A 45-year-old woman is admitted to a hospital because of a third-degree burn injury to 40% of her TBSA, and her wounds are treated with topical silver sulfadiazine cream (Silvadene). Three days after admission, a burn wound biopsy semiquantitative culture shows 104 Pseudomonas organisms per gram of tissue. The patient's condition is stable at this time.
The most appropriate management for this patient would be to:
A. Repeat the biopsy and culture in 24 hoursBacterial proliferation in a burn wound may occur despite topical antibacterial agents. When bacterial proliferation has escaped control, as proved by quantitative burn wound biopsy, administration of antibiotics by needle clysis beneath the eschar is indicated. This therapy is most effective if initiated early, before invasive burn wound sepsis has developed or wound colonization has reached greater than 104 organisms per gram of tissue. Systemic antibiotics usually are ineffective at this point because by the third day after a burn, blood flow to a burn wound is markedly decreased. Thus, adequate levels of antibiotic are not achieved at the eschar-viable tissue interface where the bacterial proliferation is occurring. Before the use of subeschar antibiotics, Pseudomonas sepsis of burn wounds accompanied by ecthyma gangrenosum was uniformly fatal in children. Once colonization of a burn wound has occurred, surgical excision is extremely dangerous, as systemic seeding will occur.