolactinemia also in patients not receiving dopamine wasunexpected; furthermorewe did not ﬁnd such an important gonadotropin suppres-sion as stress should have led to. Finally, themost interesting datawas testosteroneand estradiol increase in postmenopausal women with the worst outcome: periph-eral actions such as aromatization are likely to be involved. More data are neededfor a better comprehension, especially because of the estradiol chance of being notonly a marker of global inﬂammatory response, but also a possible agent in thedevelopment of burn complications.doi:10.1016/j.burns.2009.06.012OC012The aftercare nurse in the burns outpatient clinic of the burn centre: An overviewof activities May 2006–April 2009J.v.d. Steenoven ∗, R. Kolkena, J. Dokter Burn Centre Rotterdam, Maasstadziekenhuis, Rotter-dam, NetherlandsRationale: Coming home after hospitalisation is a happy occasion for most patients.For burn survivors, however, this can be different: how to cope with changes inappearance, with a disrupted everyday life? Only after discharge the problemsconcerning the burns and their consequences become clear. To spot and tacklepractical andpsychosocial problemsof burnpatients and their relatives, likewoundcare, mobility problems and itching, but also anxiety, depression and post trau-matic stress we started in May 2006 a nurse outpatient clinic. Here patients canconsult the burn nurse about various issues. She offers information and coun-selling and when necessary refers to other (burn care) professionals. The aftercarenurse works in close consultation with a multidisciplinary team.Methods: At discharge a brochure is handed out to the patient. Patients are activelyapproached and invited by the aftercare nurse or can apply for specialised aftercarethemselves. In addition, patients are referred by professionals of the clinical day-care or outpatients clinic. Patient information and ﬁles are managed in a database.Results: A total of 262 patients were seen in 34 months. The majority of patientswere young, 39.2% was under 5 years of age. The age of patients ranged from 0up to 79 years. Scalds were the major cause of burn (42.0%) followed by ﬂame(35.9%) and fat burns (9.2%). The mean TBSA was 10.3%, ranging from 1 to 84%.The number of contacts with the aftercare nurse varied between 1 and 14. Onaveragepatientshad three contacts. In 31.3% theaftercarenurse referred to anotherspecialist, predominantly the psychologist (68.3%).Conclusion: Aftercare for burn survivors and their relatives is vital. The aftercarenurse plays a key role in its coordination and implementation and in the referralto relevant other (burn care) professionals.doi:10.1016/j.burns.2009.06.013OC013Assessment of workload in dressing changes in a burn centerP. Jault ∗, A. Cirodde, L. Bargues, D. Brousse, K. Ausset, H. Le Bever Burn Center,Military Teaching Hospital Percy, Clamart, FranceRationale: Workload in a burn unit is very important. It is assessed only by fewstudies. The impact is major on the team life: professional lifetime; prevention ofinfection and quality of care. The workload in our burn unit was assessed by anindependent society. They focus on dressing changes under general anesthesia,and operative theatre activity.Methods: During 3 weeks, we complete a reference worksheet. the hour of begin-ning, hour of end, and all the personnel (quantity and quality) used was noted. Theinterpreting process was made by an independent board.Results: The audit was realised from the ﬁrst to the 21st December 2008. During thisperiod 127 events were recorded: 20 surgical interventions, 3 admissions in inten-sive care and 104 dressing changes. Dressing changes begin at 08h00 AM and mostare closed after 12h15. The team occupation (anesthesiologists, nurses specializedin anesthesiology, nurses and nurse’s aid) is over 90% during this time. Surgeonsworked only in operating theatre. The operating theatre was used during 4h and30min 4 days a week. Nurses specialised in surgical intervention were usually free0 9 ) S1–S47after 12h00 to 03h00 (end of work). Despite a worksheet built only for operatingtheatre analyze, the results are similar as reality. In the morning it is difﬁcult toabsorb more activity: admission, emergency care, etc. A very strict organization isessential. We ﬁnd ﬂexibility only in the afternoon. The rhythm of work is tiring.It probably explain that the professional lifetime in this type of unit of nurses isusually under 5 years.Conclusion: The workload is very high in a burn unit, it is now demonstrated bythis independent study. These results must be probably similar in the others burnsunit. More studies are necessary to assess the impact of this speciﬁc workload onthe quality of care.doi:10.1016/j.burns.2009.06.014OC014Ventilation of burn victims without inhalation injury is associated with increasedﬂuid requirements and morbidityL.M.J. Janssen1,∗, C. Boer1, P. Knape2, D.P. Mackie2 1 Department of Anesthesiology, VUUniversity Medical Center, Amsterdam, Netherlands 2 Burns Center, Red Cross Hospital, Beverwijk, Nether-landsRationale: It has recently been reported that burn victims who are primarily treatedby positive pressure mechanical ventilation (PPV) without the presence of inhala-tion injury (INHI) show an increased need for ﬂuid resuscitation. In the presentstudy we investigated whether PPV-induced ﬂuid requirements affect patient out-come.Methods: 186 patients with burns of more than 30% of the total body surface area(TBSA) who were admitted to the Beverwijk Burns Centre between 1995 and 2006were retrospectively studied. Patients were typically male (72.6%) and aged 38±17years. Cumulative ﬂuid balance (CFB) was calculated on days 3 and 7 post-burn.The population was divided into three groups: (1) INHI-PPV- (no INHI, no venti-lation, n=75); (2) INHI-PPV+ (ventilation without INHI; n=62); and (3) INHI+PPV+(ventilation with INHI; n=49). Data are represented as mean±SD and were ana-lyzed by ANOVA/regression analysis with TBSA, weight and age as covariates or aChi-square test.Results: CFB was signiﬁcantly higher on day 7 in both ventilation groups, comparedto non-ventilated patients (22.0±9.5, 34.2±15.9 and 35.7±14.1 l for INHI-PPV-, INHI-PPV+ and INHI+PPV+, P<0.001 vs non-ventilated patients). Ventilation ofpatients without INHI was associated with an increased length of hospital stay(LOHS) corrected for %TBSA (P=0.007), development of sepsis (P=0.014), devel-opment of organ dysfunction (P=0.001), a lower pO2/ﬁO2 ratio (P=0.001) andincreased use of inotropics (P=0.004). Overall mortality rates were highly inﬂu-enced by % TBSA (P=0.000) and age (P=0.000).Conclusion: In conclusion, ventilation-associated increased requirements of ﬂuidresuscitation in burn patients may alter outcome in terms of the development oforgan dysfunction, LOHS and complications. These results warrant considerationwhen deciding to intubate and commencemechanical ventilation in burn patients.doi:10.1016/j.burns.2009.06.015OC015Morbidity and mortality of blood stream infections in severely burned patientsN. Brusselaers1,∗, T. Snoeij 2, S.J. Monstrey1, E.A. Hoste3, D.P. Vogelaers2, S.I.Blot 2 1 Plastic Surgery, Ghent University Hospital, Ghent, Belgium 2 General Internal Medicine, GhentUniversity Hospital, Ghent, Belgium 3 Intensive Care Unit, Ghent University Hospital, Ghent, BelgiumRationale: The objective of this study was to investigate the epidemiology of blood-stream infection (BSI) in severely burned patients.Methods:Weretrospectively collected (1992–2006) data of all adult patients admittedto the burn unit of GhentUniversityHospitalwhose burn unit staywas complicatedbymicrobiologically documentedBSI (n=76).Mortalitywas evaluatedwith theBOBIscore.Results: During the study period approximately 1125 patients were admitted tothe burn unit, whereof 76 developed a BSI (6.7%). In total, 178 episodes of BSIoccurred, resulting in a prevalence of 15.8 episodes/100 admissions. Predomi-nant pathogens were P. aeruginosa (17.1%), S. aureus (12.6%) and coagulase-negativeStaphylococcus (13.8%). The appropriate antibiotic therapy was initiated in 76.3%within the ﬁrst 48h (and 65.8% within 24h). The source of the infection was theburn wound in 47.2%, the catheter in 24.7% and in 16.9% not certain. The mediantime to BSI was 11 days (IQR: 5.3–19.8), and median ICU stay was 47 days (IQR:26.3–82.5). Median BSA was 40.0% (IQR: 25.3–50.0), median age was 41.6 years(IQR: 31.3–52.8), and respiratory failure was present in 46 patients (61%) with amedian of 21 mechanical ventilation days (IQR: 15.0–33.0). Acute renal failure waspresent in 5 cases (6.6%), and 44 patients required vasopressors (57.9%) because of2 0 0hpnrCms4tdCawMSBlaLRaoiiaMtIthsRtHsmClcttdCaLsRwoaerMﬁ(aubddfRe(cBurns 3 5 S (emodynamic failure. Inhalation injury was present in 35 patients (46.1%). Nineatients died (11.8%), which was less than expected with the BOBI score (not sig-iﬁcant): median BOBI score was 4 (mean 3.7) representing an expected mortalityate of 20%.onclusion: In this cohort, BSI occurred in 7% of the burn patients, with an observedortality of 12%. This did not deviate from the mortality as predicted by the BOBIcore, in spite of moderate rates of appropriate antibiotic therapy within the ﬁrst8h. As such, BSI does not adversely affect survival in burn patients on the condi-ion of early appropriate therapy.oi:10.1016/j.burns.2009.06.016OC016lonal enrichment of integrated resistance plasmid-containing Staphylococcusureus in a burn centre associated with persistent carriage among health careorkers. Kooistra-Smid1,∗, E. van Zanten1, M. Nieuwenhuis2, W. van Wamel3,. Snijders3, N. Lemmens-den Toom3, W. Vogels4, G. Beerthuizen5, A. vanelkum3, H. Verbrugh3 1 Research and Development, Laboratory for Infectious Diseases, Nether-ands 2 Burn Centre, Association of Dutch Burn Centres, Groningen, Netherlands 3 Medical Microbiologynd Infectious Diseases, Erasmus University Medical Centre, Rotterdam, Netherlands 4 Medical Microbiology,aboratory for Infectious Diseases, Netherlands 5 Burn Centre, Martini Hospital, Groningen, Netherlandsationale:Burnwound surfaces are generally infected by S. aureus, but the reservoirsnd transmission routes remain to be elucidated. The genetic population structuref serial S. aureus isolates obtained from patients and healthcare workers (HCWs)n a burn centre was investigated; we assessed the frequency of auto- versus exo-nfection and established a model describing import and local persistence of S.ureus clones.ethods: Three populations of S. aureus isolates were collected (2001–2005) andyped by PFGE. Population I comprised 375 strains from HCWs, PopulationI harboured 586 nosocomially acquired strains from burn wounds. Popula-ion III involved 202 strains from patients at admission. Comparative genomeybridisation (CGH) was performed for endemic versus incidental S. aureustrainsesults: The diversity index for Population III was signiﬁcantly higher thanhose for Populations I and II. Three PFGE types were clearly endemic amongCWs and nosocomially acquired S. aureus strains. CGH revealed that endemictrains possessed a potentially integrated plasmid encoding resistance to heavyetals.onclusion: Genetic diversity for S. aureus strains circulating in the burn centre wasower than that of strains in the open community. Apparently, endemic S. aureuslones have a superior potential to colonize burns which may be associated withheir heavymetal resistance in an environmentwhere silver and ceriumcontainingopical agents are the most used.oi:10.1016/j.burns.2009.06.017OC017olistin covered silk membranes against wound infection with Pseudomonaseruginosa. Steinstraesser ∗, G. Trust, A. Rittig, S. Al-Benna, T. Hirsch, H. Steinau, F. Jacob-en Plastic Surgery, Burn Center, BG University Hospital Bergmannsheil, Bochum, Germanyationale: Wound infections by multidrug-resistant bacteria are a major issue inound care. An occlusive dressing delivering an antimicrobial agent to the woundver several days may be advantageous. The objective of this study was to createn occlusive silk membrane (pore size of <100nm) loaded with colistin in order tostablish an effective antimicrobial wound dressing against Gram-negative bacte-ia in vitro and in vivo.ethods: The membranes (100m thick, pore size<100nm) were produced frombroin, the silk protein. Membranes were covered with a log-scale colistin dilution0.027–270mg/ml) and a modiﬁed Microbroth Dilution assay against Pseudomonaseruginosa (ATCC 27853) was performed. A rat burn infection model (RBIM) wassed to demonstrate the antimicrobial activity of the colistin loaded silk mem-rane (270mg/ml). Finally a porcinewound infectionmodelwas performed to studyose–response (2.7, 27 and 270mg/ml) in a time dependent manner (0, 2, 4 and 6ays). Wound ﬂuids and tissue biopsies were collected for quantiﬁcation of colonyorming units (cfu).esults: The in vitro study demonstrated a concentration dependent antimicrobialffect against P. aeruginosawith complete elimination at the highest concentrations2.7, 27 and 270mg/ml). All colistin membranes demonstrated lower cfu countsompared to the corresponding PBSor carrier controls.Within theRBIMa cfu reduc-9 ) S1–S47 S5tion of more than 3 log-scales was observed for the colistin covered silk membraneafter 3 days. On average the wounds’ cfu quantity remained at > 1000 during thewhole follow-up of 6 days, apart from3woundswhere complete bacterial clearancewas observed.Conclusion: This study demonstrates that this occlusive silk membrane loaded withan antimicrobial agent is a feasible and effective dressing for wound care.doi:10.1016/j.burns.2009.06.018OC018Impact of wound healing problems and P. aeruginosa on burn patientsB.K.H.L. Boekema1, E. Bot2, M.M.W. Ulrich1, J.F.P.M. Vloemans2, E. Middelkoop2,F. Tempelman2,∗ 1 Preclinical Research, Association of Dutch Burn Centres, Netherlands 2 BeverwijkBurn Centre, Red Cross Hospital, Beverwijk, NetherlandsRationale: One of the predominant pathogens in burnwound centres is Pseudomonasaeruginosa. To assess the impact of P. aeruginosa on burn patients, a review of burnpatients admitted to the Beverwijk Burn Centre was carried out.Methods: Patients with wound healing problems and P. aeruginosa were assigned tothe study group (n=23). Wound healing problems were deﬁned as hyper granula-tion, poor graft take, graft loss, progression of wound depth and delayed woundhealing. Patients were assigned to control group 1 (n=25) when the presence ofP. aeruginosa in their wounds was not accompanied by wound healing problems.Control group 2 was compiled of patients without positive swabs for P. aeruginosaand were matched with the study group for age, sex, total body surface area burned(TBSA) and percentage full thickness burns (n=19). Premorbid conditions did notdiffer between groups.Results: Compared to control group 1, the study group was characterized by higherTBSA, higher percentage full thickness burns and more often inhalation injury.In addition, P. aeruginosa and Staphylococcus aureus were detected 9.5 and 16.3 dayslater in the burnwound respectively and bothwere foundmore frequently togetherin one burn at the same time. The study group had compared to control group 2:poorer per-operative quality of wound bed, reduced graft take (86%), 1.8 times moreskin transplanting surgeries and 1.7 times longer length of stay. Wound healingproblems contributed signiﬁcantly to a lack of beneﬁcial effects of initial therapyagainst P. aeruginosa, graft take, number of skin transplanting surgeries and lengthof stay as determined by hierarchical multiple regression.Conclusion: The presence of P. aeruginosa together with wound healing problemsseverely affect the clinical course and outcome of patients with large burns.doi:10.1016/j.burns.2009.06.019OC019Human cytomegalovirus DNA detection in plasma of severe burn patients: Aprospective studyJ. Bordes1,∗, G. Lacroix1, J. Maslin2, B. Prunet1, A. Montcriol 2, E. Meaudre2, P.Goutorbe1 1 Intensive Care and Anaesthesiology, Sainte Anne Hospital, Toulon, France 2 Biology, SainteAnne Hospital, Toulon, FranceRationale: Burn patients are known to be immunocompromised, and it is generallyaccepted that human cytomegalovirus (HCMV) infection can cause severe diseasein immunocompromised patients. But the limited available literature remains con-troversial whether HCMV infection contribute to the morbidity and mortality ofburn patients.Methods: We examined HCMV load in plasma samples by polymerase chain reac-tion (PCR) in a prospective cohort of severe burn patients. Plasma samples werecollected twice a week from the admission until discharge from the center. Spe-ciﬁc CMV serologywas also performed at admission. AHCMV infectionwas deﬁnedby a positive plasma DNA detection.Results: We studied eight patients over a 6-month period. Age varied between 23and 81 years (mean 52 years), and the total body surface burned between 15% and93% (mean 40%). Prolonged sedation and mechanical ventilation were required inall cases. HCMV IgG were negative in 2 patients at admission. HCMV DNA wasnever detected in these two patients. Human CMV DNA was detected in 5 of the6 seropositive patients. The mean delay of DNA detection from admission was 19days (range 13–24 days). For 3 patients, HCMV DNA detection and serology wereperformed simultaneously during the hospital stay. In two of them, IgM remainednegative. The third patient had a positive IgM reaction 21 days after DNA detection.The pathogenic role of HCMV was considered to be involved in one patient whodeveloped a haemophagocytic syndrome.Conclusion: These results demonstrate that HCMV infection is frequent in seropos-itive burn patients. Diagnosis of HCMV infection is achieved earlier by PCR thanspeciﬁc serology. As a results, HCMV infection may have been under estimated in

Morbidity and Mortality of Blood Stream Infections in Severely Burned Patients

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Morbidity and Mortality of Blood Stream Infections in Severely Burned Patients

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