Factors Associated with Clinical Outcomes of Bloodstream Infections at a Burn Unit in Indonesia: A Three-Year...

Burn injuries have a relatively high prevalence in Indonesia, and infection, as one of the serious complications, can significantly increase the risk of morbidity and mortality in patients. This study aimed to investigate the bacteriological profile, antimicrobial susceptibility pattern, and clinical outcomes of burn patients with bloodstream infection (BSI) in Indonesia. A retrospective cohort design was employed from January 2019 to December 2021 using secondary data from the patients' medical records. Factors associated with length of stay (LoS) and in-hospital mortality were evaluated through Mann-Whitney/Kruskal-Wallis test and chi square/Fisher's exact test, respectively. A total of 43 burn patients with culture-proven bloodstream infections were included in the analysis. Gram negative bacteria were the most commonly isolated pathogens (61.9%), with Acinetobacter baumannii being the primary species (34.9%). Coagulase-negative Staphylococci (CoNS) was the second most common species (26.9%), accounting for the majority of gram-positive bacteria. Carbapenem non-susceptibility was remarkably high in gram-negative bacteria, with piperacillin-tazobactam, amikacin, and tetracycline offering higher activity. The presence of other coinfections apart from BSI was significantly associated with prolonged LoS (p=0.039). Factors associated with in-hospital mortality include flame burns (p=0.041), TBSA ≥40% (p=0.003), and early BSI of <7 days (p=0.046). However, no difference in LoS or mortality was demonstrated in patients with A. baumanniii infection compared to CoNS. Prolonged length of stay and increased risk of mortality necessitates clinicians to further improve infection control within the burn unit and evaluate prudent use of antibiotics for patients.