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]
