Timeline of health care–associated infections and pathogens after burn injuries - 12/10/16

Doi : 10.1016/j.ajic.2016.07.027

David van Duin, MD, PhD ^a,^* , Paula D. Strassle, MSPH ^b, Lauren M. DiBiase, MS ^c, Anne M. Lachiewicz, MD, MPH ^a, William A. Rutala, PhD ^a,^c, Timothy Eitas, PhD ^d,^e, Robert Maile, PhD ^e, Hajime Kanamori, MD, PhD, MPH ^a,^c, David J. Weber, MD, MPH ^a,^c, Bruce A. Cairns, MD, FACS ^d,^f, Sonia Napravnik, PhD ^a,^b, Samuel W. Jones, MD ^d,^f
^a Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC
^b Department of Epidemiology, University of North Carolina, Chapel Hill, NC
^c Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC
^d North Carolina Jaycee Burn Center, Chapel Hill, NC
^e Host Defense Discovery Performance Unit, Glaxosmithkline, Research Triangle Park, NC
^f Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC

^*Address correspondence to David van Duin, MD, PhD, Division of Infectious Diseases, Department of Medicine, University of North Carolina, 130 Mason Farm Rd, Mail code CB# 7030, Chapel Hill, NC 27599-7030. (D. van Duin).Division of Infectious DiseasesDepartment of MedicineUniversity of North Carolina130 Mason Farm Rd, Mail code CB# 7030Chapel HillNC27599-7030

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Highlights

•	Of patients with burn injuries, 7% develop a hospital-acquired infection.
•	Gram-positive bacteria predominate early during the hospitalization after burn injury, whereas gram-negative bacteria become more common later during the admission.
•	Bacterial pathogens isolated from burn patients tend to become resistant to an increasing number of antibiotics as time from admission increases.

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Abstract

Background

Infections are an important cause of morbidity and mortality after burn injuries. Here, we describe the time line of infections and pathogens after burns.

Methods

A retrospective study was performed in a large tertiary care burn center from 2004-2013. Analyses were performed on health care–associated infections (HAIs) meeting Centers for Disease Control and Prevention criteria and on all positive cultures. Incidence rates per 1,000 days were calculated for specific HAI categories and pathogens and across hospitalization time (week 1, weeks 2-3, and week ≥4).

Results

Among 5,524 patients, the median burn size was 4% of total body surface area (interquartile range, 2%-10%). Of the patients, 7% developed an HAI, of whom 33% had >1 HAI episode. Gram-positive bacteria were isolated earlier, and gram-negative bacteria were isolated later during hospitalization. Of 1,788 bacterial isolates, 44% met criteria for multidrug resistance, and 23% met criteria for extensive drug resistance. Bacteria tended to become increasingly resistant to antibiotics as time from admission increased.

Conclusions

We observed differences in infection type, pathogen, and antibiotic-resistant bacterium risk across time of hospitalization. These results may guide infection prevention in various stages of the postburn admission.

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Key Words : Burn, Intensive care unit, Health care–associated infection, Timing, Bloodstream infection, Pneumonia

Plan

Materials and methods

Study population and design

Patient and burn characteristics

Hospitalizations

HAIs

Potential pathogens

Antibiotic resistance

Discussion

Conclusions

	Funding/support: Supported by the National Center for Advancing Translational Sciences, National Institutes of Health (grant no. UL1TR001111). S.W.J. is supported by National Institute of General Medical Sciences (no. K08GM109106-02).
	Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
	Conflicts of interest: D.v.D. is on the advisory board for Actavis, Tetraphase, Sanofi-Pasteur, Astellas, and Medimmune and has received research funding from Steris Inc and Scynexis. All other authors have no conflicts reported.