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Colonization with Multidrug-Resistant Enterobacteriaceae is Associated with Increased Mortality Following Burn Injury

Jared R Gallaher1, Wone Banda2, Anne M Lachiewicz3

  • 1Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.

World Journal of Surgery
|April 27, 2018
PubMed
Abstract

Insights

Multidrug-resistant (MDR) bacteria, particularly Enterobacteriaceae, frequently colonize burn wounds in Malawi, increasing mortality risk. Enhanced prevention and stewardship are crucial in resource-poor settings to combat this threat.

Area of Science:

  • Infectious Diseases
  • Public Health
  • Clinical Medicine

Background:

  • Multidrug-resistant (MDR) bacteria pose a significant global health threat, especially in low- and middle-income countries.
  • Immunocompromised individuals, such as burn patients, are particularly vulnerable to MDR bacterial infections.
  • Burn wound colonization by MDR bacteria complicates treatment and worsens outcomes in vulnerable populations.

Purpose of the Study:

  • To investigate the epidemiology of burn wound colonization by MDR bacteria in a Malawian tertiary burn center.
  • To determine the clinical outcomes associated with MDR bacterial colonization in burn patients.
  • To identify specific bacterial species, like Enterobacteriaceae, prevalent in burn wound infections.

Main Methods:

  • Prospective analysis of burn patients admitted to Kamuzu Central Hospital, Malawi.
  • Collection of wound swabs at admission and weekly intervals for bacterial culture.
  • Statistical analysis using log binomial models to assess the association between MDR colonization and in-hospital mortality, adjusting for confounders.

Main Results:

  • Ninety-nine patients were enrolled; 36% experienced colonization with MDR bacteria, predominantly Enterobacteriaceae.
  • In-hospital mortality was 19%, with MDR Enterobacteriaceae colonization significantly associated with increased mortality (RR 1.86).
  • Adjusted analysis accounted for factors including burn severity (TBSA), burn type, age, sex, and MRSA colonization.

Conclusions:

  • MDR bacteria, especially Enterobacteriaceae, are prevalent in burn wounds and linked to poorer outcomes in Malawi.
  • Resource-limited settings require strengthened strategies for MDR bacterial prevention, diagnostics, and antibiotic stewardship.
  • Improved infection control measures and targeted interventions are essential to mitigate the impact of MDR bacteria in burn care.

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