Incidence of risk factors for bloodstream infections in patients with major burns receiving intensive care: A retrospective single-center cohort study

Burns. 2018 Jun;44(4):784-792. doi: 10.1016/j.burns.2017.12.009. Epub 2018 Feb 1.

Abstract

Objectives: The objective was primarily to identify risk factors for bloodstream infections (BSI) caused by different pathogens.

Methods: A retrospective single-center cohort study was performed on 472 burn patients with an abbreviated burn severity index (ABSI)≥3, a total burn surface area (TBSA)≥10%, and an ICU stay of at least 24h. Risk factors for different BSI pathogens were analyzed by competing risks regression model of Fine and Gray.

Results: A total of 114 burn patients developed 171 episodes of BSIs caused by gram-negative bacteria (n=78;46%), gram-positive bacteria (n=69;40%), and fungi (n=24;14%) median after 14days (range, 1-164), 16days (range, 1-170), and 16days (range, 0-89), respectively. A total of 24/114 patients (21%) had fatal outcomes. Isolation of the most common bloodstream isolates Enterococcus sp. (n=26), followed by Candida sp. and Pseudomonas sp. (n=22 for both) was significantly associated with increased TBSA (p≤0.006) and ABSI (p<0.0001) and need for fasciotomy (p<0.01). The death risk of patients with MDR gram-negative bacteremia was significantly increased by a hazard ratio of 12.6 (95% CI:4.8-32.8; p<0.0001).

Conclusions: A greater TBSA and ABSI were associated with a significantly higher incidence of BSIs caused by Pseudomonas sp., Enterococcus sp. and Candida sp.

Keywords: Bloodstream infections among burn patients; Burn patients and septic complications; Multidrug resistant bacteria; Severe burn injury; Thermal injury.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bacteremia / epidemiology*
  • Bacteremia / mortality
  • Body Surface Area
  • Burn Units
  • Burns / epidemiology*
  • Candidiasis / epidemiology*
  • Candidiasis / mortality
  • Child
  • Cohort Studies
  • Critical Care
  • Drug Resistance, Multiple, Bacterial
  • Enterococcus
  • Female
  • Fungemia / epidemiology*
  • Fungemia / mortality
  • Gram-Positive Bacterial Infections / epidemiology*
  • Gram-Positive Bacterial Infections / mortality
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Pseudomonas Infections / epidemiology*
  • Pseudomonas Infections / mortality
  • Retrospective Studies
  • Risk Factors
  • Trauma Severity Indices
  • Young Adult