Nosocomial infections in pediatric patients with burns

doi:10.1016/S0196-6553(97)90004-3

American Journal of Infection Control

Volume 25, Issue 3, June 1997, Pages 195-201

https://doi.org/10.1016/S0196-6553(97)90004-3 Get rights and content

Abstract

Background: Nosocomial infections (NI) are believed to occur more commonly in patients with burns than in patients undergoing surgery, but benchmark rates have not been well described, and widely accepted definitions of NI in patients with burns are not available. We present a clinically useful set of definitions for NI for the pediatric burn population and provide benchmark infection rates for NI at selected sites.

Methods: Centers for Disease Control and Prevention definitions were modified to more accurately describe nosocomial burn infection and secondary bloodstream infections (BSI) in the burn population. A surveillance system was developed and included calculation of NI rates by 1000 patient or device days, stratified into one of three risk groups (<30% burn injury, 30% to 60% burn injury, and >60% burn injury). All patients with acute burns admitted from January 1990 to December 1991 were included, and NI rates were calculated for burn infection, primary and secondary BSI, ventilator-related pneumonia and urinary catheter-related urinary tract infection (UTI).

Results: Overall 12.5% of patients with central venous catheters had development of primary BSI for a rate of $4.9 1000$ central venous catheter-days. Incidence of secondary BSI was 5.8% of patients for a rate of $5.3 1000$ patient-days. Incidence of burn infection was 10.1% of patients for a rate of $5.6 1000$ patient-days. Incidence of ventilator-related pneumonia was 17.5% of patients for a rate of $11.4 1000$ ventilator-days. Incidence of urinary catheter-related UTI was 17.9% of patients, for a rate of $13.2 1000$ urinary catheter-days. When rates were stratified by risk groups, incidence increased with increasing burn size for secondary BSI (p ≤ 0.0001) and urinary catheter-related UTI (p = 0.08), although rates based on number of patient-days or device-days more accurately reflected risk of infection over time.

Conclusions: Infection remains a cause of significant morbidity and death for patients with burns. The definitions and benchmark rates reported here may be useful in evaluation of NI surveillance strategies and calculation of infection rates, which could then be used to evaluate current treatment modalities and improve outcomes for the burn population.

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Cited by (79)

Does early bloodstream infection pose a significant risk of in-hospital mortality in adults with burns?
2022, Journal of Microbiology, Immunology and Infection
Bloodstream infections (BSI) are common in patients with major burns, but its effect on mortality remains controversial. This study was aimed to investigate if BSI is significant risk factor of mortality?
This is a retrospective chart review study included 266 adult patients admitted to our burn center from 2000 to 2019. Age, sex, inhalation injuries, total burn surface area (TBSA), duration of stay in intensive care unit, BSI and mortality were variables studied. Fisher exact test, Mann–Whitney test and logistic regression was used for statistical analysis.
There were 234 survivors and 32 non-survivors. Male was predominant. The overall incidence of BSI was 18.8%, and the overall crude mortality was 12%. Burns $\geq$ 30% TBSA and BSI were significant risk factors. A predictive function based on30% TBSA and BSI within 14 days after the onset of burns (BSI-14) was derived. The function has a sensitivity of 0.97, specificity of 0.42 and achieved a maximum Youden Index at functional value $\geq$ 0.05727. The mortality probability of BSI-14 in burns $\geq$ 30% TBSA was 40.8%.
BSI and burns $\geq$ 30% TBSA were significant risk factors of mortality. Early detection of BSI-14 is critical in burn care as its probability of mortality can be as high as 40% in patients $\geq$ 30% TBSA of burns. To reduce the risk of mortality, early in ventilator withdrawal, invasive lines and tubes removal, and early grafting should be emphasized besides infection control and appropriate use of antibiotics.
The implementation of an infection control bundle within a Total Care Burns Unit
2021, Burns
Citation Excerpt :
HAI’s a contributing factor in 87.1% of hospitalized patient deaths with HAI rates ranging from 11 to 32.5% in adult burn patient populations and 13.6 to 33.9% in paediatric burn populations [5–9]. Burn wound infections are the most common HAI amongst this population, with paediatric burn populations reporting burn wound HAI rates of 10.1–55% [5,8–10]. Common burn wound pathogens include Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacter cloacae, Escherichia coli, Enterococcus species, Candida albicans, Acinetobacter and Aspergillus species with an increasing incidence of multi-drug resistant organisms reported [11–15].
To evaluate the impact of the implementation of a best practice infection prevention and control bundle on healthcare associated burn wound infections in a paediatric burns unit.
Burn patients are vulnerable to infection. For this patient population, infection is associated with increased morbidity and mortality, thereby representing a significant challenge for burns clinicians who care for them.
An interrupted time series was used to compare healthcare associated burn wound infections in paediatric burn patients before and after implementation of an infection prevention and control bundle. Prospective surveillance of healthcare associated burn wound infections was conducted from 2012 to 2014. Other potential healthcare associated infection rates were also reviewed over the study period, including urinary tract infections, pneumonia, upper respiratory tract infections and sepsis. An infection prevention and control bundle developed in collaboration between the paediatric burn unit and infection control clinicians was implemented in 2013 in addition to previous standard practice.
During the study period a total of 626 patients were admitted to the paediatric burns unit. Healthcare associated burn wound infections reduced from 34 in 2012 to 0 in 2014 following the implementation of the infection prevention and control bundle. Pneumonia and sepsis also reduced to 0 in 2013 and 2014, however one upper respiratory tract infection occurred in 2013 and urinary tract infections persisted in 2013.
The implementation of an infection prevention and control bundle was effective in reducing healthcare associated burn wound infections, pneumonia and sepsis within our paediatric burns unit. Urinary tract infections remain a challenge for future improvement.
Rehabilitation in the Acute Versus Outpatient Setting
2017, Clinics in Plastic Surgery
Citation Excerpt :
The challenges in the rehabilitation of patients with burn injuries are on one hand similar to those in other critically ill patients and on the other hand unique in regard to burn injury and its sequelae. Generally, prolonged immobility during intensive care, resulting in muscle and bone wasting,3,4 loss of strength and coordination,4 as well as complications arising from secondary infection are common problems in all critically ill patients.5–7 Specifically in patients with severe burn injury, factors such as periodically recurring operations,8,9 delayed closure and secondary infection of dermal wounds,10,11 pulmonary dysfunction resulting from inhalation injury,12 and the need for specific positioning of patients in order to protect skin-grafted areas or donor sites represent serious challenges to early rehabilitation.13
Changing trends in antimicrobial susceptibility pattern of bacterial isolates in a burn unit
2017, Burns
Emerging antimicrobial resistance in nosocomial bacterial isolates, limits the available treatment options for burn wound infections, among them multi-drug resistant Gram negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) are major contributors to the increase in morbidity and mortality rates.
A retrospective cross-sectional study was done in the Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi. A total of 818 wound samples from patients admitted in the burn wards and Intensive Care Units (ICUs) examined between 2010-2014 (5 years period). Pseudomonas aeruginosa was found as the most common isolate (37%) followed by Klebsiella pneumoniae (15%) and Acinetobacter baumanii (12%) among Gram negative organisms while S. aureus (12%) remained the major isolates among Gram positive organisms. A significant decrease in incidence of Gram positive organisms was observed in comparison with previous study. However, resistance to ceftazidime and aminoglycosides were increased significantly in Gram negative organisms. Multi-drug resistant P. aeruginosa (MDR PA) accounted for 15.2%, multi-drug resistant A. baumanii (MDR AB) was prevalent in 13.8% and MRSA in 77.4% of burn wound infections.
Emerging bacterial drug resistance has both clinical and financial implications for the therapy of infected burn patients. Spectrum of bacterial drug resistance in an institution is important for epidemiological as well as clinical purposes. Rising frequency of MDR strains in burn patients is alarming for clinicians as it downgrades the treatment efficacy.
Anesthesia for Burn Injuries
2016, Smith's Anesthesia for Infants and Children, Ninth Edition
Epidemiological and bacteriological profiles in children with burns
2014, Burns
Citation Excerpt :
The higher rate of CVC device use in the series of Santucci et al. [20] was associated with a higher rate of primary BSI associated with CVC (a rate of 34 per 1000 CVC-days whereas this rate was almost six-fold lower in our series: 5.7 per 1000 CVC-days). It has been noted that other factors may interfere in the development of primary bacteraemia; these could be direct inoculation of the bacteria into the bloodstream after the destruction of the skin surface [10,20] or translocation of bacteria secondary to an intestinal hypoperfusion often observed during A. baumanii shock states [9,14,25,35–37]. However, in our study, the average injury size was significantly smaller than in other reported series (The mean BBSA of our patient population was 10%).
The aim of our study is to determine the most prevalent bacteria responsible for nosocomial infection (NI) in burned children.
A prospective analytic study was conducted over a period of 30 months at the Children's Hospital of Tunisia. All burned children were enrolled.
A total of 185 children were hospitalised during the study period. The mean age was 30 months (interquartile range, IR:18; 48). The gender ratio of the study population was 1.3 (104 males and 81 females). The mean total body surface area burned (TBSA) was 10% (IR:6; 16). The incidence rate of NI was 39.1 NIs per 1000 patient-days and two-thirds of the infections were polymicrobial. The most common isolated micro-organisms were methicillin-susceptible Staphylococcus aureus (MSSA, 57.7%), wild-type Pseudomonas aeruginosa (35.9%) and wild-type Enterobacter cloacae (26.9%). The case fatality rate was 5.9% corresponding to a crude death rate of 1.32 deaths per year. Septic shock with multiple organ failure was the leading cause of death.
The most common micro-organisms responsible for NI in our series were of the wild-type phenotype. Thus, on suspicion of sepsis, empiric antibiotic treatment combining piperacillin, oxacillin and gentamicin can be proposed until identification of the causative microorganism is available.

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ArticleNosocomial infections in pediatric patients with burns

Abstract

AJIC Am J Infect Control

J Surg Res

Burns

Does early excision of burn wounds change the pattern of mortality?

J Burn Care Rehabil

Does infection control control infection?

Arch Surg

The nationwide nosocomial infection rate: a new need for vital statistics

Am J Epidemiol

CDC definitions for nosocomial infections, 1988

AJIC Am J Infect Control

Effectiveness of a surgical wound surveillance program

Arch Surg

Continuous, 10-year wound infection surveillance: results, advantages, and unanswered questions

Arch Surg

Surgical wound infection

Am J Med

Article
Nosocomial infections in pediatric patients with burns