Pseudomonas aeruginosa Bacteremia After Burn Injury

Abstract

To evaluate the clinical impact of multiple-drug resistance in burn patients with Pseudomonas aeruginosa (Pa) bacteremia. A retrospective cohort study in a 10-bed burn intensive care unit (BICU) was performed. Univariate and multivariate analyses were used to analyze the influence of multiple-drug resistance on mortality and length of BICU stay in Pa bacteremic patients. During a 21-year study period (1989-2009), 87 patients with Pa bacteremia were identified; 45 patients had multiple-drug resistant (MDR) strains and 42 susceptible strains. On comparison of the two populations, one with multiple-drug resistant strains and the other with the susceptible strains, the following parameters were found to be significantly different in the univariate analysis: age (32.7 vs 43.6 years; P = .013), sex (males: 91.1 vs 66.7%; P = .005), intubation status on admission (75.6 vs. 54.8%; P = .041), escharotomy (57.8 vs 33.3%; P = .022), burn size (51.0 vs 35.3% of TBSA; P = .002) and Abbreviated Burn Severity Index score (9.2 vs 8.1; P = .048). In terms of outcome parameters, multiple-drug resistance was not significantly related to mortality (adjusted odds ratio 1.076; 95% confidence interval [CI] 0.356-3.254; P = .897) and length of BICU stay after Pa bacteremia (Kaplan-Meier analysis log-rank test P = .945; Cox's proportional hazards regression hazards ratio, 0.994; 95% CI 0.513-1.925; P = .985) in the univariate and multivariate analyses. The data from this study suggest that multiple-drug resistance is not associated with significant increases in mortality and length of BICU stay among burn patients with Pa bacteremia.

Colonization with Multidrug‐Resistant Enterobacteriaceae is Associated with Increased Mortality Following Burn Injury in Sub‐Saharan Africa

“…Furthermore, the literature is equivocal on the relationship between MDR bacterial colonization and burn-associated mortality. [34,35] While our study did not show burn wound colonization progressing to systemic infection, we clearly demonstrated an association between MDR Enterobacteriaceae colonization and mortality after adjusting for relevant confounders in our patient population. Increased mortality may result from a failure to recognize the progression from wound colonization to invasive disease or from inappropriate empirical antimicrobial therapy, which can lead to eventual sepsis, multi-organ failure, and death.…”

Multiple-Drug Resistance in Burn Patients

“…Theodorou et al 17 conducted a similar study to our own. Their main goal was to investigate the role of resistance of P. aeruginosa on survival and length of stay.…”

“…Several studies have sought to identify the most common multiple-drug resistant pathogens, 17–20 but the impact of MDROs on survival and other outcome parameters remains unclear. In our study, we aimed to shed some light on this issue by examining 126 burn patients with infections who were admitted to our burn unit.…”

“…Several studies have been performed in multiple countries to identify the most frequently occurring multiple-drug resistant organisms (MDROs) in specific burn units. Pseudomonas aeruginosa , 17–19 Staphylococcus aureus , 17,19 and Acinetobacter baumannii 13,20 are among the most frequently cultured sources of infection in burn patients. These pathogens are often resistant to many of the antimicrobial treatments we use today, and there are very few new antimicrobial agents being developed.…”

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

“… 20 – 24 Several studies failed to demonstrate that infections with MDR pathogens are independently associated with an increased risk of mortality. 18 , 25 , 26 However, these studies showed conflicting results about secondary clinical outcomes, such as length of hospital stay.…”