The Incidence of Bacteremia following Burn Wound Excision

Early excision with immediate skin grafting is becoming increasingly popular as a method of achieving wound coverage in thermally injured patients. The complications of this technique include major hemorrhage, shock, and hypothermia in acutely ill, hypermetabolic patients. A two-stage technique for excision and grafting has been employed at the Intermountain Burn Center. This technique allows for overnight stabilization following excision of the burn wound for correction of temperature, blood volume, and red cell mass with autografting the following day. The two-stage technique alleviates most of the disadvantages of primary excision. A remaining theoretical detriment to excision is the risk of bacteremia following manipulation of a large contaminated wound. This study was designed to determine the incidence of bacteremia and sepsis following primary excision of burn wounds. Forty-six burned patients who underwent excision were studied prospectively for evidence of bacteremia or sepsis. Blood cultures were obtained immediately before excision and within 1 hour following the procedure. Qualitative and quantatitive burn wound cultures were evaluated from patients during their hospital course. All patients received perioperative antibiotics before excisional therapy. The mean burn size of the patients was 36.2% TBSA (range, 13.5–74.0%), and mean area of full-thickness burn was 19.4% (range, 3.5–51% TBSA). Sixty-six excisional procedures were performed in the 46 patients. The incidence of bacteremia following excision was 1.6%. The frequency of positive burn wound cultures increased directly with the length of time the burn wound remained open. Burn wounds that were excised and grafted less than 10 days postburn had a significantly decreased incidence of bacterial colonization than wounds which were not autografted until 30 days following burn injury (p < 0.001). Of the 46 patients, 42 patients survived their burn (91.3%). All of the deaths occurred in patients with inhalation injuries. Pulmonary failure was the cause of death in three patients, and one patient died of burn wound sepsis. Excisional therapy did not result in a high incidence of bacteremia even in patients with heavily contaminated burn wounds and it did not lead to the development of fatal sepsis in this group of patients.