Introduction Les infections liées à Pseudomonas aeruginosa représentent un défi croissant en raison de l'émergence de souches résistantes aux traitements conventionnels. Des associations ceftazidime/avibactam (CZA) et ceftolozane/tazobactam (CT) ont suscité un intérêt en tant que solutions thérapeutiques prometteuses.L'objectif de notre travail est d'évaluer l'efficacité des associations CZA et CT sur les souches de Pseudomonas aeruginosa collectées, afin d'évaluer l'intérêt de leur introduction dans notre centre. Matériels et méthodes Notre étude était prospective descriptive menée au laboratoire de biologie médicale de notre centre durant 29 mois (Août 2021-Décembre 2023). Nous avons inclus toutes les souches de Pseudomonas aeruginosa isolées à partir des prélèvements à visée diagnostique reçus au laboratoire. L'identification bactérienne était faite selon les méthodes conventionnelles et l'étude de la sensibilité aux antibiotiques selon les normes du CA-SFM 2023.La recherche et le typage moléculaire de carbapénèmases ont été réalisés pour 161 souches par une PCR GeneXpert® (Cepheid) par le kit Xpert® Carba-R détectant les principaux gènes codant pour les carbapénèmases (blaVIM, blaNDM, blaIMP, blaOXA48 et blaKPC). Résultats Durant la période d'étude, 843 souches non redondantes de Pseudomonas aeruginosa ont été isolées, essentiellement provenant des services de réanimation des brûlés (57,41%) et d'anesthésie réanimation (15.3%).La résistance à CZA et CT parmi l'ensemble des souches étudiées était de 31.74% et 35.51% respectivement, occupant la 2ème et 3ème place des bêtalactamines les plus actives après l'aztréonam (23.99%).Parmi les 388 souches de Pseudomonas aeruginosa résistantes à la ceftazidime (CAZ-R), la résistance passait à 70.60% et 76.55% au CZA et CT respectivement contre 94.75% pour les carbapénèmes et 45.87% pour l'aztréonam.Les 506 souches résistantes aux carbapénèmes étaient sensibles dans 47.60% au CZA, 39.96% au CT et 60.21% à l'aztréonam.Parmi les souches typées (n=68), celles résistantes au CZA étaient des souches productrices de métallo-β-lactamase de type VIM dans 39,7% des cas. Conclusion Les souches de Pseudomonas aeruginosa isolées affichent un profil de sensibilité aux associations CZA et CT bien meilleur que la plupart des bêtalactamines utilisées dans notre centre, constituant une alternative thérapeutique intéressante face aux souches multirésistantes.Aucun lien d'intérêt

Venous thromboembolic disease (VTE) in burn patients is an under-diagnosed and potentially serious complication. Its incidence varies according to studies performed. This retrospective and descriptive study conducted in an intensive burn care department in Tunisia over a period of 22 months (January 1, 2021 to October 30, 2022) included 24 patients who presented a thromboembolic complication among a total of 785 admissions (incidence of 3%): pulmonary embolism in 15 cases and deep venous thrombosis (DVT) in 9 cases. The mean age of the patients was 43.8 years, with a male:female sex ratio of 2:1. Two thirds of patients (n=17) had a pathological history: hypertension (n=3); diabetes (n=2) and neoplasia (n=2). Three patients were obese. The average TBSA was 29%. Burns involved lower limbs in 19 patients (79%). The mean time to onset of VTE was 27.8 days. Acute dyspnea was present in 1/2 of cases and tachycardia in 1/3 of cases. The association hypoxia-hypocapnia was found in 5 patients. The diagnosis was confirmed by: thoracic angioscan (n=14), pulmonary scintigraphy (n=1), venous Doppler ultrasound of the lower limbs (n=2) and phleboscan of lower limbs (n=7). Factors correlated with thromboembolic risk in our study were: TBSA 20% - 39% (p=0,029; RR=4), with lower limb involvement (p=0,068), catheterization duration ≥7 days (p=0,048; RR=3) and number of catheters >1 (p=0,01; RR=3). The outcome was favorable in 13 patients and fatal in 11 patients.

Electrical burn injuries (EBI) affect both adults and children and are responsible for a very high number of major limb amputations. Their management is still a major challenge. This retrospective review concerns 42 children, admitted to an intensive burn care department in Tunisia for high electrical burns, from January 2016 to September 2022. The average age of our patients was 12 years, with a male predominance (90.5%). Electrotrauma was accidental in the majority of cases (93%) and secondary to a domestic accident in 54.8% of cases. Total body surface area was 19%. Burns were second degree in 2/3 of cases and third degree in 1/3 of cases. The most affected areas were distal extremities in 2/3 of the cases. Rhabdomyolysis was observed in 93% of cases and troponins were elevated in half of the patients. Escharotomy was required in 38% of cases. Amputation was performed in 18 children (43%): one limb (n=10); 2 limbs (n=6) and 3 limbs (n=2). The outcome was favorable in 9 children (21.4%); functional and cosmetic sequelae with an impact on schooling and psychology were reported in 25 cases. Mortality was 16.7%.

Burns in diabetics are quite frequent and serious in relation to diabetic neuropathy, which is common in this population, delaying healing and predisposing to the risk of infection. The objective of this study was to describe the characteristics of burns in diabetics hospitalized at the CTB of Tunis over 18 months. During the study period, 891 patients were hospitalized, including 43 diabetics (5%). The average age of our patients was 57 years old with a male predominance (65%). Type 2 diabetes was present in 86% of cases and type 1 diabetes in 14% of cases. Degenerative complications were reported in 10 cases (23%), such as diabetic retinopathy (n=6), diabetic nephropathy (n=4) and diabetic neuropathy (n=6). The circumstances of burns were related to a domestic accident in 2/3 of the cases (76.7%). Thermal burns were involved in 83.7% of cases. 86% of the patients had decompensated their diabetes during their hospitalization. Sepsis marked the evolution of the patients in 55.8% of cases. In our study, poor prognostic factors were: a glycosylated haemoglobin > 13%, an extent of burns greater than 20%, and a delay in consultation greater than 6 hours. The mortality rate was 18.6%.

IntroductionLa bactériémie chez les patients brûlés est une complication fréquente en réanimation, où une identification rapide des agents pathogènes à partir d'hémocultures positives peut améliorer la prise en charge. Le test BioFire® FilmArray® (BCID2) permet l'identification de 33 agents pathogènes et 10 gènes de résistance en une heure. Notre étude vise à comparer les performances de ce test moléculaire à la culture classique et à évaluer son impact sur la gestion des patients.Matériels et méthodesNous avons réalisé une étude prospective incluant les hémocultures positives provenant du service de réanimation de brûles sur une période de 2 ans allant du janvier 2022 à décembre 2023. Pour chaque hémoculture positive, le test (BCID2) a été fait parallèlement à une culture classique et un antibiogramme réalisés selon les méthodes conventionnelles.Chez le même malade, un délai de trois jours entre deux hémocultures positives a été respecté avant de refaire le test moléculaire.RésultatsAu total, 81 malades ont bénéficié de 106 tests moléculaires. Le sexe ratio (H/F) des malades était de 2,8. L'âge moyen était de 34 ans (± 18,7). Le test a montré une sensibilité globale de 70% et une spécificité de 96%, ces taux passaient à 88% et 92%, respectivement pour les cibles microbiennes du panel.La concordance d'identification totale était de 64%. Ce taux passait de 72% en cas de culture monomicrobienne à 45,4% en cas de culture polymicrobienne.Quant à la détection des mécanismes de résistance, une concordance totale de 64% a été retrouvé : la détection de béta-lactamase à spectre étendu, de carbapénèmase, de Staphylococcus résistant à la méticilline et d'Enterocoque résistant à la vancomycine a été faite dans 5/9, 20/30, 8/16 et 4/5 des cas, respectivement. Le délai de communication des résultats du test moléculaire était d'une 1h et 09 minutes contre 74 h et 20 min pour la culture classique, soit un gain de temps de 73h.L'antibiothérapie a été ajustée selon le résultat du test moléculaire chez 48% (n=39) des patients.Celle-ci était faite dans un délai médian de 4,9h de la réception du résultat du test [intervalle interquartile 2,5h – 23h]. Chez 53% de ces malades une réponse favorable a été notée.La majorité des patients (95%) ayant eu une escalade du traitement. Le test a permis aussi une désescalade appropriée du traitement chez 5,5% des patients.ConclusionNotre étude a montré une bonne performance du test BioFire®FilmArray® (BCID2) avec une sensibilité et spécificité élevées, ainsi qu'un gain de temps dans la prise en charge des patient avec un ajustement de l'antibiothérapie chez plus que le tiers des patients.Aucun lien d'intérêt

The incidence of extubation failure varies between 2 and 25% depending on the studied population. Few studies have been conducted in burn victims. To determine the incidence, causes, risk factors and outcome of burned patients after a failed extubation, a retrospective single-center case-control study was conducted over a period of 3 years (January 2018-December 2021). All burned patients aged over 16, ventilated for at least 24 hours and having had at least one extubation attempt were included. Extubation failure was defined as the need for re-intubation within 48 hours. Eighty-eight patients had planned extubation. These patients were divided into 2 groups comparable in terms of age and sex. Failure group: including patients with failed extubation (N= 34) and a success group (N= 64) including patients who succeeded. The incidence of extubation failure was 36.6%. Hypophosphatemia, anemia <8g/dl, duration of mechanical ventilation of 8,5 days and abundant secretions during extubation were identified as risk factors for extubation failure (p<0.05). The main cause of failure was retention of secretion (50%). Extubation failure was associated with prolonged length of stay (34 vs. 19 days, P= 0.005), increased infectious complications (P=0.007) and mortality rate (79.4%, 1.5%, P<0.001).

Les infections liées à Pseudomonas aeruginosa représentent un défi croissant en raison de l'émergence de souches résistantes aux traitements conventionnels. Des associations ceftazidime/avibactam (CZA) et ceftolozane/tazobactam (CT) ont suscité un intérêt en tant que solutions thérapeutiques prometteuses. L'objectif de notre travail est d'évaluer l'efficacité des associations CZA et CT sur les souches de Pseudomonas aeruginosa collectées, afin d'évaluer l'intérêt de leur introduction dans notre centre. Notre étude était prospective descriptive menée au laboratoire de biologie médicale de notre centre durant 29 mois (Août 2021-Décembre 2023). Nous avons inclus toutes les souches de Pseudomonas aeruginosa isolées à partir des prélèvements à visée diagnostique reçus au laboratoire. L'identification bactérienne était faite selon les méthodes conventionnelles et l'étude de la sensibilité aux antibiotiques selon les normes du CA-SFM 2023. La recherche et le typage moléculaire de carbapénèmases ont été réalisés pour 161 souches par une PCR GeneXpert® (Cepheid) par le kit Xpert® Carba-R détectant les principaux gènes codant pour les carbapénèmases (blaVIM, blaNDM, blaIMP, blaOXA48 et blaKPC). Durant la période d'étude, 843 souches non redondantes de Pseudomonas aeruginosa ont été isolées, essentiellement provenant des services de réanimation des brûlés (57,41%) et d'anesthésie réanimation (15.3%). La résistance à CZA et CT parmi l'ensemble des souches étudiées était de 31.74% et 35.51% respectivement, occupant la 2ème et 3ème place des bêtalactamines les plus actives après l'aztréonam (23.99%). Parmi les 388 souches de Pseudomonas aeruginosa résistantes à la ceftazidime (CAZ-R), la résistance passait à 70.60% et 76.55% au CZA et CT respectivement contre 94.75% pour les carbapénèmes et 45.87% pour l'aztréonam. Les 506 souches résistantes aux carbapénèmes étaient sensibles dans 47.60% au CZA, 39.96% au CT et 60.21% à l'aztréonam. Parmi les souches typées (n=68), celles résistantes au CZA étaient des souches productrices de métallo-β-lactamase de type VIM dans 39,7% des cas. Les souches de Pseudomonas aeruginosa isolées affichent un profil de sensibilité aux associations CZA et CT bien meilleur que la plupart des bêtalactamines utilisées dans notre centre, constituant une alternative thérapeutique intéressante face aux souches multirésistantes. Aucun lien d'intérêt

Diabetes causes peripheral neuropathy with loss of sensitivity of feet to pain, predisposing diabetic patients to a high risk of severe burns. Our retrospective study aimed to look at epidemiological, clinical, therapeutic and outcome characteristics of feet burns occurring in patients with diabetes, hospitalized in the burn trauma center of Tunis over 4 years (from 2019 to 2022). We included 34 patients, among which 9 had only feet burns. Their mean age was 60 years (range: 41-83 years), with male predominance (sex ratio = 1.83). A quarter of patients (n=9) were on oral antidiabetic drugs (OADs) and more than half (n= 18) were at the stage of degenerative complications. At admission, blood glucose level was higher than 10 mmol/l in 73% of patients. TBSA was 19%. Twenty-two patients had deep feet burns, among which 5 patients underwent aponerrotomy for deep, circular burns. Amputation was done in 15 patients: toes (n=9), one limb (n=3) and two limbs (n=3). Duration of ICU stay was 18.3 days and mortality was 20.58%.

Resistance to carpabenems in burns is rapidly spreading in many countries. Therefore identification of carbapenemase pathogen carriers is imperative in order to establish adequate infection control precautions and stop outbreaks of these multidrug-resistant bacteria. The aim of our study was to evaluate the distribution of carbapenemase producers in burn patients admitted to a burn center in Tunisia over 9 months. PCR for carbapenemase portage was performed in all patients within 48 hours of admission. Seventeen patients carried a single carbapenemase, 11 carried two, and 25 carried three. The enzymes detected were VIM (n=41), NDM (n=41) and OXA48 (n=32). Enzyme mapping revealed two main areas of carriage in central western Tunisia: Kairouan (NDM/OXA48) and Kasserine (NDM/VIM). Predictive factors for carriage of carbapenemase were: prior antibiotic therapy (n=24); mechanical ventilation (n=30); vascular catheterization (n=31) and a previous stay in intensive care (n=11).

Self-immolation represents a relatively frequent cause of burn, especially in Tunisia after the revolution, with high costs at the individual and societal level. In this retrospective study, we report epidemiological, clinical and evolutionary characteristics of burns by immolation at the CTB of Tunis over a period of 10 years. The study involved 755 patients over the 10 years. The mean age was 33.38 years with a sex ratio of 4.5:1 (618 M/ 137F). Half of the patients (51%) were single, 2/3 (74.3%) had an unfavourable or medium socioeconomic level, 35.8% were unemployed. The educational level was secondary in 46% of cases and primary in 33.9%. Secondary transfer was noted in 53.6% of cases with agreement in 57.8%. The patients came from all regions of Tunisia with a predominance of those from the Tunis area (37.8%). One third of our patients had a psychiatric history, with the notion of a previous suicide attempt in 5.1% of cases. Alcoholism and/or drug addiction was reported in 17.7% of cases. The act of self-immolation was performed in a public place in 59.2% of cases. TBSA was 41.48%. Burns were deep in 66.2% of cases. Facial involvement was noted in 90% of patients. ABSI was 7.35 and Baux index 78 +/- 50. The average length of stay was 17.64 days. 2/3 of patients (72.1%) required intubation and mechanical ventilation. The mortality rate was 57.2%.

Venous thromboembolism (VTE) complications in burn patients are often under-diagnosed and potentially serious. Thromboprophylaxis in this population remains controversial. Objective: Assess the impact of optimizing prophylactic anticoagulation with enoxaparin in burn patients on the incidence of venous thromboembolism (VTE). Methods: Case-control study conducted in intensive burn care department in Tunisia during 24 months, (February 2018- February 2020). Patients were divided into 2 groups according to the prophylactic anticoagulation modalities: - G1 (Equation) receiving enoxaparine en mg/12H = 22.8 + (3.3 × % TBSA/10) + (1.89 × (weight in kg)/10)) - G2 (No équation) receiving enoxaparine at a dose of 0.5mg/kg, twice daily The goal of prophylactic antifactor Xa level was 0.2- 0.4 IU/ml Results: During study period, 216 patients were included divided into 2 groups: G1 (n= 108) et G2 (n= 108). The groups were comparable in terms of sex, age, weight, burned skin surface and VTE risk. Also, severity of the 2 groups was comparable regarding: smoke inhalation (p=0.46), use of mechanical ventilation (p=0.22), use of catecholamines within 48 hours (p=0.56) and rescue incision (p=0.77). In the equation group, initial dose of enoxaparin was 0.42± 0.12 mg. Target anti Xa was reached at the 1st dosage in 55 patients 55 (50.9%). The median final dose of enoxaparin required to reach the anti Xa target was 52 mg every 12 hours (range, 35-69 mg). No episodes of bleeding, thrombocytopenia, or heparin allergy were documented in either group. The incidence of VTE complications was higher in group 2 than in group 1 (8.3% versus 3.7%; p=0.001 with an OR=1.6 and CI [0.47-1.03]). The length of stay was longer for G2 with a significant difference (30 days vs 22 days; p=0.001). Mortality was the same for two groups. Conclusion: Optimizing thromboprophylaxis in severely burned patients with enoxaparin, using the enoxaparin dosing eqauation allows to achieve prophylactic anti-Xa level and to reduce risk of VTE complications.

Drug-induced acute pancreatitis (AP) associated with tigecycline (TGC) is considered a rare complication (incidence between 1‰ and 1%). In this paper, we report five cases of AP occurring after the administration of TGC in septic patients hospitalized in intensive burn care in Tunisia over 9 years. The diagnosis of AP was based on clinical and/or biological signs. Among 303 cases treated with TGC, AP occurred with an incidence of 1.65%. The mean age was 28±6 years. Only one patient had a history of chronic alcoholism. The prescribed dose was 200 mg as a loading dose, followed by 100 mg twice a day. The time to onset of symptoms after initiation of TGC was 5.4 days [2-7]. PA was suspected due to abdominal pain associated with nausea and vomiting (n=2), occlusive syndrome (n=1) and fortuitously increased pancreatic enzymes in 2 patients under mechanical ventilation. The mean lipase level at diagnosis was 447 IU ± 135 IU (4.5 to 10 times the normal). All the aetiologies of AP were ruled out, including gallstones, hypercalcemia, hypertriglyceridemia, trauma and infections. The mean time to symptom resolution after stopping TGC was 4±2 days [5-7] and to the normalization of pancreatic enzymes it was 9 days [2-20 days]. In conclusion, clinical and biological monitoring was necessary in patients treated with TGC in order to avoid severe forms, especially in at-risk patients.

The goal of this study was to assess plasma procalcitonin (PCT) concentrations during infectious events of burns in the ICU. We conducted a prospective, observational study in a 20-bed Burn Intensive Care Unit in Tunisia. A total of 120 septic patients admitted to the Burn ICU were included in our study. Sepsis was assumed according to the French Burn Association criteria for the presence of infection. Serum PCT was measured over the entire septic episode every 48 hours until resolution of infection, based on clinical signs and decrease of PCT of about 80% compared to its initial value. Patients were assigned to two groups depending on clinical course and outcome: Group A = patients with favourable evolution; Group B = patients with unfavourable evolution. Monitoring of kinetics of PCT allowed us to judge the effectiveness of the initial antibiotic therapy, with a threshold of 43.5% decrease at day 3 of treatment, with a better sensitivity and specificity of 79.6% and 87.7% respectively. In addition, PCT monitoring allowed a reduction in the duration of antibiotic therapy of 5±2.8 days versus 8 to 10 days before the use of PCT.

Self-immolation is a violent way of committing suicide. Few studies have focused on this phenomenon in children. The aim of this study was to determine the epidemiological profile of children who committed suicide by fire. A retrospective descriptive study was conducted in an intensive burn care department in Tunis, over a period of 10 years (2011-2020). Of a total 3077 patients, 761 were admitted for burns by suicide attempt, among them 62 children and adolescents (8%). The number was on average six per year. The highest annual prevalence was noted in 2011 (27% of cases). The mean age was 16 and a half years old. The majority of cases were adolescents aged 15 or older. There is a male predominance (sex ratio:3). Total burn surface area (TBSA) was on average 44%. The act of self-immolation occurred in public places in 58% of cases. Socio-economic environment was unfavorable in 60% of cases. The suicidal act of self-immolation was due to a family conflict in 34% of cases (n=21). Seven patients (11%) had a history of mental illness. Forty-three patients (70%) required mechanical ventilation. The length of hospital stay was on average 30 days. The mortality rate was 56.5%. In conclusion, self-immolation is frequent in the pediatric population; it induces severe burns associated with a poor prognosis.

Ocular lesions in burns are common and diagnosis is often late, leading to functional impairment including loss of vision to these individuals. A retrospective study was conducted to assess ocular lesions in burns during ICU stay (01/01/2013 to 30/09/2020) in a 20-bed burn ICU in Tunis. Twenty-six cases combining burns and ocular lesions were reviewed. The average age was 26, with a sex-ratio 3.3/1. TBSA was 22±13%. Face was affected in 23 patients, and mechanical ventilation was required in 10 cases. Diagnosis of ocular lesion was noted at 4.5 H (1-33 H) after burn injury. Main clinical signs were: eye redness (n=5) and purulent eye discharge (n=5). Lesions were mainly corneal abscess and corneal ulcer. Treatment combined local antibiotics (n=16) associated to systemic antibiotics in 10 cases. Surgery was required in 2 cases. Loss of vision was noted in 2 patients. Risk factors of corneal abscess were: facial burn (p=0,01); burn depth (p=0,02) and mechanical ventilation (p=0,04).

Hypernatremia is associated with poor outcomes in critically ill patients. Hypernatremia risk factors in burned patients are not well studied. We aimed to identify hypernatremia risk factors and to evaluate outcomes in burned patients admitted to our burns intensive care unit. A case control study was conducted in adult burned patients hospitalized between January 1st 2017 and December 31st 2019. Cases who developed hypernatremia (>145 meq/L) during hospitalization were matched 1:1 with controls based on age and total burn surface area. There were 57 cases and 57 controls with a mean age of 41 ± 18 years. The majority of patients had major burns (n=99, 86.8%). The time onset of hypernatremia was seven days post burn. Compared to controls, the case group mostly consisted of transferred patients with longer time from injury to intensive care unit admission. Inhalation injury, mechanical ventilation, intravenous fosfomycin and colistin were associated with hypernatremia. Admission to the intensive care unit after six hours post-burn was the independent risk factor (OR=4.5). Hypernatremia was associated with longer length of stay and with higher mortality. We conclude that delayed management, inhalation injury, mechanical ventilation, fosfomycin and colistin administration are the main hypernatremia risk factors in burned patients.

Nosocomial bacteremia (NB) is one of the most severe infections in burns in intensive care units. Their prognosis is worsened with the emergence and spread of multidrug resistant bacteria (MDR). Our retrospective study aimed to investigate clinical and bacteriological characteristics of NB occurring in patients hospitalized in the Trauma and Burn Center's Burn Unit (TBC-BU) in Tunisia, during a 3-year period (2016-2018). We found 261 NB in 216 patients, for a prevalence of 25.7% and an incidence density of 13.4‰ days of in-patient stay. The vast majority (88.9%) of NB occurred during the first 2 weeks of hospitalization. The catheterrelated bacteremia rate was 11.1%. P. æruginosa (20.2%) and A. baumannii (16.8%) were the 2 species most frequently isolated when S. aureus represented only 7.5% of isolates. Resistance rates were high, with 71% of P. æruginosa resistant to ceftazidime, 64% of S. aureus being MRSA, 69,5% of resistance to 3rd generation cephalosporins among Enterobacteriaceae, and colimycin remaining the only regularly active antibiotic (98%) on A. baumannii. The MDR rate was 44%, represented mainly by A. baumannii, ESBL-E and P. æruginosa. The mortality rate due to NB was 25%, with a significantly higher rate of MDR in fatal NB compared to that in NB with favorable outcome (p = 0,000019).

Patients with epilepsy are a high-risk population for severe burns. A retrospective study was conducted to assess burns during epileptic seizure in epileptic patients. The study was conducted in a 20- bed burn ICU in Tunis over the period 01/01/2011 to 30/06/2019. Fifty cases combining burns and epilepsy were reviewed. Twenty patients (11 women and 9 men, sex-ratio 0.6) suffering a burn following an epileptic seizure were included. The average age was 46. Epileptic disease was uncontrolled in 75% of our patients and 35% were not receiving any antiepileptic treatment. Burns were related to domestic accident in 95% of cases, 2/3 of which were related to a fall on a brazier. Lesions were deep in 70% of cases, requiring excision of necrotic tissue. Only two patients benefited from a dermal-epidermal graft. Amputation was necessary in 5 patients. Mortality was 25%, related to refractory septic shock.

Chemical burns are rare but have specific diagnosis and treatment characteristics. We present a retrospective study among the 123 patients treated in the Tunis Burns Unit during the year 2018. They were young (36.4 years), active men (69%). Most (51%) burns were work-related. Only fiftyseven patients had their burn immediately washed, and time to the first specialized examination was 3.7 days. Burned surface was low, frequently involving the hands. The majority of patients (121/123) did not need surgery and the treatment length was 20 days, resulting in aesthetic or functional disability in 46.3% of the cases. It seems that information and prevention measures are lacking, despite the fact they are the best means to reduce the incidence of chemical burns, which have high individual and collective costs. If a chemical burn occurs, it should be copiously washed, and the victim should be urgently examined by a burn specialist.

Tracheal stenosis remains frequent, especially in intensive care patients requiring prolonged intubation or tracheotomy. There is little data in the literature regarding this complication in burn patients. The aim of our study was to determine incidence, characteristics and risk factors of tracheal stenosis in burn patients. A retrospective study was conducted in a 20-bed burn ICU in Tunis over 7 years. It included all patients who presented tracheal stenosis confirmed by endoscopic and/or radiological exploration. Tracheal stenosis was confirmed in 15 patients with an overall incidence of 0.8% and an incidence of 3.5% in intubated patients. The mean age was 24 years, with TBSA of 28±15%. The burn was thermal in all patients. Facial burn was noted in all patients. Inhalation syndrome was observed in 12 patients. Duration of intubation was 16±12 days. Dyspnea, stridor and dysphonia were the most common symptoms. The onset of clinical signs was 30 days on average after extubation. All patients underwent bronchoscopy and/or cervico-thoracic scan for diagnosis. The average distance between the stenosis and vocal cords was 27 mm and the average degree of stenosis was 68%. The average length was 20 mm. Therapeutic management was based on: dilation in 3 cases, Montgomery tracheal T-tube insertion in 2 cases, and endoscopic laser therapy in 3 cases. Tracheal resection-anastomosis was performed in 5 patients. The evolution was favorable in 8 patients. Restenosis was observed in 2 patients. Five patients died. Inhalation injury, facial burn and prolonged intubation were recognized as risk factors that increase the likelihood of this complication.