Wound infections in burn victims Practice Question #6 After a horrible fire ravaged a bloc of flats, several residents were brought to the hospital for mild to severe burn treatments (see Table 1). Table 1: Patients admitted at the hospital following the fire. Name Age (years) Medical condition Sandra 63 Second-degree burns on 40% of her body Marco 19 Deep third-degree burns on 90% of his legs Alexandre 29 Deep third-degree burns on 35% of his legs Matthieu 58 Superficial burns on his arms and legs Maddie 38 Partial thickness burns on her left arm Matthieu and Maddie, who were less severely burned, were treated with various topical anesthetic ointments and antibiotics, they were released from care and made full recoveries. Severely burned Sandra, Marco, and Alexandre were all moved to an isolated section of the ICU and initially treated through intravenous (for fluid resuscitation) and intra-arterial (for invasive blood pressure monitoring) catheters. After being treated for shock and after their conditions were stabilized, Sandra, Marco, and Alexandre were treated in the hydrotherapy room (warm running water) twice daily for 2-3 days. Hydrotherapy can stimulate recovery and act as a pain relief for burn victims. However, the patients soon started exhibiting signs of infection with high fevers/malaise, and their wounds started emitting sweet-like odors. Dr. Moochin, the physician in charge of Sandra, Marco and Alexandre, was very worried about the symptoms her patients were exhibiting. She suspected bacterial infections and without waiting for diagnostic results, she immediately prescribed antibiotics for all 3 patients. During the twice daily dressing changes, wound exudates (fluid that leaks out from the lymph and blood into injured tissues) were collected from each patient using a sterile collection system, and bacterial culture tests were performed to confirm the presence of bacterial infection. After gram staining, microscopy examination showed that dominated by blue/purple coccoid cells, indicating a Staph infection. However, Marco's wounds were colonized by both red/pink rods and blue/purple coccoid cells. The rods were identified as Pseudomonas aeruginosa, and the cocci were Staphylococcus aureus. from all patients the ICU were Several tests were made on the samples collected from patients' wound. Dr Moochin was aware of the various other ways bacteria can transiently survive antibiotic treatments and wanted to know which mechanism was at cause. Knowing the cause could help her treat her patient in the best possible way.