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Meta-Analysis
. 2014 Apr 21;9(4):e95042.
doi: 10.1371/journal.pone.0095042. eCollection 2014.

Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-

Ernest A Azzopardi  1 , Elayne Azzopardi  2 , Liberato Camilleri  3 , Jorge Villapalos  4 , Dean E Boyce  5 , Peter Dziewulski  6 , William A Dickson  5 , Iain S Whitaker  1
Affiliations
Meta-Analysis

Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-

Ernest A Azzopardi et al. PLoS One. .

Abstract

Background: Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres.

Methods: Studies investigating adult hospitalised patients (2000-2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance.

Primary findings: Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84).

Interpretation: Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA-style scheme reporting the literature retrieval and selection strategy arriving to the final 7 studies whose data could be pooled for statistical analysis.
Figure 2
Figure 2. Box-whisker plot reporting data dispersion for the standardised incidence of Gram-negative burn wound injury in civilian adult hospitalised patients.
Data shown represents mean±1SD.
Figure 3
Figure 3. Geographic distribution of the centres from which studies were critically appraised.
The study design and sample size are provided in figure 2.
See this image and copyright information in PMC

References

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