Background: Burn patients are particularly vulnerable to infection. We assessed the incidence and outcomes of burn patients with common infections in acute care hospitals. We also investigated the risk factors for infection and the effect of infection on the mortality of burn patients.
Methods: Using the Nationwide Inpatient Sample database (2005-2014), we identified adult patients (≥18 years) with burn injury by ICD-9 codes. The infections of our interest included bacteremia, pneumonia, urinary tract infection (UTI), surgical infection, Clostridium difficile infection, skin and soft tissue infection, cardiovascular infection, infection of throat, nose and ear. The infection rate, mortality, length of hospital stay (LOS) and hospital charge of burn patients were evaluated. The risk factors for infection and in-hospital death of burn patients were analyzed by logistic regression.
Results: 125,957 burn cases were identified, and 10,301 (8.2%) had at least one infection. UTI and pneumonia were the most common infections of burn patients, and their incidences were 3.0% and 2.8% respectively. Infection of burn patients was associated with 2.5 times increase in mortality (7.7% vs. 3.0%, P<0.001), nearly 5 times prolonged LOS (median 19 days vs. 4 days, p<0.001) and 6.5 times higher hospital charge (median $145,389 vs. $22,477, p<0.001). In 10-year study period, the infection rate of burn patients increased from 5.1% in 2005 to 9.5% in 2008, then stayed around 9.0% until 2014 (Figure 1). The mortality of burn patients decreased from 3.7% in 2005 to 3.0% in 2014, while the mortality of the patients with infection varied by year (Figure 2). In multivariate analysis, pneumonia was the only infection type that increased the risk for in-hospital death (OR=1.38, 95% CI 1.20-1.58). Age and total body surface area (TBSA) of burn were the major risk factors for infection and in-hospital death of burn patients.
Conclusion: The incidence of infection in burn patients increased during 2005-2014. The age and TBSA of burn are the major risk factors for infection and mortality. Except for pneumonia, most infections were not associated with increased risk for in-hospital death of the burn patients.
R. Luo, None