Burn and scald injuries

Burns are one of the most harmful physical and psychological traumas. Infection is the major cause of morbidity and mortality in burns. Infections acquired from hospital or from the patient's own endogenous flora have a significant prevalence after burns. Pseudomonas aeruginosa and Staphylococcus aureus are the most frequent colonizing agents whereas group A beta-haemolytic streptococci are the most virulent bacteria. Anaerobic bacteria and fungi are also prevalent. Viral infection is less frequent. Aggressive resuscitation, nutritional support, thorough surgical excision of infected wounds, early wound closure, grafting and the development of effective topical and systemic chemotherapy have largely improved morbidity and mortality rates of burn patients

Bone infection

Osteomyelitis, or bone infection, affects all age groups and develops from various sources including haematogenously from distant infection foci, from external sources such as post-operative or post-traumatic wound infections and from adjoining soft tissue infections. Staphylococcus aureus, Streptococcus pyogenes and Haemophilus influenzae are the most common pathogens of haematogenous osteomyelitis. Aerobic and facultative gram-negative bacteria have emerged as significant pathogens in some types of osteomyelitis while anaerobic bacteria are increasingly recognized as potential pathogens in non-haematogenous osteomyelitis. The emergence of antibiotic resistance is of increasing concern, although improvements in radiologic imaging, antibiotic treatment and heightened awareness have led to earlier detection such that long-term sequelae and morbidity are now primarily due to delays in diagnosis and inadequate treatment

Infection following orthopaedic implants and bone surgery

Forty-seven patients were investigated for early or late postoperative infections of orthopaedic implants and/or bone. A total of 88 isolates were recovered [64 aerobes and 24 anaerobes]. Pseudomonas aeruginosa and Staphylococcus epidermidis were the most common causative agents. Anaerobic bacteria were isolated from 16 [34%] patients; 50% of patients with late-onset infection and 10.5% with early-onset infection. In 6 [12.8%] patients, infection was with anaerobic organisms alone. All these patients had retained an extramedullary internal fixation device. Anaerobic microorganisms appear to play a significant role in the pathogenesis of late-onset postoperative infection, especially where there is an extramedullary internal fixation device

Acute haematogenous osteomyelitis: microbial conversion and unusual age presentation

From 1983 to 1989, 110 cases of haematogenous osteomyelitis were studied retrospectively. The most commonly affected were children under 1 year. No adult cases were reported. Staphylococcus aureus was isolated from 72.7% of cases. During 1992-1997, 80 cases were studied prospectively. The most commonly affected were children aged 9 years. This group included 19 adults. S. aureus was isolated from 43.7% of the cases. There was a clear difference in the incidence of S. aureus and age presentation in the cases before and after the Gulf conflict. Working children and malnutrition might have caused changes in the infecting organisms and age presentation in recent years

Fungal infection of burn wounds in patients with open and occlusive treatment methods

Fungal infection of burn wounds was investigated in a prospective study of 130 patients managed either with open or occlusive treatment methods. In all, 30 fungal isolates were recovered from 26 patients all of whom had bacterial infection also, except for one patient. The predominant fungi recovered were Aspergillus spp. and Candida spp. Fungal infection was more common in patients treated with open dressing [25.5%] than occlusive dressing [16.0%]. Fungal culture from tissue specimens gave a better isolation rate of fungi than from cotton swab specimens

Anaerobic osteomyelitis

The prevalence and role of anaerobic bacteria in bone infection were investigated in this prospective study on 134 cases with pyogenic osteomyelitis. Specimens were inoculated immediately in the operating theatre or in the ward and incubated under aerobic and anaerobic conditions without using transport media. Anaerobic organisms were isolated from 39 of the 134 cases [29%] of all types of pyogenic osteomyelitis. The total number of aerobic and anaerobic isolates was 224, of which 50 were anaerobes [22%]. Syringe-aspirated specimens were better than swab specimens for the isolation of anaerobes. Anaerobes were mostly isolated from osteomyelitis cases of long duration