Burn Wound Manipulation-induced Bacteremia

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Blood cultures were obtained from 19 patients with thermal injury of from 7 to 73% (mean 38%) of the total body surface area before, during, and after manipulation of the burn wound. Procedures were separated into a group which required general anesthesia and those which did not, and extent of trauma associated with manipulation was noted. Simultaneous wound cultures were obtained. Two hundred sixty-three individual cultures were drawn in 63 sequential blood culture sets. The maximum rate of false positive blood cultures was 3.1%. Bacteria grew in one or more cultures in 19 out of the 63 sequential culture sets. Manipulation-induced bacteremia occurred in 13 cultues sets (20.6% of the procedures). Increased frequency of manipulation-induced cultures occurred with larger burn areas and with increased trauma to the burn wound during manipulation. The organisms most frequently isolated from blood cultures were Klebsiella and Staphylococcus aureus. Bacteremia which lasted longer than 15 minutes was identified in four cases. In two patients, organisms found during manipulation were later isolated from blood cultures during periods of sepsis. There was no direct evidence that manipulation-induced bacteremia caused clinical harm. However, these findings support the concept of gentle wound care.

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