Treatment of 1,963 Burned Patients at 106th General Hospital

Comparison of Combat and Non-Combat Burns From Ongoing U.S. Military Operations

“…They reported increased associated injuries with combat burns and in their experience, only 43% of burns were related to combat, but these accounted for 69% of mortality. The authors experienced a similar distribution of injury causes, with landmines, mortars, and rocket-propelled grenades accounting for the bulk of combat injuries and gasoline and ammunition misuse accounting for most of the noncombat burns [4].…”

“…This distribution is similar to that experienced in historical military conflicts. In Vietnam, 66% of burn patients had less than 20% TBSA involvement and in the 1982 war in Lebanon, 50% of casualties had burns involving less than 10% TBSA [4,8]. The small average size of the burns seen in this population belies their morbidity.…”

“…Military burn injuries occur either during combat operations as the result of direct enemy action, or during non-combat situations, with their cause unrelated to enemy activity. During the Vietnam War the non-combat component accounted for over half of the burns seen, indicating a significant role of such wounds on the overall burden of military burns [4,5].…”

Activity of topical antimicrobial agents against multidrug-resistant bacteria recovered from burn patients

“…Inhibits nucleotide synthesis [8] Bacteriostatic against gramnegative organisms including P. aeruginosa and gram-positive organisms [13,39] 11.1% cream, 5% solution Rapidly penetrates full thickness eschar making it effective in heavily colonized wounds and established burn wound infection [3,5,33] 11.1% concentration is painful when applied to the superficial partial-thickness burns with intact free nerve endings [3,40] Can dry into a tenacious gum (neoeschar) that attaches to the wound requiring hydrotherapy to remove [41] 5% aqueous solution is less painful and does not leave a residue [42] Absorbed systemically with highest blood levels of mafenide and its metabolite (pcarboxybenzenesulfonamide) in 2nd-4th hour resulting in urinary alkalinization from carbonic anhydrase inhibition [43] Possible metabolic acidosis, especially in patients with pulmonary dysfunction such as atelectasis or pneumonia that limits respiratory compensation [14,40,44] Electrolyte disturbances [45] 7% incidence of hypersensitivity, usually a rash [5] Rapid absorption from the tissue requires twice daily application to keep levels high enough for bacterial inhibition [33] No resistance reported to P. aeruginosa [6] Some resistance described to Providencia [5] Mortality benefit in prevention of burn wound sepsis described in animal models [13] Reduction in mortality and the rate of invasive burn wound infections in patients from before the introduction of mafenide to after, particularly in patients with 40-79% TBSA in one study [5] and between 20 and 59% TBSA in another study [14,15] Found to be the most effective topical agent against A. baumannii [18] Poor correlation between broth microdilution and agar well diffusion [23] b u r n s 3 6 ( 2 0 1 0 ) 1 1 7 2 -1 1 8 4…”

“…Topicals such as honey have been in use since antiquity, and others for decades [4][5][6][7][8][9][10][11]. There are both animal studies and clinical studies that provide data about the morbidity and mortality benefits associated with use of various topical antimicrobial agents in the prevention and treatment of burn wound infections [5,[12][13][14][15][16][17]. Another benefit of topical agents is that they can be delivered directly to the site of colonization or infection and can be used for both the prophylaxis and treatment of burn wound infections [18].…”