Infections in Diabetic Burn Patients

Abstract

OBJECTIVE -Diabetic burn patients comprise a significant population in burn centers. The purpose of the study was to determine the demographic characteristics of diabetic burn patients and their rate of community-acquired and nosocomial infections.RESEARCH DESIGN AND METHODS -This was a 46-month retrospective chart and patient registry review comparing diabetic with nondiabetic burn patients. Statistical analysis consisted of means Ϯ SD, descriptive statistics, one-way ANOVA, and 2 tests. , P ϭ 0.001). Adult diabetic burns had a significant increase in sepsis (P Ͻ 0.002) and community-acquired burn wound cellulitis (P Ͻ 0.001) compared with adult nondiabetic patients; and senior diabetic patients had a significantly increased frequency of urinary tract infections compared with senior nondiabetic burn patients (P Ͻ 0.04).The most common organisms in diabetic burn infections were Streptococcus, Proteus, Pseudomonas, Candida species, and MRSA (methicillin-resistant Staphylococcus aureus). Forty-two percent of the diabetic patients were admitted during the winter months and 25% in the spring. Only 49 of 130 (38%) diabetic burn patients presented for treatment within 48 h after injury compared with 669 of 1,126 (62%) nondiabetic patients (P ϭ 0.001).CONCLUSIONS -Peripheral neuropathy may have precipitated and delayed medical treatment in lower-extremity burns of diabetic patients. Hospitalized diabetic burn patients were also at an increased risk for nosocomial infections, which prolonged hospitalization. Diabetic patient education must include not only caution about potential burn mishaps but also educate concerning the complications from burns that may ensue. Diabetes Care 27:229 -233, 2004A pproximately 17 million (6.2%) of the U.S. population are diabetic; this disease is the seventh leading cause of death in the U.S. (1). The American Diabetes Association lists the hazards of treating diabetic feet with hot water bottles, heating pads, and hot water soaks but does not alert the readers to the actual severity and consequences of injuries that can ensue (1). There have been numerous anecdotal literature reports about diabetic foot burns from electric heating pads, foot spas, and water baths (2-9). Diabetic patients are known to experience more inf e c t i o n s i n c l e a n w o u n d s t h a n nondiabetic patients and to heal more slowly, especially in the extremities (10 -11). The purpose of this study was to determine the demographic characteristics of diabetic burn patients at a large urban hospital and compare their propensity for nosocomial infections with that of the general burn population. RESEARCH DESIGN AND METHODS Burn careResuscitative fluids were administered dependent on requirements for all injuries using modified Parkland formula guidelines. All patients were treated with closed silver sulfadiazine-embedded gauze dressings or Collagenase Santyl (Advance Biofactures, Lynbrook, NY), an enzymatic debriding product, until either the wound healed or surgical intervention was initiated. Arterial blood ...

Burn Wound Infections

“…Individuals with deliberate self-inflected burn injuries and the disabled have been shown to have more severe injuries and longer hospital stays than those with accidental injuries (18,211,332). Obese adults and those who have an underlying medical condition such as diabetes have also been shown to have higher morbidity and mortality (169,276,290). AIDS patients appear to have more complications due to infection, delayed wound healing, and increased mortality, although reported outcome data for human immunodeficiency virus-infected and AIDS patients are limited (115,289,310,400).…”

Foot Burn Injury in Patient with Diabetic Neuropathy—Case Report and Review of Literature

“…As burn injuries are highly susceptible to secondary infection, any delay in presentation further complicates and prolongs hospital stay [2,13]. Not surprisingly, our two patients who presented two weeks after their burn injury had a prolonged treatment course.…”

“…In a study done by Memmel et al [13] on 1794 patients (of which 130 were diabetics) showed that non-diabetic burn patients presented earlier to the burn clinic than diabetic patients for the treatment of their injury.…”

Systematic review of complications and outcomes of diabetic patients with burn trauma

“…This provides easy access for bacteria to enter the wound and bloodstream, causing both wounds and sepsis to the patient. In fact, Memmel et al [25] revealed that diabetic patients had a higher prevalence of bacteraemia and sepsis. Our calculated unadjusted odds ratio with their data revealed that diabetic patients has a 2.91 times higher odds of getting bacteraemia and 4.36 times higher odds of getting sepsis in the setting of burn trauma.…”