Risk factors for multidrug‐resistant <scp>G</scp>ram‐negative infection in burn patients

Vickers, Mark L.; Dulhunty, Joel M.; Ballard, Emma; Chapman, Paul T.; Müller, Michael; Roberts, Jason A.; Cotta, Menino Osbert

doi:10.1111/ans.14144

Cited by 11 publications

(18 citation statements)

References 18 publications

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“…Studies were published between 1994 and 2017 and combined data spanning from 1990 to 2015. The highest number of contributions came from France (two) and Turkey (two), while one study each was carried out in Australia, Brazil, Canada, Germany, Singapore, Spain and Taiwan . Studies ran for a median of 15 months (interquartile range 12–24) and analysed a total of 289 cases from a cohort of 2221 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Two (18%) studies included patients from an ICU only, two (18%) from a burn ICU and seven (64%) combined data on ICU patients with patients from the burn ward . Seven (64%) studies focused exclusively on A. baumannii , two (18%) on P. aeruginosa , one (9%) study on K. pneumoniae and one (9%) analysed Gram‐negative bacteria collectively . Five (45%) studies used molecular typing to identify bacterial clones .…”

Section: Resultsmentioning

confidence: 99%

“…There exists a growing body of research on modifiable risk factors for MDR Gram‐negative infection and colonization following burn injury . To date, consensus on the hierarchy of modifiable risk factors has not yet been reached.…”

Section: Introductionmentioning

confidence: 99%

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Modifiable risk factors for multidrug‐resistant Gram‐negative infection in critically ill burn patients: a systematic review and meta‐analysis

Vickers

Malacova

Milinovich

et al. 2019

ANZ Journal of Surgery

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Background: We conducted a systematic review and meta-analysis to identify potentially modifiable risk factors for multidrug-resistant Gram-negative colonization or infection in critically ill burn patients. Methods: A systematic search was conducted of PubMed, Embase, CINAHL, Web of Science and Central (Cochrane). Risk factors including antibiotic use and hospital interventions were summarized in a random-effects meta-analysis. Risk of publication bias was assessed using the Grading of Recommendations Assessment, Development and Evaluation method and funnel plots. Results: A total of 11 studies met the inclusion criteria. We identified several potentially modifiable risk factors and were able to grade their importance based on effect size. Related to prior antibiotic exposure, extended-spectrum cephalosporins (pooled odds ratio (OR) 7.00, 95% confidence interval (CI) 2.77-17.67), carbapenems (pooled OR 6.65, 95% CI 3.49-12.69), anti-pseudomonal penicillins (pooled OR 4.23, 95% CI 1.23-14.61) and aminoglycosides (pooled OR 4.20, 95% CI 2.10-8.39) were most significant. Related to hospital intervention, urinary catheters (pooled OR 11.76, 95% CI 5.03-27.51), arterial catheters (pooled OR 8.99, 95% CI 3.84-21.04), mechanical ventilation (pooled OR 5.49, 95% CI 2.59-11.63), central venous catheters (pooled OR 4.26, 95% CI 1.03-17.59), transfusion or blood product administration (pooled OR 4.19,) and hydrotherapy (pooled OR 3.29, 95% CI 1.64-6.63) were most significant. Conclusion: Prior exposure to extended-spectrum cephalosporins and carbapenems, as well as the use of urinary catheters and arterial catheters pose the greatest threat for infection or colonization with multidrug-resistant Gram-negative organisms in the critically ill burn patient population.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Modifiable risk factors for multidrug‐resistant Gram‐negative infection in critically ill burn patients: a systematic review and meta‐analysis

Vickers

Malacova

Milinovich

et al. 2019

ANZ Journal of Surgery

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“…While P. aeruginosa is the most commonly isolated aerobic Gram‐negative species identified in DFU, and while Gram‐negative wound infection due to the presence of multidrug resistant and totally drug resistant organisms such as Klebsiella pneumonia , Stenotrophomonas maltophilia , and Enterobacteriaceae spp. can be deadly, these organisms are a much more serious concern for other types of wounds, such as burns . Indeed, GPC are the major participants associated with chronic wound infection.…”

Section: Culture‐based Characterization Of Chronic Wound Microbiomesmentioning

confidence: 99%

“…can be deadly, these organisms are a much more serious concern for other types of wounds, such as burns. [60][61][62] Indeed, GPC are the major participants associated with chronic wound infection.…”

Section: Culture-based Characterization Of Chronic Wound Microbiomesmentioning

confidence: 99%

The role of the microbiome in nonhealing diabetic wounds

Kalan

Brennan

2018

Annals of the New York Academy of Sciences

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Wound healing is a highly coordinated and complex process, and there can be devastating consequences if it is interrupted. It is believed that, in combination with host factors, microorganisms in a wound bed can not only impair wound healing but can lead to stalled, chronic wounds. It is hypothesized that the wound microbiota persists in chronic wounds as a biofilm, recalcitrant to antibiotic and mechanical intervention. Cultivation-based methods are the gold standard for identification of pathogens residing in wounds. However, these methods are biased against fastidious organisms, and do not capture the full extent of microbial diversity in chronic wounds. Thus, the link between specific microbes and impaired healing remains tenuous. This is partially because local infection and, more specifically, the formation of a biofilm, is difficult to diagnose. This has led to research efforts aimed at understanding if biofilm formation delays healing and leads to persistent and chronic infection. Circumventing challenges associated with culture-based estimations, advances in high-throughput sequencing analysis has revealed that chronic wounds are host to complex, diverse microbiomes comprising multiple species of bacteria and fungi. Here, we discuss how the use of genomic methodologies to study wound microbiomes has advanced the current understanding of infection and biofilm formation in chronic wounds.

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Bacterial infection profile and predictors among patients admitted to a burn care center: A retrospective study

Bourgi

Said

Yaakoub

et al. 2020

Burns

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Risk factors for multidrug‐resistant Gram‐negative infection in burn patients

Abstract: Prior meropenem exposure, Gram-negative colonization on admission, escharotomy and superficial partial thickness burn size may be potentially important factors for increasing the risk of MDR Gram-negative infection in the critically ill burn patient.

Cited by 11 publications

References 18 publications

Modifiable risk factors for multidrug‐resistant Gram‐negative infection in critically ill burn patients: a systematic review and meta‐analysis

Modifiable risk factors for multidrug‐resistant Gram‐negative infection in critically ill burn patients: a systematic review and meta‐analysis

The role of the microbiome in nonhealing diabetic wounds

Bacterial infection profile and predictors among patients admitted to a burn care center: A retrospective study

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