Prognosis in thermal injury patients with sepsis

One of the gravest problems in the development of burn disease are infections that considerably impede wound healing and can lead to blood stream infection and sepsis, which, in turn, always poses a threat to life. The factors that precipitate infections in patients after thermal injuries feature decreased immunity, multiple entry points for both endo- and exogenous infections as well as multiple antibiotic drug resistance of microbes causing infections. The study encompassed 338 patients who were hospitalized immediately following the injury in the Burn Treatment Centre in Siemianowice Śląskie throughout the period 2003-2004. What was examined was the impact of the severity and type of burn, type of microbes involved and the interval to sepsis onset upon thermal injury patient’s survival prognosis. The subjects’ age ranged from 18 to 96 years of age (on average, 44 yrs). Among them were 66 women aged from19 to 96 years (on average, 46 yrs) and 272 men aged 18 to 80 years (on average, 42 yrs). All patients’ were found to manifest clinical symptoms of general infection. Based on the material examined, two groups of patients were identified with the first, A-165, containing patients with general infection and positive results of blood culture and the second, B- 173, including patients with blood infection and negative results of blood culture. In group A-106 (64,3 %) patients recovered while 59 (35,7 %) died. In group B -155 (89,6%) patients were cured whereas 18 (10,4%) died. Statistical analysis in both groups involved the severity of thermal injury as defined in terms of total percentage of body surface area - % of TBSA (total body surface area), the interval till the onset of clinical symptoms of blood infection, type of microbes isolated from blood and burn wound, the presence of homo- and heteronymous blood and burn wound infections as well as survival rate and death rate. Drawing on the results obtained, the following conclusions were put forth: 1.Sepsis may develop in patients with a deep thermal burn even below 30 % of TBSA. 2.The risk of death attributable to sepsis is higher if both body surface burns and respiratory tracts were involved simultaneously. 3.The risk of death is higher in the event of sepsis caused by Gram-negative rather than Gram-positive bacteria. 4.In patients after thermal injuries there is a heightened risk of death in case of sepsis within he first two weeks of injury. 5.Homonymous blood and burn wound infection caused by Pseudomonas aeruginosa and Acinetobacter baumanii raises the risk of death from sepsis in patients after thermal injuries.