Influence of burn size on the incidence of contamination of burn wounds by fecal organisms.

Ischemia and reperfusion injury of the gut mucosa after severe injury have been shown to allow endogenous gastrointestinal tract microorganisms to pass into systemic areas (bacterial translocation); this has been hypothesized as a source of burn-wound contamination. To study this phenomenon, 53 pediatric patients with burns underwent routine fecal culture at the time of admission. These cultures were compared with wound cultures that were obtained at the time of admission and throughout their hospitalization. Patients were grouped according to burn size: Small (1% to 20% total body surface area burned), Moderate (21% to 50%), and Severe (greater than 50%). The incidence of corresponding isolates was determined for each group and compared by analysis of variance. No difference in the frequency of corresponding isolates could be demonstrated between the Small (4.0%) and Moderate (7.7%) groups, whereas the Severe group (53.3%) demonstrated a significantly larger incidence of corresponding isolates (p less than 0.0001). Translocation of gut flora after severe burn injury may account for some instances of burn-wound contamination.