Pathogenic Characteristics and Risk Factors for ESKAPE Pathogens Infection in Burn Patients

Zhaoyinqian Li; Jingling Xie; Jiaxin Yang; Siyi Liu; Zixuan Ding; Jingchen Hao; Yinhuan Ding; Zhangrui Zeng; Jinbo Liu

doi:10.2147/IDR.S338627

Pathogenic Characteristics and Risk Factors for ESKAPE Pathogens Infection in Burn Patients

Infect Drug Resist. 2021 Nov 12:14:4727-4738. doi: 10.2147/IDR.S338627. eCollection 2021.

Authors

Affiliation

¹ Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China.

^# Contributed equally.

Abstract

Objective: This study aimed to determine the clinical manifestations, antimicrobial resistance, molecular characteristics, and risk factors for ESKAPE pathogens infection in burn patients.

Methods: A retrospective study of 187 burn patients infected with ESKAPE pathogens was conducted at the Department of Plastic and Burn Surgery of the Affiliated Hospital of Southwest Medical University (Luzhou, China) from October 2018 to June 2021. All strains were identified using a MicroScan WalkAway 96 Plus System, and antimicrobial susceptibilities were determined using the VITEK system or the disk diffusion method. The antimicrobial resistance genes of multi-drug resistant ESKAPE (MDR-ESKAPE) were detected by polymerase chain reaction (PCR). The multivariable logistic regression analysis was used to estimate the risk factors for ESKAPE infection and MDR-ESKAPE infection.

Results: A total of 255 strains were isolated in various types of clinical specimens from 187 burn patients, of which 47.5% were ESKAPE pathogens (121/255). Among these, MDR-ESKAPE pathogens accounted for 55% (67/121). Additionally, aph3'III, mecA, bla _SHV, bla _TEM, bla _PDC, and bla _SHV were the most prevalent genes detected in Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp., respectively. The independent risk factors for ESKAPE infection were total body surface area (TBSA) >30-50% (odds ratio [OR] = 10.428; 95% confidence interval [CI], 2.047 to 53.108), TBSA >50% (OR = 15.534; 95% CI, 1.489 to 162.021), and parenteral nutrition (OR = 3.597; 95% CI, 1.098 to 11.787). No independent risk factors were found for MDR-ESKAPE infection.

Conclusion: Clinical staff should be alert to the risk of nosocomial infection with ESKAPE pathogens in burn patients receiving parenteral nutrition and under TBSA >30%. Full attention should also be paid to the ESKAPE resistance, strict adherence to infection control protocols for the rational use of antimicrobial agents, and enhanced clinical standardization of antimicrobial agents management.

Keywords: ESKAPE pathogens infection; antimicrobial resistance; burn; risk factors.

Grants and funding

This work was supported by the grants from Sichuan Science and Technology Program (2021YFS0329, 0QYCX0056), Southwest Medical University Science Program (2020ZRQNB025), and Luxian Government and Southwest Medical University Cooperation Program (2020LXXNYKD-04).