The Epidemiology of Bloodstream Infections in a Tertiary Care Burn ICU Over a 5 Year Period
Infections continue to be the leading cause of death among burn patients, and many types of nosocomial infections (NIs) can be present in the burned patient. The presence of bloodstream infections (BSI) has been shown to result in a four-fold increase in mortality in this population.
The purpose of this study is to review the rates and epidemiology of hospital acquired bloodstream infections in a tertiary care center burn unit over a five year period from 2009-2013. We also assessed risk factors that have been associated with a documented increase in the number of BSI in 2013 at our institution.
This study is a retrospective cohort study conducted at a 650 bed tertiary care hospital in Edmonton, Canada. All patients admitted to the burn ICU and had a nosocomial bloodstream infection (defined according to CDC criteria) from Janurary 2009 to December 2013 were included. Charts were then reviewed for additional epidemiologic data.
Twenty one patients developed 30 episodes of BSI. The majority of BSIs were associated with skin/burn infection (13/30). Eight episodes were classified as central-line associated BSI, making this the second most common cause of BSI.
In 2013 the BSI rate increased dramatically to 58.18 per 1,000 admissions, compared with an average rate of 9.56 (8.9-10.07) per 1,000 admissions from 2009-2012. This was associated with increased median length of hospital stay (25.57 days vs 96.75 days) and burn severity (TSB: 58% vs 85%).
The most common pathogen isolated was Pseudomonus aeruginosa (7/30). There were seven episodes of multidrug resistant BSIs. All multidrug resistant (MDR) BSIs were seen > 4 weeks after admission. The mortality rate in the bacteremic group was 13%.
Burn patients are at high risk for BSI and this is closely related to % TBSA and length of hospitalization. The mortality is associated with severity of burn injury, older age and resistant pathogen bacteremia.
H. Y. Zhou,
J. Durand, None
S. Smith, None