Are burn wound biopsies obsolete? A comparative study of bacterial quantitation in burn patients using the absorbent disc and biopsy techniques.

A study of bacterial quantitation in burn wounds was undertaken to compare a new absorbent paper disc technique with the standard burn wound biopsy technique. In the first part of the study 228 paired samples were used to compare the two methods; a high correlation coefficient was found with the four most commonly encountered bacteria, and both methods showed a high specificity and sensitivity for each of the organisms. In the second portion of the study, the discs were compared with burn wound biopsies that had been divided into their superficial and deep segments. Thirty paired samples were studied and again the correlation was high, indicating that the disc technique also measured the organisms found in the deeper tissue levels. The absorbent disc technique is simple, convenient, noninvasive, inexpensive, and yields reproducible results. These findings indicate that burn wound biopsies may no longer be required for infection monitoring in the burn patient.

Elective colon surgery: clindamycin versus metronidazole prophylaxis.

Orally administered clindamycin-neomycin as a prophylactic antibiotic in patients scheduled to undergo colon surgery was compared to orally administered metronidazole-neomycin. Clindamycin levels of the colon contents and the mucosa were 8 to 10 times higher than the serum levels. Three of the 43 patients who received metronidazole had wound infection whereas none of the 38 patients who received clindamycin did. Clindamycin may help to prevent staphylococcal infection, a known problem associated with metronidazole use. It may also play a role in preventing infection at the anastomosis in patients who undergo colon resection.

The influence of oral versus parenteral preoperative metronidazole on sepsis following colon surgery.

The incidence of wound infection following surgery on the colon is reduced by the preoperative adminstration of appropriate antibiotics. Quantitative bacteriologic studies raise the fundamental question as to whether effective antibiotic prophylaxis results from reduction of the bacterial content of the gut prior to surgery or whether effective tissue levels of the antibiotic is the key factor. Oral neomycin and metronidazole have been shown to markedly reduce the incidence of wound infection following colon surgery. A prospective randomized double-blind clinical trial was undertaken to compare the effectiveness of intravenous metronidazole (high tissue level) with oral administration (tissue and gut activity) on the incidence of wound infection. There was no difference in wound infection rates between the two groups of patients. Surprisingly, there was a significant reduction in the bacteroides content in the colon of patients who received intravenous metronidazole one hour before operation to a level almost equal to that achieved by the administration of the drug for two days by mouth before operation. Metronidazole levels in the colon at the time of surgery were comparable for both groups. The median time for recolonization of the colon was six days for the oral group, and four days for the intravenous group. Although peritoneal fluid contained significant numbers of coliforms and enterococci, clinical infection did not occur. These data suggest that systemic antibiotics effective against anerobic flora of the colon markedly reduce postoperative septic complications.