Some aspects on prevention and treatment of infection in burns.

Formerly, death due to burns was usually caused by shock in 50% of the cases. Today only 5% of the deaths are caused by shock; 95% of all deaths are due to infection and half of these deaths are due to septicaemia. The treatment of infections depends on two factors: -- Prevention of contamination -- Prevention of bacterial growth. Contamination can be prevented by early skin grafts, a no-touch method when applying dressings, nursing in ventilated rooms and local antiseptics. The history of the use of various antiseptics starting with penicillin V and ending with cerium nitrate is discussed. For the prevention of bacterial growth chemotherapy, active and passive immunisation, and such general methods as the correct treatment of associated diseases and a high calory diet are necessary. Chemotherapy should only be given when there are definite indications. Indiscriminate chemotherapy is dangerous. The most useful immunisation methods are vaccinations against pseudomonas as these vaccinations are also active against other gram-negative bacteria. In children the diagnosis of septicaemia is often difficult. As septicaemia may develop very quickly in children, it is sometimes necessary to start chemotherapy blindly before the results of the blood culture are known.