Epidemiology and outcomes of bloodstream infections in severe burn patients: a six-year retrospective study

Hu, Yangmin; Li, Danyang; Xu, Lei; Hu, Yuping; Sang, Yiwen; Zhang, Gensheng; Dai, Haibin

doi:10.1186/s13756-021-00969-w

Cited by 21 publications

(17 citation statements)

References 28 publications

(35 reference statements)

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“…Our study found that the median time from the burn incident to BSI onset was 32 days and that 84.4% of BSIs occurred after 2 weeks. This finding was different from past studies that reported that the median time from the burn incident to BSI onset was 7 days 4 or 8 days, 12 probably because early aggressive excision of the eschar was performed in our burn center within 2 weeks after the burn. Excising the eschar and covering the wound as early as possible is crucial for infection control in burn patients, 13 and total debridement should be completed within 2 weeks at the latest in our burn center.…”

Section: Discussioncontrasting

confidence: 99%

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Epidemiology of bloodstream infections and surface swab cultures in burn patients

Kaita

Otsu

Tanaka

et al. 2022

Acute Medicine & Surgery

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Aim For infection control in burn patients, it is essential to understand the epidemiology of bloodstream infection (BSI) and the local microbiological situation. There are few studies on blood and swab culture results among burn patients in Japan. The purpose of this study was to investigate the epidemiology of BSI and swab cultures in burn patients. Methods Data from 355 burn patients over 13 years from 2008 were analyzed retrospectively. Bloodstream infection was defined as the isolation of bacteria or fungi from two or more blood cultures. The characteristics of burn patients and microorganisms detected from various cultures were analyzed. Results The mortality rate among burn patients with BSI was 37.8%, which was more than twice that among burn patients without BSI. The univariate analysis showed that inhalation injury, total burn surface area (TBSA), and mortality were associated with BSI. The multivariate logistic analysis indicated that TBSA was an independent risk factor for BSI. The most frequently isolated organism from blood and swab cultures were Candida species and Pseudomonas aeruginosa, respectively. Seventy‐five percent of the microorganisms isolated from blood were detected previously in swab cultures performed within 1 week from blood cultures. Conclusions The prognosis of burn patients with BSI was poor, and TBSA was an independent risk factor for BSI. The predominant organisms isolated from blood and swab cultures were Candida species and P. aeruginosa, respectively. Surveillance wound swab cultures could be utilized for monitoring the local microbiological situation in burn patients.

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Section: Discussioncontrasting

confidence: 99%

“…These findings were consistent with the results of previous similar reports. 12 Thus, we should be cognizant of poor BSI outcomes, and that the risk of BSI increases with higher TBSA in burn patients.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of bloodstream infections and surface swab cultures in burn patients

Kaita

Otsu

Tanaka

et al. 2022

Acute Medicine & Surgery

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“…The results of the multivariate analysis indicated that MODS and septic shock were closely associated with poor outcomes in immunosuppressed patients with CRGNB-BSI, indicating that the severity of the patient’s disease was closely related to death, which was consistent with some previous studies. 5 , 16 , 21 , 36 In this study, gastrointestinal bleeding often indicated a poor prognosis. A study by Amy et al showed that gastrointestinal bleeding had a negative impact on the short-term survival of patients with BSI.…”

Section: Discussionmentioning

confidence: 77%

“…However, those studies were conducted in certain groups of immunosuppressed patients or for specific microbial infections in different types of immunosuppression. 1,[16][17][18][19] Studies related to CRGNB-BSI in the overall immunosuppressed population are still scarce. This study evaluated the clinical characteristics of immunosuppressed patients with CRGNB-BSI and investigated the prognostic factors in immunosuppression status for the overall population and different subgroups.…”

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confidence: 99%

Prognostic Risk Factors of Carbapenem-Resistant Gram-Negative Bacteria Bloodstream Infection in Immunosuppressed Patients: A 7-Year Retrospective Cohort Study

Gao¹,

Xu²,

Yao³

et al. 2022

IDR

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Purpose Carbapenem-resistant Gram-negative bacteria bloodstream infection (CRGNB-BSI) has gradually become a major threat worldwide due to its treatment difficulty and high mortality. This study aimed to determine the risk factors for CRGNB-BSI in immunosuppressed patients. Patients and Methods A total of 427 immunosuppressed patients with CRGNB-BSI were retrospectively investigated from 2015 to 2021. Both univariate and multivariate logistic regression analyses were applied to evaluate independent risk factors for CRGNB-BSI. Results The most common etiology was Klebsiella Pneumoniae (50.59%; 216/427), while the Acinetobacillus baumannii infection was associated with the highest mortality (58.25%) among all etiologies. The 60-day mortality of immunosuppressed patients with CRGNB-BSI was 52.48% (224/427). Procalcitonin (PCT) > 0.5 μg/L (OR = 2.32, 95% CI: 1.28–4.19, P = 0.005) and age > 55 years (OR = 2.06, 95% CI: 1.17–3.64, P = 0.012) were found to be predictors of 60-day mortality of CRGNB-BSI, and tigecycline regimen (OR = 3.20, 95% CI: 1.81–5.67, P < 0.001) was associated with higher mortality. Multivariate analysis also revealed that patients who developed acute kidney injury (AKI) (OR = 2.19, 95% CI: 1.11–4.30, P = 0.023), gastrointestinal bleeding (OR = 3.18, 95% CI: 1.10–9.16, P = 0.032), multiple organ dysfunction syndrome (MODS) (OR = 12.11, 95% CI: 2.61–56.19, P = 0.001), and septic shock (OR = 3.24, 95% CI: 1.77–5.94, P < 0.001) showed worse outcomes. The risk factors were also significantly associated with mortality in the different subgroups. Conclusion This study demonstrated that PCT > 0.5 μg/L, age > 55 years, and the tigecycline regimen were significantly associated with higher 60-day mortality among immunosuppressed patients with CRGNB- BSI. Patients developing MODS, septic shock, or AKI had worse clinical outcomes.

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“…The risk factors related to death of burn patients are mainly age, burn severity, inhalation injury and nutrition [6][7][8][9]. Some studies have shown that clinicians include in ammatory indicators in early sepsis diagnosis [10,11].…”

Section: Introductionmentioning

confidence: 99%

Predictive value of perioperative monocyte counts for bacteremia and 90-day all-cause mortality in patients with severe burn

Chen

et al. 2022

Preprint

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Objective To explore the predictive value of changes in monocytes (M), lymphocytes (L), white blood cell-to-platelet ratio (WPR), neutrophil-to-lymphocyte ratio (NLR) in peripheral blood and changes in temperature (T-37) for bacteremia and 90-day mortality in patients with severe burns during the first perioperative period.Methods Data from 169 patients treated at the First Affiliated Hospital of Sun Yat-sen University from 2011 to 2020 were retrospectively analyzed. The patients were divided into a bacteremia group and a control group based upon blood culture. Data on M, L, NLR, WPR and T-37 were collected at the day before the first surgery (0), the first day after the first surgery (1) and the third day after the first surgery (3). Independent risk factors for bacteremia and 90-day mortality were identified. The risk prediction models were established with multivariate logistic regression analysis and externally validated in another cohort of 191 patients with severe burns.Results The 90-day mortality rate was 21.3% (36/169), which was significantly higher in the Bac group than in the con group (42.8% vs. 10.6%, P<0.01). WPR0, M0, WPR1, and T3-37 were significantly higher in the Bac group than in the con group (P<0.01), whereas M1 and M3 were significantly lower in the Bac group than in the con group (P<0.01). Multivariate regression analysis showed that SOFA0, WPR0, M3, and T3-37 were independently associated with bacteremia. The prediction model for bacteremia Xbac = 0.1809 × SOFA0 + 6.532 × WPR0-1.171 × M3 + 0.6987 × ⎮T3-37⎮- 2.297. TBSAB, SOFA0, and ∆M (M0-M3) were independently correlated with 90-day mortality. The risk prediction model X90d-m= 0.055 × TBSAB + 0.301×SOFA0+1.508 × ∆M) - 7.196. External validation of the prediction models suggested that the specificity, sensitivity, and AUC were 90.7%, 62.5% and 0.797, respectively, for Xbac and 69.2%, 90.0% and 0.873, respectively, for X90d-m.Conclusion ∆M and WPR0 were independent risk factors for bacteremia and 90-day mortality in patients with severe burns. The predictive models could inform clinical antimicrobial judgment and prognostication.

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Epidemiology and outcomes of bloodstream infections in severe burn patients: a six-year retrospective study

Cited by 21 publications

References 28 publications

Epidemiology of bloodstream infections and surface swab cultures in burn patients

Epidemiology of bloodstream infections and surface swab cultures in burn patients

Prognostic Risk Factors of Carbapenem-Resistant Gram-Negative Bacteria Bloodstream Infection in Immunosuppressed Patients: A 7-Year Retrospective Cohort Study

Predictive value of perioperative monocyte counts for bacteremia and 90-day all-cause mortality in patients with severe burn

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