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The burn patient is at high hazard for nosocomial infections (NI) as a result of the nature of the burn damage itself, the immune-compromising impacts of burns, prolonged clinic stays, and intensive diagnostic and therapeutic strategies. The aim of this study is to describe the actual epidemiology of burn wound colonization and infection in the Intensive Care Unit (ICU) of the Service of Burns and Plastic Surgery at the University Hospital Center in Tirana, Albania. The study is retrospective clinical and analytical. Microbiology data, total body surface area (TBSA), patient days (LOS) and mortality were collected from a hospital database for all patients admitted to the ICU of the Service of Burns at the UHC in Tirana, Albania in 2020. The burn wound infection prevalence rate was greater than in 2010 (17.2 vs. 12 infections per 100 patients), while the burn wound colonization prevalence rate was reduced by half (20.6 vs. 44 colonized patients for 100 patients). The burn wound infection incidence rate was increased (47 vs. 42.6 infections per 1000 hospitalization days) and also the attack rate was increased (0.7 vs. 0.5 infections for 100 patients in 2010). The main pathogens were grampositive bacteria (60 strains; 71%), followed by Gram-negative bacteria (22 strains; 26%), and fungi (3 strains; 3%). The predominant five bacteria were Staphylococcus aureus (55.0%), Pseudomonas aeruginosa (9%), Acinetobacter baumannii (8%), Staphylococcus coagulase-negative (8%) and Enterococcus faecalis (5%). Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 55.3% (31/56) of Staphylococcal isolates. Implementation of anti-microbial stewardship programs is necessary to optimize the treatment of sepsis. [ABSTRACT FROM AUTHOR]

The different formulae for resuscitation therapy after thermal damage recommend 0.5-0.6 mmol sodium for each % TBSA burned, suggesting fluid requirements from 2-4 ml/kg/% burn because of sodium loss in burned and unburned tissues. There is a gap especially in the recommendations regarding dysnatremia in the burn population. Many studies have focused on calculating amount of resuscitation fluids, avoiding the situation of "fluid creep", and not on calculating sodium remaining in the body after resuscitation. The goal of this observational study was to provide data for sodium disturbances in the shock period after burns. Our study underscores the challenge of understanding whether there is a relationship between amount of crystalloid fluids given during resuscitation and meeting sodium needs. We set out to examine sodium balance (sodium deficit, received, excreted, and retained) after burns. The area under the ROC curve was performed by analyzing fluid and sodium load. Moreover, we conducted linear regression to analyze if there was a correlation between sodium retained and sodium excreted. Sodium deficit persisted until the second 24h despite resuscitation. Resuscitation was performed using Parkland formula, but urine output (UO) values were higher than expected. The threshold for fluid administration (ml/kg/%) or fluid load in the first 24h and sodium load (mmol/kg/%) for positive state (sodium received >0.5-0.6 mmol/kg/%) was 3.7 ml/kg/%. With linear regression, it was evident that sodium excreted was responsible for sodium retained, indicating a moderate correlation in the first 24h and a strong correlation in the second 24h. Resuscitation with LR did not correct hypoosmolality hyponatremia, which persisted even after the first 24h, especially in patients with burns >60%. If more than 3.7 ml/kg/% of LR is given, a sodium load higher than the normal level will be introduced, leading to increased urinary output, elevated sodium excretion, and non-correction of plasma sodium at the end of resuscitation. What is important for colleagues in clinical practice is that the focus of burn resuscitation should be expanded with data regarding sodium balance and the impact of dysnatremias in morbidity and mortality. [ABSTRACT FROM AUTHOR]

Numerous burn mortality indicators and prognostic scores are necessary to classify with priorities severely burned patients in order to predict outcome. The purpose of this paper is to evaluate mortality predictors on admission, in order to determine Lethal Area 50 and to validate burn prognostic scores. The study is retrospective, clinical and analytical. The data utilized were accessed by investigating the medical charts of 5033 patients hospitalized with severe burns within the Intensive Care Unit of the Service of Burns in Tirana, Albania over the period 1992-2019. Descriptive and inferential statistics were performed using PSS 23 software. Statistical significance is defined as p<0.05. The incidence rate of hospitalization of patients with severe burns initially increased from 4.1 to 7.9 persons per 100,000 population/year in the period 1992 to 1999, followed by a decrease from 7.9 to 4.8 in 2019. Mortality was 12.2% and the average burn crude death rate was 0.7 patients per 100,000 population/year. Lethal Area 50 for the second decade (2010-2019) was 82.2%. All tested burn prognostic scores had good predictive values. In addition to the commonly used outcome predictors such as age, burn size and inhalation burn, we concluded that additional determinants like depth of burn and etiology of burns determined an unfavorable outcome. Fatality risk was 4 times higher in patients with full-thickness burns, 2.6 times higher in patients with flame burns, and 4 times higher in patients with inhalation injury. [ABSTRACT FROM AUTHOR]