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Predictors of infectious complications after burn injuries in children
G L Rodgers1, J Mortensen, M C Fisher
1Section of Infectious Disease, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
Insights
Infections in children with burns are common, with burn wound infections and catheter-associated septicemia being most frequent. Flame, inhalation, extensive, and full-thickness burns increase infection risk.
Area of Science:
- Pediatric Infectious Diseases
- Burn Care and Management
- Clinical Microbiology
Background:
- Infections are a primary life-threatening complication in pediatric burn injuries.
- Existing knowledge on pediatric burn infections is often extrapolated from adult studies.
- This study prospectively investigated infectious complications in children with burns.
Purpose of the Study:
- To define the epidemiology of infections in pediatric burn patients.
- To identify risk factors associated with infection development.
- To characterize the microbiology of infections under optimal burn care.
Main Methods:
- Prospective study design enrolling hospitalized pediatric burn patients.
- Assessment of burn injury characteristics (mechanism, extent, depth).
- Active surveillance for infectious complications throughout hospitalization.
Main Results:
- Twenty-seven percent of 70 patients developed 39 infections; common types included burn wound infections and catheter-associated septicemia.
- Key pathogens identified were Staphylococcus aureus, Candida albicans, and Pseudomonas aeruginosa.
- Risk factors for infection included flame/inhalation injury, total body surface area (TBSA) >30%, and full-thickness burns.
Conclusions:
- Burn wound infections and catheter-associated septicemia are the most prevalent infections in pediatric burn patients.
- Specific burn characteristics significantly predict the risk of infectious complications.
- Children with flame/inhalation injuries, TBSA >30%, and full-thickness burns require vigilant monitoring for infection.
Background:
Infections are the major life-threatening complication of burn injury and occur with the greatest frequency in children. Knowledge of their occurrence and management, however, is extrapolated from studies in adults. We performed a prospective study of infectious complications in burned children.
Objective:
To delineate epidemiology, risk factors and microbiology of infections in burned children where burn care and surgical interventions are optimal.
Methods:
Children hospitalized for burns were entered into prospective study. Characteristics of the burn injury were assessed, and active surveillance for infections was performed.
Results:
Seventy patients were entered [mean age, 42 months; mean total body surface area (TBSA), burn 15%]. Twenty-seven percent of patients developed 39 infections: 13 involved the burn wound (burn wound sepsis, 6; graft loss, 5; and cellulitis, 2); 13 were catheter-associated septicemia; 13 involved other sites (i.e. pneumonia, 4; urinary tract infection, 3; bacteremia, 2; endocarditis, 1; myocardial abscess, 1; toxin-mediated syndrome, 1; and otitis media, 1). Twenty-three infections were caused by a single organism, 9 infections by more than 1 organism and in 7 infections defined by CDC criteria no organism was recovered. Organisms causing infection were: Staphylococcus aureus, 19; Candida albicans, 4; Pseudomonas aeruginosa, 4; coagulase-negative Staphylococcus, 4; Enterococcus sp., 3; Escherichia coli, 1; Klebsiella oxytoca, 1; Serratia marcescens, 1; Streptococcus pneumoniae, 1; Streptococcus pyogenes, 1; Aspergillus fumigatus, 1; and Candida parapsilosis, 1. Burn mechanism (flame and inhalation), extent (TBSA >30%) and depth (full thickness) were risk factors for infection; young age and site of burn were not.
Conclusion:
The most common infections occurring in burn children are burn wound infections and catheter-associated septicemia. Characteristics of burn injury predict risk of infection. Children with flame and inhalation injury, TBSA burned >30% and full thickness burns are at high risk of infectious complications.