Perineal Diagnostic Microbial Swabs As A Predictive Parameter In Pediatric Burn Injury.

Abstract

The aim is to evaluate the predictive usefulness of perineal diagnostic microbial swabs (PDMS) which will identify an enteric reservoir as possible source of concomitant wound infection following scald burn injury in infants. Perineal swabs were taken on admission of infants presenting with scald burn injury along with a standardized protocol of initial sterile surgical field cleansing and dressing. Complicated (CC) and uncomplicated (UC) clinical cases were discriminated based on parameters of significant microbial burn wound colonization, such as onset of fever, white blood cell count (WCC), C-reactive protein (CRP) and a concomitant need for surgical wound revision with/without guided antibiotic therapy. Relative risks (RR) / odds ratios (OR) based on microbial swab results were calculated related to anticipated wound infection. We found PDMS to be an independent predictive parameter for clinically relevant microbial wound colonization in pediatric patients (n=274; age 2.81±2.69). Most importantly, we show that in patients with initial total burn surface area (TBSA) >5%, clinically relevant burn wound infection requiring intervention can be predicted from initial perineal swab results with ORs ~10fold. Infants presenting with scald burn injury are exposed to a relevant risk of wound infection emanating from a unique microbial enteric reservoir, even with initial surgical decontamination and sterile dressing protocols, warranting further hospitalization. Based on our findings we suggest PDMS as a useful additional predictive parameter to (i) characterize the relevant enteric microbial reservoir and (ii) direct further therapeutic measures with the aim of preventing complicated wound infections, including preemptive aseptic wound dressings, guided antibiotic therapy and surgical wound revision.