To determine the characteristics of bloodstream infections (BSIs) and to evaluate the impact of BSIs on mortality in severe burn patients” Tang et al (2017).
OBJECTIVES: To determine the characteristics of bloodstream infections (BSIs) and to evaluate the impact of BSIs on mortality in severe burn patients.
METHODS: A retrospective observational study was conducted in 20 tertiary hospitals. A total of 185 Patients who experienced a massive dust explosion in eastern China were included.
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RESULTS: After exclusion, 177 patients were analyzed. The median total body surface area (TBSA) burned was 95% (interquartile range [IQR], 85%-98%). Inhalation injuries occurred in 97.2%. The overall 90-day mortality was 35% (62/177). During the study period, 120 (67.8%) patients developed 253 episodes of BSI with 323 unique causative pathogens. Sixty-six episodes were polymicrobial infections. Catheter-related BSIs (CRBSIs) accounted for 41.5% of the episodes. Acinetobacter baumannii (19.5%), Klebsiella pneumoniae (13.9%), and Candida (12.7%) were the most common organisms. Sixty-three point five percent of the isolates were antimicrobial resistant, particularly in gram-negative bacteria. Patients who developed BSIs had a greater illness severity at ICU admission, and worse outcomes. After adjusting for demographics, severity of illness, and treatment characteristics in a multivariate logistic model, there was a trend toward BSI increasing the risk of 90-day mortality (adjusted OR 3.4; 95%CI 0.9-12.9; p=0.069). In subgroup analyses, CRBSI (adjusted OR 5.7; 95%CI 1.3-24.9; p=0.021 vs. no BSI) and polymicrobial BSIs (adjusted OR 6.1; 95%CI 1.3-28.1; p=0.020 vs. no BSI) had greater risk of 90-day mortality.
CONCLUSIONS: A strikingly high rate of BSIs was observed in severe burn patients. Gram-negative organisms and fungi were the leading causes. CRBSIs and polymicrobial BSIs were associated with high mortality.
Tang, C., Li, J., Shou, B., Pan, B., Chen, T., Xiao, Y., Zheng, X., Xiao, S., Tan, Q. and Xia, Z. (2017) Epidemiology and Outcomes of Bloodstream Infections in 177 Severe Burn Patients from an Industrial Disaster: A Multicenter Retrospective Study. Clinical Microbiology and Infection. June 19th. [epub ahead of print].
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