Novel Predictors of Burn Wound Infections in Severely Burned Children
Author(s):
Arham Ali, University of Texas Medical Branch / Shriners Hospital for Children; Hyunsu Ju, University of Texas Medical Branch; James Gwosdz, University of Texas Medical Branch; David Herndon, Shriners Burn Institute; Celeste Finnerty, UTMB/SHC
Background: The ability to identify infections early during hospital admission following burn injury has been augmented by genomic and proteomic techniques. The aim of this study is to identify novel early predictors of gram negative or positive wound infections in children.
Hypothesis: We hypothesize that early identification of gram negative or positive infections can be accomplished using serum markers.
Methods: Data from 63 children (age <18 years) with burns covering ≥30% of the total body surface area (TBSA) was analyzed in this study. The American Burn Association definition of burn wound infections (BWIs) was used- wound biopsies growing >105 bacteria/g of tissue with the identification of a pathogen. Pathogens were divided based on gram stain into gram positive and gram negative species. Cytokines, serum metabolites, and various clinical outcomes were identified as possible predictors of BWIs. Data was analyzed using a multivariate logistic regression model. Odds ratio estimates and Wald confidence intervals of each predictor were evaluated for statistical significance with a two–sided significant level of 0.05.
Results: Average age at the time of burn injury was 9 ± 5 years. Children endured large (64 ± 16, %TBSA) and severe (56 ± 21, % TBSA 3rd) burns and were admitted on average at 2 ± 1 days post burn. Each child acquired 6 ± 7 BWIs up until hospital discharge. Development of gram positive BWI was significantly related to interleukins 1b and 7, cytokine G-CSF, transferrin, α1- acid glycoprotein, and hyperglycemia (p=0.02, p=0.02, p=0.03, p=0.01, p=0.02, and p=0.02 respectively). Conversely, interleukin 8, TNF-α, MIP 1b, complement factor C3, and total number of surgeries were significantly associated with BWI from gram negative bacteria (p=0.01, p<0.01, p<0.01, p<0.01, and p=0.01 respectively).
Conclusions: Inflammatory markers are unique to gram positive and gram negative colonizing pathogens in children with severe burn injury. These predictors may be used for early identification of burn wound infections or may be useful in guiding early, appropriate antibiotic therapy.