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Outcomes of bacteremia in burn patients involved in combat operations overseas
Roseanne A Ressner1, Clinton K Murray, Matthew E Griffith
1Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.
Background:
Burn patients constitute approximately 5% of casualties injured in support of US military operations in Iraq (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]). Since the onset of these conflicts, there have been numerous casualties infected with multidrug-resistant bacteria. It is currently unclear if bacteremia with these multidrug-resistant organisms in OIF/OEF burn casualties is associated with increased mortality.
Study Design:
We performed a retrospective cohort study of all patients admitted to the US Army Institute of Surgical Research burn center from January 2003 to May 2006 to evaluate bacteremia in our burn-patient population.
Results:
One hundred twenty-nine of 1,258 patients admitted to the burn center became bacteremic during their hospitalization. Of these, 92 had bacteremia with the top four pathogens in our burn center, ie, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter calcoaceticus-baumannii complex, and Staphylococcus aureus. Presence of any bacteremia was associated with mortality and increased ventilator days. Bacteremia with K pneumoniae was associated with a statistically increased mortality and a prolonged ventilator course relative to all other pathogens.
Conclusions:
Casualties of OIF/OEF with burn injuries did not have different outcomes than patients whose burns were not associated with military operations. Bacteremia, especially with a multidrug-resistant organism, causes increased mortality in burn patients. Of all the pathogens causing bacteremia, K pneumonia appears to have the greatest impact on mortality.
Insights
Bacteremia, particularly with multidrug-resistant organisms like Klebsiella pneumoniae, significantly increases mortality in burn patients. Military burn casualties did not show different outcomes compared to civilian burn patients.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Military Medicine
Background:
- Burn patients from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) conflicts often experience multidrug-resistant bacterial infections.
- The impact of bacteremia caused by multidrug-resistant organisms on mortality in these burn casualties remains unclear.
Purpose of the Study:
- To evaluate the incidence and outcomes of bacteremia in burn patients admitted to a military burn center.
- To determine if bacteremia, especially with multidrug-resistant organisms, is associated with increased mortality in burn casualties.
Main Methods:
- A retrospective cohort study was conducted.
- Data from 1,258 burn patients admitted to the US Army Institute of Surgical Research burn center between January 2003 and May 2006 were analyzed.
Main Results:
- 129 patients (10.2%) developed bacteremia during hospitalization.
- The most common pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter calcoaceticus-baumannii complex, and Staphylococcus aureus.
- Bacteremia was linked to increased mortality and longer ventilator use. Klebsiella pneumoniae bacteremia showed a statistically significant increase in mortality.
Conclusions:
- Burn injuries sustained during OIF/OEF did not lead to different outcomes compared to non-military burn injuries.
- Bacteremia, especially from multidrug-resistant organisms, is a significant risk factor for increased mortality in burn patients.
- Klebsiella pneumoniae demonstrated the most substantial impact on mortality among the studied pathogens.
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