Timeline of health care–associated infections and pathogens after burn injuries

Duin, David van; Strassle, Paula D.; DiBiase, Lauren; Lachiewicz, Anne; Rutala, William A.; Eitas, Timothy K.; Maile, Robert; Kanamori, Hajime; Weber, David J.; Cairns, Bruce A.; Napravnik, Sonia; Jones, Samuel

doi:10.1016/j.ajic.2016.07.027

Cited by 72 publications

(70 citation statements)

References 32 publications

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“…In contrast, after 1 week of hospitalization, drug-resistant Gram-negative species predominate; e.g., the colonization rates for carbapenem-resistant Enterobacteriaceae increased from 0.004 in week 1 to 0.82 in week 4. Likewise, P. aeruginosa increased from 0.04 to 1.85 , while isolation rates of both P. aeruginosa and K. pneumoniae increased from 1.27 to 2.26 ( P <0.001 for all) [4]. In our study, Gram-negative bacteria were detected in the fourth week, with the presence of P. aeruginosa and K. pneumoniae in the blood stream.…”

Section: Discussionsupporting

confidence: 47%

New Delhi Metallo-Beta-Lactamase (NDM-1)-Producing Klebsiella Pneumoniae Isolated from a Burned Patient

et al. 2017

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Patient: Male, 32Final Diagnosis: NDM-1-producing Klebsiella pneumoniae • bacteremiaSymptoms: FeverMedication: —Clinical Procedure: NoneSpecialty: Infectious DiseasesObjective:Diagnostic/therapeutic accidentsBackground:Infections affecting burn patients are frequently caused by Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae species. Infections with these pathogens have become increasingly difficult to treat due to evolving antibiotic resistance mechanisms, including the production of carbapenemases.Case Report:The present case report describes the evolution of a burn patient with polymicrobial healthcare-associated burn infections, including a bloodstream infection due to an emergent multidrug-resistant New Delhi metallo-beta-lactamase (NDM-1)-producing Klebsiella pneumoniae. During hospitalization, initial antibiotic treatment eradicated some of the infecting species. Newer isolates were found to be multidrug-resistant and required unique antibiotic combinations. The patient’s condition continued to deteriorate after the isolation of multidrug-resistant P. aeruginosa and NDM-1-positive K. pneumoniae from the blood.Conclusions:This case report illustrates the need for adequate antibiotic therapies in burn patients with subsequent infections due to a carbapenemase-producing multidrug-resistant bacteria. The potential danger of new bacterial pathogens should be considered in this group of susceptible patients.

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Section: Discussionsupporting

confidence: 47%

New Delhi Metallo-Beta-Lactamase (NDM-1)-Producing Klebsiella Pneumoniae Isolated from a Burned Patient

et al. 2017

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“…20–23 Patients tend to start off being colonized with more susceptible Gram-positive organisms early in their hospitalization, whereas after some time in the burn unit, multidrug resistant (MDR) gram-negative bacteria including Pseudomonas aeruginosa tend to predominate. 20 In our hospital, almost half of the pathogens colonizing burn patients were MDR organisms, and the rates of MDR infections increased the longer a patient was hospitalized. Furthermore, the rate of catheter-associated bloodstream infection (CLABSI) has decreased over the past decade, likely due to a bundled intervention introduced to the unit.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously described the timeline of HAIs and pathogens among patients with burn injuries, as well as temporal trends in HAIs in our burn unit 20 23 Patients tend to start off being colonized with more susceptible Gram-positive organisms early in their hospitalization, whereas after some time in the burn unit, multidrug resistant (MDR) gram-negative bacteria including Pseudomonas aeruginosa tend to predominate 20 . In our hospital, almost half of the pathogens colonizing burn patients were MDR organisms, and the rates of MDR infections increased the longer a patient was hospitalized.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Healthcare-Associated Infections in Adult Burn Patients

Strassle

Williams

Weber

et al. 2017

Infect. Control Hosp. Epidemiol.

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Objective Burn patients are particularly vulnerable to infection, and an estimated half of all burn deaths are due to infections. This study explored risk factors for healthcare-associated infections (HAIs) in adult burn patients. Design Retrospective cohort study. Setting Tertiary-care burn center. Patients Adults (≥18 years old) admitted with burn injury for at least 2 days between 2004 and 2013. Methods HAIs were determined in real-time by infection preventionists using Centers for Disease Control and Prevention criteria. Multivariable Cox proportional hazards regression was used to estimate the direct effect of each risk factor on time to HAI, with inverse probability of censor weights to address potentially informative censoring. Effect measure modification by burn size was also assessed. Results Overall, 4,426 patients met inclusion criteria, and 349 (7.9%) patients had at least 1 HAI within 60 days of admission. Compared to <5% total body surface area (TBSA), patients with 5%–10% TBSA were almost 3 times as likely to acquire an HAI (hazard ratio [HR], 2.92; 95% CI, 1.63–5.23); patients with 10%–20% TBSA were >6 times as likely to acquire an HAI (HR, 6.38; 95% CI, 3.64–11.17); and patients with >20% TBSA were >10 times as likely to acquire an HAI (HR, 10.33; 95% CI, 5.74–18.60). Patients with inhalational injury were 1.5 times as likely to acquire an HAI (HR, 1.61; 95% CI, 1.17–2.22). The effect of inhalational injury (P = .09) appeared to be larger among patients with ≤20% TBSA. Conclusions Larger burns and inhalational injury were associated with increased incidence of HAIs. Future research should use these risk factors to identify potential interventions.

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“…This rate is higher than that of the study of Van Duin and his colleagues who identified a rate of 1.78/1000 patient days. 13 However, another comprehensive study of the epidemiology of burn infection showed that the rate among patients with TBSA >30% exceeds 5/1000 patient days. 14 It is worth to mention that our setting is the only referral center for burn patients in the state of Kuwait, so any age group or degree of burn, type of burn injury or TBSA will be receiving management in our setting.…”

Section: Discussionmentioning

confidence: 99%

“…15,20 Van Duin and his colleagues reported that half of the patients who spend 80 days from admission will experience at least one HAI. 13 Also Coetzee et al reported that the risk of wound infection increases by time. 21 Burn wounds are known to be good media for bacterial growth, and colonization occurs shortly after the injury as virulent microorganism strains invade the skin and soft tissue; as the host defense is weak, an increase in the number of microorganisms will be able to reach the venous system to cause infection.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and distribution of MDROs among patients with healthcare associated burn wound infection

ALfadli¹,

El-Sehsah²,

Ramadan³

2018

Germs

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Introduction Patients with burn wounds are more susceptible to develop healthcare associated (HA) infection. Bacterial isolates from HA burn wound infection vary from one place to the other and also differ in terms of antimicrobial susceptibility pattern. The aim of our study was to assess the incidence of HA burn wound infection, risk factors and to determine the microbiological profile and antimicrobial susceptibility pattern of isolated pathogens. Methods This was a one-year retrospective descriptive study conducted between January 2017 and December 2017, in Al-Babtain Burn and Plastic Surgery center, Kuwait. The identification of bacterial isolates was conducted by conventional biochemical methods according to standard microbiological techniques and commercially available kits using analytical profile index procedure. Results Total body surface area >35% affected and length of stay more than 14 days were statistically significant risk factors for HA burn infection (RR of 10.057 and 5.912, respectively). Analysis of microbiological profile of these positive cultures indicated that the most common isolated organism was Acinetobacter baumannii followed by Klebsiella pneumoniae. Multidrug resistant organisms composed 65.85% of the positive isolates. Vancomycin, tigecycline, teicoplanin and linezolid showed 100% effectiveness for all Gram positive isolates. For Gram negative organisms, imipenem and meropenem showed 38.71% and 41.93% efficacy, respectively. Conclusion Identification of antimicrobial susceptibility patterns helps to tailor the required antibiotic policy to minimize the acquired infections among these vulnerable patients.

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Timeline of health care–associated infections and pathogens after burn injuries

Cited by 72 publications

References 32 publications

New Delhi Metallo-Beta-Lactamase (NDM-1)-Producing Klebsiella Pneumoniae Isolated from a Burned Patient

New Delhi Metallo-Beta-Lactamase (NDM-1)-Producing Klebsiella Pneumoniae Isolated from a Burned Patient

Risk Factors for Healthcare-Associated Infections in Adult Burn Patients

Risk factors and distribution of MDROs among patients with healthcare associated burn wound infection

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