Central nervous system infections in patients with severe burns

Central nervous system (CNS) infections develop in 3-9% of neurosurgical ICU patients and 0.4-2% of all patients hospitalized with head trauma. CNS infection incidence in burn patients is unknown and this study sets out to identify the incidence and risk factors associated with CNS infections.

A retrospective electronic chart review was performed from 1 July 2003 to 30 June 2008 evaluating inpatient medical records along with cerebrospinal fluid (CSF) microbiological results for the presence of CNS infection. The presence of facial and head injuries and burns, along with intracranial interventions were reviewed for association with CNS infections.

There were 1964 admissions with 2 patients (0.1%) found to have CNS infection; 1 each with MRSA and Acinetobacter baumannii. Both patients had facial burns and trauma to their head that required intracranial surgery. Of note, both patients had bacteremia with the same microorganisms isolated from their CSF and both survived. Of all patients, 29% had head or neck trauma and burns; 0.35% of those had a CNS infection. Scalp harvest for grafts or debridement of burned scalp was performed on 125 patients of which 9 had an invasive surgical procedure that involved penetration of the skull. The 2 infected patients were from these 9 intracranial surgical patients revealing a 22% infection rate.

The incidence of CNS infections in patients with severe burns is extremely low at 0.1%. This rate was low even with head and face burns with trauma unless the patient underwent an intracranial procedure.