May, 2006

Dear Readers,

       In this month’s Evidence Corner, Dr. Laura Bolton discusses the challenges facing the severely burned patient and summarizes 2 recent articles addressing these challenges and improving outcomes of treatment. The first article by Ong et al [Meta-analysis of early excision of burns. Burns. 2006;32(2):145–150] compared early excision and grafting versus conservative treatment on several outcomes including mortality, operating hours, complications of surgery, burn wound healing time, duration of sepsis, length of hospital stay, blood transfusion requirements, and long-term morbidity. The authors concluded that early excision reduced mortality in burn patients without inhalation injury and shortened hospital stay for all burn patients. Greater blood loss was the only negative aspect of early excision. The second article by Wibbenmeyer et al [Prospective analysis of nosocomial infection rates, antibiotic use, and patterns of resistance in a burn population. J Burn Care Res. 2006;27(2):152–160] analyzed infection rates in hospitalized burn patients, including those infections caused by resistant organisms, and identified risk factors and interventions to decrease antimicrobial drug use. The factors significantly related to hospital-acquired infection were found to be total body surface area burned, comorbidities, and the use of invasive devices. In her clinical perspective, Dr. Bolton reviews the conclusions of these reports and provides an interesting discussion of parallels between the findings in burn patients and chronic wound patients.  

       McCrary (A proposed final post-treatment wound outcome-tracking tool) presents a wound assessment and grading approach for determining and documenting post-treatment outcomes. He hopes that this report “…will stimulate input from the field with the ultimate product gaining wide acceptance and utilization in the wound healing community.”

       Kilpadi et al (Composition of wound fluid from pressure ulcers treated with negative pressure wound therapy using V.A.C.® Therapy in home health or extended care patients: a pilot study) characterized wound fluid from 8 patients with Stage III and Stage IV pressure ulcers at 0 time and after 1, 3, and 7 days of continuous treatment with negative pressure wound therapy (NPWT). The authors found statistically significant decreases from the 0-time baseline in levels of matrix metalloproteinase (MMP)-3, MMP-9, and MMP-3 to TIMP-1 ratios. The data presented in this pilot study are interesting and might explain the success of NPWT for wounds; however, further controlled study will be required to confirm this hypothesis.

       In the article, “Newer Antistaphylococcal Agents: In-Vitro Studies and Emerging Trends in Staphylococcus aureus Resistance,” Shittu and Lin review the advances made since the 1940s in developing antibacterial agents to combat infections caused by Staphyloccus aureus (SA). They discuss the history and apparently never-ending emergence of resistant strains of SA and, therefore, the importance of continued research and development of new antimicrobial agents. The authors provide an excellent review of the history, newer antimicrobials and their mode of action, and a snapshot of novel antimicrobials in development.


David T. Rovee, PhD
Editor, WOUNDS