WoundReference improves clinical decisions
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Azzopardi EA, Azzopardi E, Camilleri L, Villapalos J, Boyce DE, Dziewulski P, Dickson WA, Whitaker IS, et al.
PloS one. Date of publication 2014 Apr 21;volume 9(4):e95042.
1. PLoS One. 2014 Apr 21;9(4):e95042. doi: 10.1371/journal.pone.0095042. eCollection 2014. Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-. Azzopardi EA(1), Azzopardi E(2), Camilleri L(3), Villapalos J(4), Boyce DE(5), Dziewulski P(6), Dickson WA(5), Whitaker IS(1). Author information: (1)Institute of Life Science, Swansea University College of Medicine, Singleton Park, Swansea, United Kingodm; The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom. (2)Research Institute for Health and Social Change, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, United Kingdom. (3)Department of Statistics and Operations, Tal-Qroqq Campus, University of Malta, Msida, Malta. (4)Department of Burns and Plastic Surgery, Chelsea and Westminster Hospital NHS Trust, London, United Kingdom. (5)The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom. (6)St. Andrews Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom. BACKGROUND: Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. METHODS: Studies investigating adult hospitalised patients (2000-2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. PRIMARY FINDINGS: Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84). INTERPRETATION: Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand. DOI: 10.1371/journal.pone.0095042 PMCID: PMC3994014 PMID: 24751699 [Indexed for MEDLINE]
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Acute Burns - Treatment