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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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SEVERE BURN INJURY AND SERIOUS INFECTIONS: OLD AND NEW THERAPEUTIC OPTIONS

Filipa Marujo, Flora Candeias, Regina Duarte, Maria João Brito

1- Infectious Diseases Unit, Department of Pediatric Medical, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon
2- Infectious Diseases Unit, Department of Pediatric Medical, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon
3- Burn Unit, Department of Pediatric Surgery, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon
4- Infectious Diseases Unit, Department of Pediatric Medical, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon

10th World Congress of the World Society for Pediatric Infectious Diseases; ePoster

Resumo:
Introduction: Infections of burn wounds are a major cause of morbidity and mortality in burned patients. Several factors increase the risk of infection, including the extent and depth of the burn, presence of comorbidities, age, etiology of thermal injury and the number of microorganisms colonizing burn wounds.
Case report: A previously healthy 2-year-old female, native of Angola, was admitted with a burn of 60% total body surface area. She was admitted to the intensive care (mechanical ventilation and central catheter). On day 21 of hospitalization Pseudomonas aeruginosa was isolated in cultures of the superficial burn exudation and ceftazidime and gentamicin were started. On day 84 of hospitalization, developed sepsis of the catheter by Candida albicans and amphotericin B was started. At the same time, HIV infection was diagnosed (viral load 1965000 copies/mL). During a long term hospitalization and fever with evidence of colonization with multidrug resistant bacteria, she completed several cycles of beta-lactams, aminoglycosides, carbapenems and glycopeptides. There continued to be rejection of skin grafts and a new sepsis has developed with a multidrug resistant Pseudomonas aeruginosa and colistin and Hyperbaric Oxygen Therapy (HBOT) was initiated. Progressive infection improvement with a favorable graft evolution was verified after thirty sessions.
Discussion: Burned patients are likely to benefit from HBOT due to increased tissue oxygenation and bigger tissue preservation, bringing benefits to burn wounds and concomitant infection. Colistin, an old antibiotic, currently be used as an agent of last resort because of its toxicity for the treatment of infections caused by multidrug-resistant organisms.

Palavras Chave: burn, colistin, Hyperbaric Oxygen Therapy, sepsis