Risk factors for antimicrobial resistance in paediatric burn infections: Insights from a retrospective cohort study

To define the microbiome, antimicrobial resistance profiles and associated risk factors among paediatric patients with infected burns.

A retrospective cohort study was conducted among paediatric patients with infected burns admitted to a tertiary burns service between January 2011 to December 2023. Basic demographic data and burn-related clinical information were extracted from the Burns Unit database and linked with microbiological data.

Among a total of 3679 paediatric burn patients admitted, 183 (5 % of overall admitted) were identified as clinically having infected burns. Of the 173 (4.7 % of overall admitted) patients with documented cultures, 152 (87.9 % of suspected clinical infections) had culture-positive burn wound infections (BWIs) and 15 (8.7 % of overall admitted) had developed blood stream infections. The most common microorganisms identified in BWI were Gram-positive bacteria (245 isolates, 63.1 %), with Staphylococcus aureus being the most prevalent (32 %) followed by Streptococcus species (11.9 %). Gram-negative bacteria were identified in 32.5 % of cases, with Pseudomonas aeruginosa being the most common organism (5.7 %). Nineteen (5 %) methicillin-resistant Staphylococcus aureus isolates were detected from 17 (9.8 %) paediatric patients with burns. The highest resistance was reported against ampicillin (100 %) followed by penicillin (91.7 %), and amoxicillin (88.6 %) against S. aureus isolates. P. aeruginosa isolates showed resistance in 58.8 % of cases to ceftazidime, followed by 47 % to piperacillin-tazobactam, and 2 isolates were resistant to imipenem, a carbapenem antibiotic considered a last-resort option. Multivariate logistic regression analysis revealed that burns to the head and neck regions (AOR = 5.2, 95 %CI: 2.20-12.31; p < 0.001), admission to the paediatric intensive care unit (PICU) (AOR = 8.2, 95 %CI: 1.03-64.86; p = 0.047) and previous medical history (AOR = 2.4, 95 %CI: 1.07-5.55; p = 0.033) were independent risk factors associated with antimicrobial-resistant (AMR) burn infections CONCLUSIONS: AMR in paediatric patients with infected burns is common and therefore early culture confirmation could improve treatment outcomes especially for patients with high risk factors.