Mortality incidence among critically ill burn patients infected with multidrug-resistant organisms: A retrospective cohort study

Moustafa Ellithy; Hassan Mitwally; Mohamed Saad; Ranjan Mathias; Adila Shaukat; Hani Elzeer; Sunil Hassan Koya; Zia Mahmood; Khaled Gazwi

doi:10.1177/20595131211015133

Mortality incidence among critically ill burn patients infected with multidrug-resistant organisms: A retrospective cohort study

Scars Burn Heal. 2021 May 25:7:20595131211015133. doi: 10.1177/20595131211015133. eCollection 2021 Jan-Dec.

Authors

Moustafa Ellithy¹, Hassan Mitwally², Mohamed Saad², Ranjan Mathias³, Adila Shaukat⁴, Hani Elzeer⁵, Sunil Hassan Koya⁵, Zia Mahmood⁶, Khaled Gazwi⁵

Affiliations

¹ Department of Critical Care, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar.
² Department of Pharmacy, Al-Wakra-Hospital, Hamad Medical Corporation, Doha, Qatar.
³ Department of Anesthesiology/Critical Care, Al-Wakra-Hospital, Hamad Medical Corporation, Doha, Qatar.
⁴ Department of Medicine-Infectious Diseases, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
⁵ Critical Care Departement, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
⁶ Department of Anesthesiology/Critical Care, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.

Abstract

Introduction: Many risk factors have been reported to increase mortality among burn patients. Previously, a higher mortality incidence was reported in acute burn patients infected with multidrug-resistant organisms (MDROs) when compared to patients infected with non-MDROs. However, considering this as an independent risk factor for mortality in acute burn patients is not yet confirmed.

Methods: We conducted an observational retrospective study in Qatar. We included adult patients admitted to the surgical intensive care unit (ICU) between January 2015 and December 2017 with burn injuries involving either at least 15% of the total body surface area (TBSA) or less than 15% with facial involvement. All patients developed infection with a positive culture of either MDRO or non-MDRO. The primary outcome was in-hospital mortality. Other outcomes included days of mechanical ventilation, ICU, length of stay in hospital, and requirement of vasoactive agents.

Results: Fifty-eight patients were included in the final analysis: 33 patients in the MDRO group and 25 patients in the non-MDRO group. Six patients (18.2%) died in the MDRO group versus four patients (16%) in the non-MDRO group (P = 1). No significant difference was observed between the two groups with regard to the ICU length of stay. However, there was a trend towards increased median length of stay in hospital in the MDRO group: 62 days versus 45 days in the non-MDRO group (P = 0.057). No significant differences were observed in the other outcomes.

Conclusion: In severely burned patients, infection with MDRO was not associated with increased mortality. There was a trend towards increased hospitalisation in MDRO-infected patients. Further studies with a larger sample size are needed to confirm these results.

Lay summary: Many factors affect mortality in burn patients admitted to the intensive care unit, such as age, total body surface area involved in the injury, and others. In this retrospective study, we evaluated whether wound infection with a bacterial organism resistant to multiple classes of antibiotics (multidrug-resistant) is considered an independent risk factor for mortality in critically ill burn patients. We included 58 patients requiring intensive care admission with burn injuries involving 15% or more of the total body surface area or less than 15% but with facial involvement. A total of 33 patients were infected with multidrug-resistant organisms (MDROs) and 25 patients with non-MDROs. Six patients (18.2%) from the MDRO group died versus four (16%) in the non-MDRO group. The MDRO group required a longer stay in hospital and an average of one more day on a mechanical ventilator. We concluded that wound infection with MDROs might not increase mortality when compared to wound infection with non-MDROs, although other studies with a larger number of patients involved need to be conducted to validate these results.

Keywords: Burns; infection; intensive care unit; mortality; multidrug resistance.