Evaluation of Antibiotic Prophylaxis and Gamma-Globulin, Plasma, Albumin and Saline-Solution Therapy in Severe Burns*

Abstract

An analysis of bacteriologic cultures from various sources among burned children on antibiotic prophylaxis revealed Staphylococcus aureus (coagulase positive) to be the most frequently isolated organism (31.5%), followed by Pseudomonas aeruginosa (21.6%). Prophylaxis with the combinations of polymyxin-B and tetracycline, polymyxin-B and chloramphenicol, colistin and penicillin-G, and singly with colistin or penicillin-G did not prevent rapid colonization of burned areas and intestine by S. aureus and P. aeruginosa. Continuous antibiotic prophylaxis resulted in the rapid development of resistant-strains. There was no increase in the percent of resistant P. aeruginosa strains during prophylaxis with colistin. Discontinuation of the antibiotics resulted in a gradual increase to original levels in the percent of sensitive strains. The least number of septicemid deaths occurred during prophylaxis with penicillin-G alone (16% in 128 cases) and with polymyxin-B and tetracycline (18% in 34 cases). The highest incidence of septicemias occurred during prophylaxis with colistin (40% in 75 cases). P. aeruginosa alone was isolated from the blood in 62 fatal cases (75%), and Pseudomonas with Staphylococcus, [beta]-hemolytic Streptococcus, Escherichia coli, and the providence and proteus group in 8 cases (10%). Pseudomonas septicemia was 3 times as frequent with colistin or colistin plus penicillin prophylaxis as with the other antibiotic regimens. S. aureus alone was isolated in 9 cases (11%) and in combination with Pseudomonas in 4 (5%). In burns from 10-30% body surface area, plasma and/or gamma-globulin therapy reduced by more than 50% the mortality from septicemias due to Pseudomonas or Staphylococcus, as compared with saline alone or saline and albumin therapy. There was a significant decrease in serum gamma-globulin levels in all therapy groups regardless of age during the first postburn week. The highest number of septicemias occurred during this period. In the 0-4 year age group serum gamma-globulin levels were higher between the third and seventh postburn day in children given plasma or gamma-globulin. Pseudomonas antibody titer was relatively low during the first 6 yrs. of age. Susceptibility to septicemia was inversely related to age and to pseudomonas antibody titer.