Patterns of multidrug resistant organism acquisition in an adult specialist burns service: a retrospective review

Abstract

Background Multidrug resistant organisms (MDROs) occur more commonly in burns patients than in other hospital patients and are an increasingly frequent cause of burn-related mortality. We examined the incidence, trends and risk factors for MDRO acquisition in a specialist burns service housed in an open general surgical ward, and general intensive care unit. Methods We performed a retrospective study of adult patients admitted with an acute burn injury to our specialist statewide tertiary burns service between July 2014 and October 2020. We linked patient demographics, injury, treatment, and outcome details from our prospective burns service registry to microbiology and antimicrobial prescribing data. The outcome of interest was first MDRO detection, stratified into the following groups of interest: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), two groups of Pseudomonas (carbapenem resistant, and piperacillin-tazobactam or cefepime resistant), carbapenem-resistant Acinetobacter species, Stenotrophomonas maltophilia, carbapenem-resistant Enterobacteriaceae (CRE), and extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE). We used a Cox proportional hazards model to evaluate the association between antibiotic exposure and MDRO acquisition. Results There were 2,036 acute admissions, of which 230 (11.3%) had at least one MDRO isolated from clinical specimens, most frequently wound swabs. While acquisition rates of individual MDRO groups varied over the study period, acquisition rate of any MDRO was reasonably stable over time. Carbapenem-resistant Pseudomonas was acquired at the highest rate over the study period (3.5/1000 patient days). The 12.8% (29/226) of MDROs isolated within 48 h were predominantly MRSA and Stenotrophomonas. Median (IQR) time from admission to MDRO detection was 10.9 (5.6–20.5) days, ranging from 9.8 (2.7–24.2) for MRSA to 23.6 (15.7–36.0) for carbapenem-resistant P. aeruginosa. Patients with MDROs were older, had more extensive burns, longer length of stay, and were more likely to have operative burn management. We were unable to detect a relationship between antibiotic exposure and emergence of MDROs. Conclusions MDROs are a common and consistent presence in our burns unit. The pattern of acquisition suggests various causes, including introduction from the community and nosocomial spread. More regular surveillance of incidence and targeted interventions may decrease their prevalence, and limit the development of invasive infection.

Development and Validation of a Nomogram Prediction Model for Multidrug-Resistant Organisms Infection in a Neurosurgical Intensive Care Unit

“…The results of this study revealed that out of 2516 NICU inpatients, 290 cases had MDROs infection, resulting in an incidence rate of 11.5%. This rate is comparable to studies conducted in Australia 18 and Ukraine, 19 and slightly lower than the domestic data in China 20 (20.6%). Possible reasons for this difference could be attributed to the healthcare technology in southeast China and the increasing attention given by hospital staff to the prevention of MDROs infection.…”

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

“…Another study showed the most positive MDRO isolates came from wound cultures with 48 patients (57.8%), followed by blood cultures of 64 patients (25.6%) [11]. Seven-year retrospective studies show the most common source of infection is pulmonary infection, followed by bloodstream infection and wound infection [28].…”

Bacterial Infection of Burn Patients and Their Drug-resistance in South Jiangsu China During 2012-2016

“…Based on a literature review on other patients with infections, Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus were usually also the main multidrug-resistance bacteria in critically ill or immunocompromised patients [7]. A. baumannii has caused healthcare-associated infections (HAI) and has become one of the most common colonizing pathogens in burn patients [8,9] Multidrug-resistant A. baumannii strains were significantly more susceptible than keratinocytes to blue light inactivation.…”