Introduction: Detection and quantification of bacterial wound infections is crucial in surgical ICU patients. Recently however, the importance of quantitative evaluation of bacterial count has become controversial. Several clinical score systems require the evaluation of microbiological samples according to their bacterial load, although the value of this qualitative examination is sometimes underestimated on the clinical side. We hypothesized that bacterial count from wound tissue samples is highly relevant when monitoring for clinically significant complications including multi organ failure, septic events, length of stay, and mortality.

Methods: Three-hundred and eleven pediatric burn patients with bacteria positive tissue samples were evaluated retrospectively with regards to clinical course and outcome. Patient demographics, length of stay, infections and number of burn operations were recorded. Patients were assigned to groups according to their highest bacterial count in the examined tissue samples [>10^2 (n=7), >10^3 (n=16), >10^4 (n=34), >10^5 (n=311)]. Multi organ failure (MOF) was assessed according to the DENVER2 score and the incidence of sepsis recorded based on clinical diagnosis and according to the ACCP consensus conference. Statistical analysis was performed by Student’s t-test,ANOVA corrected with Bonferroni`s post-hoc test, Chi-square test and forward stepwise logistic regression, with statistical significance set at p<0.05.

Results: All study groups were similar in age, gender, burn type and size. Length of stay increased significantly with the bacterial count (p<0.05). Forward stepwise logistic regression revealed a statistically significant correlation between a bacterial count of >10^5 for sepsis and >10^3 for MOF (p<0.05).

Conclusion: The results of our study demonstrate the importance of quantification of bacterial infections. We found that bacterial count is indeed an important indicator for clinical complications and patient outcome in the burn ICU setting.