Early burn related gram positive systemic infection in children admitted to a pediatric surgical ward

Background: Gram positive infections, including toxic shock syndrome (TSS), may be an early complication following burns, especially in children. Objective: To identify risk factors associated with early burn related gram positive systemic infection (EBGI) in children admitted to a Pediatric Surgical Ward. Methods: A retrospective analysis of the records of all EBGI patients treated from January 1995 to December 2004. EBGI patients were defined as having systemic signs of infection appearing in the first 48 h following the burn and associated with: (1) clinical signs of toxin mediated illness and/or (2) positive blood culture of either Staphylococcus aureus or group A beta hemolytic Streptococcus. Demographic and clinical data were also collected from the charts of 150 randomly selected burn patients admitted during the study period. Results: We identified 13 cases of EBGI (2.5%) among 518 children admitted for thermal burns (mean age: 2.4 years). Three had bacteremia without rash. The 10 other patients were diagnosed as having a toxin mediated disease. S. aureus grew from the burn wound in six patients. All EBGI patients recovered following antibiotic therapy. Significant differences between the groups included: percentage of burned body surface area (6.9% versus 3.9%), and head and face localization (64% versus 31%) in the EBGI and control groups, respectively. Conclusions: EBGI is not rare even in pediatric patients with minor-moderate burns. Burns localized to the face or the head may be predisposing factor for such an infection.