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Infections in a burn intensive care unit: experience of seven years
S G Santucci1, S Gobara, C R Santos
1Nosocomial Infection Control Department, Hospital das Clínicas, Brazil.
Insights
Hospital-acquired infections are common in severe burn patients, with bloodstream infections being most frequent. Antibiotic resistance in pathogens like Staphylococcus aureus and Pseudomonas aeruginosa poses a significant challenge in burns intensive care units.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Burn Surgery
Background:
- Hospital-acquired infections (HAIs) are a major concern in specialized burns intensive care units (BICUs).
- Understanding infection patterns and causative agents is crucial for effective prevention and treatment strategies in burn patients.
Purpose of the Study:
- To describe the incidence, types, and etiological agents of hospital-acquired infections in a specialized burns intensive care unit.
- To provide epidemiological data on infections in burn patients admitted between 1993 and 1999.
Main Methods:
- Prospective surveillance of hospital-acquired infections using modified Centers for Disease Control and Prevention criteria.
- Analysis of patient demographics, infection types, and identified microorganisms over a seven-year period.
- Calculation of infection rates, including vascular catheter-associated bloodstream infections and ventilator-associated pneumonia.
Main Results:
- Out of 320 admitted patients, 175 (55%) developed 388 HAIs.
- Primary bloodstream infections were most common (49%), followed by burn wound infections (21%) and pneumonia (14%).
- Staphylococcus aureus (24%), Pseudomonas aeruginosa (18%), and Acinetobacter spp. (14%) were the most frequent pathogens; significant antimicrobial resistance was observed.
Conclusions:
- Burn patients admitted to specialized units face a high risk of developing HAIs, particularly bloodstream infections.
- The prevalence of multidrug-resistant organisms necessitates vigilant infection control measures and targeted antimicrobial therapy.
- These findings underscore the need for ongoing surveillance and the development of evidence-based strategies to combat HAIs in critically ill burn patients.
Abstract:
The objective of this study is to describe infections in a specialized burns intensive care unit from 1993 to 1999. The criteria for admission to the unit are: children with burns involving at least 10% or adults with burns involving at least 20% of total body surface; burns affecting face, perineum or feet; suspected or proven airway injury; electric or chemical burns; age less than one year or above 50; or pre-existing disease with any extent of burns. Surveillance of hospital-acquired infection was prospective. Hospital-acquired infection criteria used were those modified from the Centers for Disease Control and Prevention. Diagnosis of infection using skin biopsy was not done. Over the study period, 320 patients were admitted to our burns intensive care unit. One hundred and seventy-five (55%) developed 388 hospital-acquired infections. The rate for vascular catheter-associated bloodstream infections was 34 per 1,000 central line-days. The rate of ventilator associated pneumonia was 26 infections per 1,000 ventilator-days. Primary bloodstream was the most common infection with 189 episodes (49%); followed by 83 burn wound infections (21%) and 56 pneumonias (14%). In 76% of these infections and in 97% of the primary bloodstream infections, aetiological agents were identified. The micro-organisms causing infections were S taphylococcus aureus (24%), Pseudomonas aeruginosa (18%), Acinetobacter spp. (14%) and coagulase-negative staphylococci (12%). Candida spp. caused 8% of infections. Gram-positive and Gram-negative organisms exhibited resistance to most antimicrobial agents used for therapy. During the first three days of hospitalization in the burns intensive care unit there were eight infections caused by S. aureus and three of these were resistant to oxacillin. These data provide background information regarding extensive burn patients on which decisions for control and prevention of hospital-acquired infections can be made.