Prevalence and Determinants of Multi-Drug Resistance Bacterial Infection Among Burn Patients in a Tertiary Care
Sujan Maharjan1, Sweta Shrestha1, Upasana Acharya1
1Department of Pharmacy, Kathmandu University, Dhulikhel, Bagmati Province, Nepal.
Purpose:
The emergence of multidrug-resistant organisms (MDROs) in burn patients poses a significant threat to patient outcomes and healthcare systems, especially in resource-limited settings. Burn injuries compromise the skin barrier and often require invasive interventions, increasing the risk of infection and antimicrobial resistance. This study aimed to determine the prevalence of multi-drug resistance (MDR) and identify the associated risk factors.
Patient And Methods:
A retrospective study was conducted among burn patients admitted to Nepal Cleft and Burn Center, Kathmandu, from January to December 2023. All culture-positive isolates were assessed to determine the prevalence of MDR and distribution of common pathogens. Sociodemographic and clinical data were evaluated using multivariate logistic regression to identify predictors of MDRO infection.
Results:
Among 535 burn patients, 348 had positive cultures. The prevalence of resistant organisms was 56.82%, comprising MDR (n = 155), Extensively Drug-Resistant (XDR) (n = 147), and Pan-drug Resistant (PDR) (n = 2). The most common Gram-negative isolates were Pseudomonas aeruginosa (29.0%), Klebsiella pneumoniae (18.1%), Citrobacter koseri (17.5%), Acinetobacter baumannii (16.4%), and Escherichia coli (13.8%). Among Gram-positive organisms, Coagulase-negative Staphylococci (15.5%) and MRSA (13.2%) were identified. The use of catheters, nasogastric tubes, and ventilators was significantly higher in MDRO cases. Bloodstream (18.8%), urinary (12.8%), and catheter-related infections (11.2%) were also observed among patients. Intensive Care Unit (ICU) admission [Adjusted Odds Ratio (AOR): 3.047, 95% Confidence Interval (CI): 1.089-8.528; p = 0.034] and nasogastric tube use [AOR: 11.830, CI: 1.339-104.489; p = 0.026] were significant predictors of MDRO infection.
Conclusion:
MDRO infections are highly prevalent (56.82%) in burn patients. ICU stay and use of invasive devices are key risk factors. These findings underscore the importance of antimicrobial stewardship, stringent infection control measures, and routine surveillance for antimicrobial resistance in burn units.
Insights
Multidrug-resistant organisms (MDROs) are prevalent in burn patients, affecting over half of those with positive cultures. Intensive Care Unit (ICU) admission and invasive devices like nasogastric tubes are significant risk factors for MDRO infections.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Burn injuries create a high-risk environment for infections due to compromised skin barriers.
- The rise of multidrug-resistant organisms (MDROs) poses a severe threat, particularly in resource-limited settings.
- Antimicrobial resistance in burn patients necessitates understanding prevalence and risk factors.
Purpose of the Study:
- To determine the prevalence of multidrug resistance (MDR) in burn patients.
- To identify sociodemographic and clinical risk factors associated with MDRO infections in this population.
Main Methods:
- A retrospective study analyzed culture-positive isolates from burn patients at Nepal Cleft and Burn Center (Jan-Dec 2023).
- Prevalence of MDR, extensively drug-resistant (XDR), and pan-drug resistant (PDR) organisms was assessed.
- Multivariate logistic regression identified predictors of MDRO infection.
Main Results:
- Over half (56.82%) of burn patients with positive cultures had resistant organisms (MDR, XDR, PDR).
- Common pathogens included *Pseudomonas aeruginosa*, *Klebsiella pneumoniae*, and MRSA.
- Intensive Care Unit (ICU) admission (AOR: 3.047) and nasogastric tube use (AOR: 11.830) were significant predictors of MDRO infection.
Conclusions:
- MDRO infections are highly prevalent in burn patients, with over half exhibiting resistance.
- ICU admission and the use of invasive devices are critical risk factors.
- Antimicrobial stewardship, infection control, and resistance surveillance are crucial in burn units.
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