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

Abstract

Introduction: Many risk factors have been reported to increase mortality among burn patients. Previously, a higher mortality incidence was reported in acute burn patients infected with multidrug-resistant organisms (MDROs) when compared to patients infected with non-MDROs. However, considering this as an independent risk factor for mortality in acute burn patients is not yet confirmed. Methods: We conducted an observational retrospective study in Qatar. We included adult patients admitted to the surgical intensive care unit (ICU) between January 2015 and December 2017 with burn injuries involving either at least 15% of the total body surface area (TBSA) or less than 15% with facial involvement. All patients developed infection with a positive culture of either MDRO or non-MDRO. The primary outcome was in-hospital mortality. Other outcomes included days of mechanical ventilation, ICU, length of stay in hospital, and requirement of vasoactive agents. Results: Fifty-eight patients were included in the final analysis: 33 patients in the MDRO group and 25 patients in the non-MDRO group. Six patients (18.2%) died in the MDRO group versus four patients (16%) in the non-MDRO group ( P = 1). No significant difference was observed between the two groups with regard to the ICU length of stay. However, there was a trend towards increased median length of stay in hospital in the MDRO group: 62 days versus 45 days in the non-MDRO group ( P = 0.057). No significant differences were observed in the other outcomes. Conclusion: In severely burned patients, infection with MDRO was not associated with increased mortality. There was a trend towards increased hospitalisation in MDRO-infected patients. Further studies with a larger sample size are needed to confirm these results. Lay Summary Many factors affect mortality in burn patients admitted to the intensive care unit, such as age, total body surface area involved in the injury, and others. In this retrospective study, we evaluated whether wound infection with a bacterial organism resistant to multiple classes of antibiotics (multidrug-resistant) is considered an independent risk factor for mortality in critically ill burn patients. We included 58 patients requiring intensive care admission with burn injuries involving 15% or more of the total body surface area or less than 15% but with facial involvement. A total of 33 patients were infected with multidrug-resistant organisms (MDROs) and 25 patients with non-MDROs. Six patients (18.2%) from the MDRO group died versus four (16%) in the non-MDRO group. The MDRO group required a longer stay in hospital and an average of one more day on a mechanical ventilator. We concluded that wound infection with MDROs might not increase mortality when compared to wound infection with non-MDROs, although other studies with a larger number of patients involved need to be conducted to validate these results.

Antimicrobial Resistance of Eskape Pathogens in Major Burns Patients – One-Year Retrospective Study

“…The expected survival rates of the study group were close to the expected survival rates, as predicted by ABSI scores. [9] In addition, our findings confirm that mortality is not influenced by MDR strains; however, they may lead to prolonged hospitalisation [25,42]. Lastly, statistical significance was found regarding the capacity of ESKAPE pathogens to be more prone to developing antibiotic resistance than non-ESKAPE pathogens, confirming the need for updating the clinician's armamentarium in critical cases with such high mortality, such as patients with major burns.…”

Infection and Burn Injury

“…Gram-negative bacteria including Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter Baumannii are infectious agents of concern that are translocated from either the digestive tract reservoir or exogenous sources (hands of clinicians, surfaces) [4,39,43]. Infected burn patients treated with various antimicrobial regimens are at risk for developing more serious infections from multi-drug-resistant organisms, yeasts, and even viruses [44,45]. Staphylococcus aureus is by far the greatest infectious microbe in burn and surgical units across the world.…”

Clinical Profile of Multidrug-Resistant Organisms at Burn Center Dr. Soetomo General Hospital Surabaya from June 2020 to June 2021

“…Another study showed the mortality rate in burn patients infected with TBSA >30% was 11 patients (30.56%) [14]. A cohort study conducted over 3 years showed that the mortality rate of burn patients with MDRO had a total of 15 patients (21.4%) out of a total of 70 patients [21].…”