Background: The relationship of the burn wound flora to microbial pathogens
in the tracheobronchial tree has important implications for antimicrobial
therapy in the severely burned patient. Management of septic complications
is bolstered by surveillance quantitative wound cultures (QWC) and bronchia
l lavage fluid (BLF) cultures.
Objectives: To compare the organisms present in ELF with those found in QWC
and to determine if QWC can predict ELF results.
Design: Results of ELF cultures from all patients who underwent bronchial l
avage from January 1, 1996, to December 31, 1996, at our institution were c
ompared with QWC data from the same date. Criteria for a positive match inc
luded an identical antibiotic susceptibility pattern and biotype. Match rat
es were calculated qualitatively and quantitatively.
Results: In 30 (48%) of the 62 ELF cultures, there was a match between the
organism identified In the ELF and the QWC. When strict quantitative criter
ia were applied, the match rate was only 9 (14%) of 62. Burn size and inhal
ation injury had no significant effect on match rate.
Conclusions: Whereas the microbial pathogens were similar in the QWC and EL
F, linear regression showed no value of QWC in predicting ELF culture resul
ts. The difference between qualitative and quantitative match rates suggest
s cross-colonization between the burn wound and tracheobronchial tree, but
little to no cross-infection. The QWC and ELF cultures must be performed in
dependently in determining antimicrobial specificity in the burned patient.