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Updated: Mar 25, 2026
Author Spotlight: A Multi-Depth Porcine Model for Comprehensive Study of Burn Injuries and Healing Processes
Published on: February 23, 2024
Invasive Infection and Outcomes in a Humanitarian Surgical Burn Program in Haiti
Richard A Murphy1, Luba Nisenbaum2,3, Amy S Labar4
1Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1000 W. Carson St, Box 466, Torrance, CA, 90509, USA. ramurphy@gmail.com.
Background:
Compare to high-income settings, survival in burn units in low-income settings is lower with invasive infections one leading cause of death. Médecins Sans Frontières is involved in the treatment of large burns in adults and children in Haiti.
Methods:
In 2014, we performed a review of 228 patients admitted consecutively with burn injury during a 6-month period to determine patient outcomes and infectious complications. Microbiology was available through a linkage with a Haitian organization. Regression analysis was performed to determine covariates associated with bloodstream infection and mortality.
Results:
102 (45 %) patients were male, the median age was 8 years (IQR, 2-28), and the majority of patients (60 %) were admitted to the unit within 6 h of injury. There were 20 patients (9 %) with culture-proven bacteremia. Among organisms in blood, common isolates were Staphylococcus aureus (42 %), Pseudomonas aeruginosa (23 %), and Acinetobacter baumannii (15 %). Among patients with burns involving <40 % total body area, 4 (2 %) of 192 died and 20 (65 %) of 31 with ≥40 % body surface area involvement died. Factors associated with mortality included involvement of ≥40 % of body surface, depth, and flame as the mechanism. Multidrug-resistant infections were common; 18 % of S. aureus isolates were methicillin resistant, and 83 % of P. aeruginosa isolates were imipenem resistant.
Conclusions:
A low mortality rate was observed in a humanitarian burn surgery project in patients with burns involving <40 % of total body surface. Invasive infection was common and alarming rates of antibiotic resistance were observed, including infections not treatable with antibiotics available locally.
Insights
Survival in burn units is lower in low-income settings, with invasive infections being a major cause of death. This study highlights high rates of antibiotic resistance in burn patients in Haiti.
Area of Science:
- Infectious Diseases
- Global Health
- Burn Care
Background:
- Survival rates in burn units are lower in low-income settings compared to high-income countries.
- Invasive infections are a leading cause of mortality in burn patients in resource-limited environments.
- Médecins Sans Frontières provides critical burn care for adults and children in Haiti.
Purpose of the Study:
- To determine patient outcomes and infectious complications in a Haitian burn unit.
- To identify factors associated with bloodstream infection and mortality in burn patients.
- To assess the prevalence and patterns of antibiotic resistance in a low-income setting.
Main Methods:
- A retrospective review of 228 consecutive burn patients admitted over a 6-month period in 2014.
- Microbiology data obtained through collaboration with a Haitian organization.
- Regression analysis to identify covariates linked to bloodstream infection and mortality.
Main Results:
- The median age of patients was 8 years, with 45% being male.
- Culture-proven bacteremia was present in 9% of patients, with common isolates including Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii.
- Mortality was significantly higher for patients with burns involving ≥40% of body surface area (65% mortality) compared to <40% (2% mortality).
- High rates of multidrug-resistant organisms were observed, including methicillin-resistant Staphylococcus aureus (18%) and imipenem-resistant Pseudomonas aeruginosa (83%).
Conclusions:
- A low mortality rate was achieved for patients with smaller burn surface areas (<40%) in this humanitarian project.
- Invasive infections were common, and alarming rates of antibiotic resistance were documented.
- The study identified infections untreatable with locally available antibiotics, underscoring a critical challenge in resource-limited settings.
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