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ABSTRACT
Loebl, Edward C , Marvin, Janet A., Heck, Ellen L., Curreri, P. William, and
Baxter, Charles R.: The method of quantitative burn-wound biopsy cultures
and its routine use in the care of the burned patient. Am. J. Clin. Pathol. 61:
20-24, 1974. A method for quantitative biopsy cultures of burn wounds has
been developed and evaluated. Specimens are obtained by full-thickness biopsy
of the burn wound using a scalpel. Specimens are processed by maceration,
suspension in physiologic saline solution, and plating of serial dilutions of the
suspension on appropriate media. Quantitative counts are performed and
expressed as the number of bacteria per Gm. of burn-wound tissue. Experience
with this technic in the care of 210 consecutive patients with burns of more than
20% total body surface area has shown it to be more reliable than surface-
culture technics. Patients were considered to have wound colonization when
104 or more organisms per Gm. of burned tissue were recovered from
different areas of the body. Appropriate antibiotic therapy was instituted
on the basis of these results. Routine use of this method was found to be
effective, simple, and practical as an aid in the early diagnosis of sepsis in
the burned patient. (Key words: Bacteriology; Burns; Burn wound biopsy;
Burn wound sepsis; Culture technics; Sepsis; Tissue bacteriology.)
glycollate broth and examined for growth Table 2. Incidence of Clinical Sepsis in
at 24 and 48 hours. Pediatric and Adult Patients with
Quantitation and preliminary bacterial Positive Surface or Biopsy
identification are available to the physician Cultures
24 hours after biopsy, while complete re-
Children Adults
sults of culture and sensitivity tests usually
require 48 hours. Patients with positive
surface cultures 44% 41%
Results Patients with positive
biopsy cultures 88% 63%
Pediatric and adult patients in this series
were evaluated as separate groups due to
the previous clinical observation of a lower
rate of infectious complications in the No patient with sterile wound biopsy cul-
younger patients (Table 1). In the pediatric tures in either the pediatric or the adult
age group, 17 of 67 patients (25%) had posi- group developed signs of systemic sepsis
tive surface cultures during their admis- unless another source of infection (e.g.,
sions. Of these 17 patients, only eight (12% pneumonia, urinary tract infection or sup-
of the total) had positive biopsies (104 or purative thrombophlebitis) was present.
more organisms per Gm. on biopsies from
different burn areas). Seven of these eight Discussion
patients (88%) developed clinical signs of
sepsis, as evidenced by three or more of This study suggests that full-thickness
the following findings: disorientation, wound biopsy cultures more accurately
hypothermia, hyperpyrexia, throm- reflect burn-wound colonization than do
bocytopenia, l e u k o p e n i a , t a c h y p n e a , surface-culture technics. In the present
tachycardia, or ileus. Two of these seven series of pediatric patients, only seven of 17
patients subsequently died of sepsis. The patients (44%) who had positive Rodac
single child who had positive biopsy cul- plates developed signs of sepsis, while seven
tures but did not develop sepsis had a 30% of the eight pediatric patients (88%) with
total body surface area partial-thickness positive biopsies developed clinical sepsis. A
burn which was treated with subeschar an- similar correlation was seen in the adult
tibiotic infusion when biopsy cultures be- series, where evidence of sepsis was ob-
came positive. served in 41 % of those with positive contact
In the g r o u p of 143 adult patients plates, compared with 63% of those with
studied with surface and biopsy cultures, positive biopsy cultures (Table 2).
100 (70%) had positive contact plates for Using the relatively simple bacteriologic
surface organisms during their admissions. technics described, we have been able accu-
Of these 100 patients, 65 had positive biop- rately to detect, quantitate and evaluate the
sies (45% of the total). Forty-one of the 65 progression of burn-wound colonization.
patients with positive biopsies (63%) subse- Many studies have reported erratic results
quently developed clinical sepsis, and 13 of with the use of surface-culture technics to
these patients died of sepsis. All of the 24 detect burn-wound colonization. 35 8,? In the
patients with positive biopsies and no clini- present series, results of surface cultures
cal evidence of sepsis had been treated with were influenced by such factors as recent
subeschar and/or systemic antibiotics, in- hydrotherapy or the time after application
itiated when biopsy cultures revealed 104 or of topical antibacterial agents. In a small
more organisms per Gm. of burned tissue. group of patients biopsied a number of