Background
Methods
Hospital and cases
Strategies for infection control
Data collection
Variables | Number (n = 37) | Percentage (%) |
---|---|---|
Number of total body surface area (%) (mean ± SD; range) | 46.1 ± 29.1 | 5–92 |
< 10 | 6 | 16.2 |
10–19 | 4 | 10.8 |
20–29 | 2 | 5.4 |
30–39 | 1 | 2.7 |
40–49 | 5 | 13.5 |
50–59 | 6 | 16.2 |
60–69 | 3 | 8.1 |
70–79 | 4 | 10.8 |
80–89 | 2 | 5.4 |
> 90 | 4 | 10.8 |
Number of third -degree burn severity (%) | ||
< 10 | 3 | 8.1 |
10–19 | 1 | 2.7 |
20–29 | 3 | 8.1 |
30–39 | 1 | 2.7 |
40–49 | 3 | 8.1 |
50–59 | 4 | 10.8 |
60–69 | 4 | 10.8 |
70–79 | 3 | 8.1 |
80–89 | 1 | 2.7 |
> 90 | 4 | 10.8 |
Main site of the third -degree burn | ||
30–50% burn of upper limb, except wrist and hand | 18 | 48.6 |
30–50% burn of lower limbs | 18 | 48.6 |
30–50% burn of trunk | 15 | 40.5 |
30–50% burn of face, head, and neck | 10 | 27.0 |
20–50% burn of wrists and hands | 4 | 10.8 |
30–50% burn of multiple specified sites | 4 | 10.8 |
Unspecified degree | 10 | 27.0 |
Number of surgeries | ||
0 | 5 | 13.5 |
1 | 7 | 18.9 |
2 | 5 | 13.5 |
3 | 7 | 18.9 |
4 | 4 | 10.8 |
5 | 3 | 8.1 |
6 | 1 | 2.7 |
Number of various surgical procedures | ||
1 | 4 | 10.8 |
2 | 1 | 2.7 |
4 | 2 | 5.4 |
5 | 2 | 5.4 |
6 | 3 | 8.1 |
7 | 4 | 10.8 |
8 | 2 | 5.4 |
9 | 1 | 2.7 |
> 10 | 8 | 21.6 |
Main types of surgery (n = 142) | ||
Operations on skin and subcutaneous tissue | 94 | 66.2 |
Operations on muscle, tendon, and fascia of hand | 18 | 12.7 |
Other operations on vessels | 11 | 7.7 |
Time spent of first surgery (mean ± SD; range) (minutes) | 58.5 ± 40.7 | 5–215 |
Time spent of surgery during the 7 days before healthcare-associated infection (mean ± SD; range) (minutes) | 76.3 ± 57.3 | 8–269 |
Variables | Number (n = 37) | Percentage (%) |
---|---|---|
Intensive care units | 24 | 64.9 |
Gender | ||
Male | 22 | 59.5 |
Female | 15 | 40.5 |
Inhalation injury | 32 | 86.5 |
Laboratory dataa | ||
White blood cell (≥10,500 mm3) | 27 | 73.0 |
Hematocrit < 35% | 8 | 21.6 |
Serum sodium (≥146 mmol/L) | 6 | 16.2 |
Serum potassium (≥5.5 mmol/L) | 4 | 10.8 |
Serum creatinine (≥1.5 mg/dL) | 4 | 10.8 |
Serum albumin (≤2.49 g/dL) | 0 | 0.0 |
Invasive devices (yes) | ||
Endotracheal tube | 23 | 62.2 |
Mechanical ventilator > 96 h | 16 | 43.2 |
Central line catheter | 18 | 48.6 |
Foley catheter | 13 | 35.1 |
Hemodialysis | 2 | 5.4 |
Extracorporeal membrane oxygenation | 1 | 2.7 |
Site of healthcare-associated infection (n = 40) | ||
Bloodstream infection | 28 | 70.0 |
Symptomatic urinary tract infection | 9 | 22.5 |
Asymptomatic bacteriuria | 2 | 5.0 |
Central nervous system infection | 1 | 2.5 |
Mortality | 1 | 2.7 |
Continuity variables | mean ± SD | min-max |
Age (years) | 22 ± 6.2 | 13–38 |
APACHE II scores | 14.3 ± 8.0 | 2–32 |
LOS before the first isolated MDR (n = 23) | 17.7 ± 16.0 | 2–55a |
Total LOS in hospital stay# | 85.4 ± 70.4 | 9–276a |
Baux score | 24.5 ± 8.7 | 6–46 |
Statistical analysis
Results
Patient demographic data
Microbiological investigations
Isolated pathogens | Total | % | Total body surface area (%) | days after admission | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
< 39 | 40–49 | 50–59 | 60–69 | 70–79 | 80–89 | > 90 | 1–3 | 4–7 | 8–14 | 15–30 | > 31 | |||
Total sampling numbers of culture specimen | 706 | 28 | 65 | 118 | 108 | 151 | 142 | 94 | 66 | 38 | 78 | 162 | 362 | |
Total number of culture-positive sample | 335 | 100 | 6 | 29 | 43 | 58 | 84 | 62 | 54 | 26 | 28 | 38 | 92 | 151 |
Rate of culture-positive (%) | 47.5 | 21.4 | 44.6 | 36.4 | 53.7 | 55.6 | 43.7 | 57.4 | 39.4 | 73.7 | 48.7 | 56.8 | 41.7 | |
Total number of MDRO | 104 | 1 | 9 | 17 | 21 | 20 | 19 | 17 | 2 | 6 | 9 | 35 | 52 | |
Rate of MDRO in total culture-positive (%) | 31.0 | 0.96 | 8.7 | 16.3 | 20.2 | 19.2 | 18.3 | 16.3 | 1.9 | 5.8 | 8.7 | 33.7 | 50.0 | |
Gram–positive cocci | 97 | 29.0 | 4 | 11 | 16 | 18 | 21 | 11 | 17 | 7 | 3 | 12 | 26 | 49 |
Staphylococcus sp. | 75 | 22.4 | 3 | 10 | 12 | 15 | 13 | 8 | 14 | 2 | 3 | 11 | 23 | 36 |
S. aureus | 2 | 0.6 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 1 |
S. aureus (MRSA) | 38 | 11.3 | 1 | 4 | 8 | 9 | 4 | 6 | 6 | 0 | 2 | 1 | 11 | 24 |
coagulase–negative staphylococcus | 21 | 6.3 | 1 | 2 | 3 | 4 | 6 | 1 | 4 | 2 | 1 | 7 | 6 | 5 |
other Staphylococcus sp. | 14 | 4.2 | 0 | 3 | 1 | 2 | 3 | 1 | 4 | 0 | 0 | 2 | 6 | 6 |
Enterococcus sp. | 9 | 2.7 | 1 | 1 | 2 | 3 | 2 | 0 | 1 | 4 | 0 | 1 | 0 | 4 |
E. faecium (VRE) | 7 | 2.1 | 0 | 0 | 1 | 0 | 4 | 2 | 0 | 1 | 0 | 0 | 2 | 4 |
Others | 6 | 1.8 | 0 | 0 | 1 | 0 | 2 | 1 | 2 | 0 | 0 | 0 | 1 | 5 |
Gram–positive bacilli | 4 | 1.2 | 0 | 0 | 3 | 0 | 1 | 0 | 0 | 2 | 2 | 0 | 0 | 0 |
Gram–negative bacilli | 46 | 13.7 | 1 | 3 | 7 | 7 | 11 | 8 | 9 | 4 | 3 | 7 | 12 | 20 |
Enterobacteriaceae | ||||||||||||||
Klebsiella pneumoniae | 9 | 2.7 | 0 | 0 | 3 | 2 | 1 | 2 | 1 | 0 | 1 | 1 | 3 | 4 |
Klebsiella pneumonia (CRKP) | 8 | 2.4 | 0 | 0 | 0 | 4 | 1 | 1 | 2 | 0 | 0 | 1 | 2 | 5 |
Escherichia coli | 5 | 1.5 | 0 | 1 | 0 | 0 | 1 | 1 | 2 | 0 | 0 | 0 | 3 | 2 |
Enterobacter sp. | 4 | 1.2 | 1 | 1 | 0 | 0 | 2 | 0 | 0 | 1 | 1 | 0 | 1 | 1 |
E. cloacae (CRE) | 1 | 0.3 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 |
Proteus mirabilis | 4 | 1.2 | 0 | 0 | 1 | 0 | 2 | 0 | 1 | 0 | 0 | 0 | 2 | 2 |
Serratia marcescens | 3 | 0.9 | 0 | 0 | 1 | 0 | 1 | 0 | 1 | 2 | 0 | 0 | 1 | 0 |
Aeromonas hydrophila | 2 | 0.6 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 0 | 0 |
Others | 10 | 3.0 | 0 | 0 | 1 | 1 | 2 | 4 | 2 | 0 | 0 | 4 | 0 | 6 |
Non-fermentative Gram-negative bacilli | 132 | 39.4 | 0 | 10 | 17 | 22 | 32 | 27 | 24 | 10 | 14 | 13 | 44 | 51 |
Acinetobacter sp. | 63 | 18.8 | 0 | 8 | 9 | 12 | 13 | 12 | 9 | 3 | 6 | 9 | 26 | 19 |
A. baumannii | 1 | 0.3 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 |
A. baumannii (IRAB) | 36 | 10.7 | 0 | 5 | 5 | 8 | 6 | 6 | 6 | 0 | 3 | 7 | 18 | 8 |
A. baumannii (PDRAB) | 13 | 3.9 | 0 | 0 | 2 | 0 | 4 | 4 | 3 | 0 | 1 | 0 | 2 | 10 |
A. baumannii complex | 13 | 3.9 | 0 | 3 | 2 | 3 | 3 | 2 | 0 | 3 | 1 | 2 | 6 | 1 |
Pseudomonas aeruginosa | 33 | 9.9 | 0 | 0 | 3 | 5 | 10 | 6 | 9 | 2 | 3 | 0 | 10 | 18 |
P. aeruginosa (PDR-PA) | 1 | 0.3 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
Stenotrophomonas maltophilia | 13 | 3.9 | 0 | 1 | 2 | 1 | 3 | 3 | 3 | 2 | 2 | 1 | 4 | 4 |
Chryseobacterium indologenes | 7 | 2.1 | 0 | 1 | 0 | 1 | 2 | 2 | 1 | 2 | 0 | 1 | 0 | 4 |
C. memingosepticum | 5 | 1.5 | 0 | 0 | 0 | 1 | 2 | 1 | 1 | 1 | 2 | 1 | 1 | 0 |
Chryseobacterium spp. | 4 | 1.2 | 0 | 0 | 0 | 1 | 1 | 2 | 0 | 0 | 0 | 0 | 0 | 4 |
Burkholderia cepacia | 3 | 0.9 | 0 | 0 | 3 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 2 | 0 |
Pseudomonas putida | 1 | 0.3 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 |
Moraxella osloensis | 1 | 0.3 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 0 |
Moraxella morganii | 1 | 0.3 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 1 |
Anaerobes | 4 | 1.2 | 0 | 1 | 0 | 0 | 0 | 2 | 0 | 2 | 0 | 0 | 0 | 2 |
Fungus | 51 | 15.2 | 1 | 4 | 0 | 11 | 19 | 13 | 4 | 1 | 6 | 6 | 10 | 28 |
Yeast | 45 | 13.4 | 0 | 3 | 0 | 10 | 15 | 13 | 4 | 1 | 6 | 4 | 8 | 26 |
Yeast | 25 | 7.5 | 0 | 1 | 0 | 8 | 7 | 9 | 0 | 0 | 2 | 2 | 4 | 17 |
Candida spp. | 14 | 4.2 | 0 | 2 | 0 | 2 | 5 | 2 | 3 | 1 | 3 | 2 | 4 | 4 |
Others | 6 | 1.8 | 0 | 0 | 0 | 0 | 3 | 2 | 1 | 0 | 1 | 0 | 0 | 5 |
MOLD | 6 | 1.8 | 0 | 1 | 0 | 1 | 4 | 0 | 0 | 0 | 0 | 2 | 2 | 2 |
Main risk factors
Variables | Logistic regression model | Cox regression model | ||||||
---|---|---|---|---|---|---|---|---|
Unadjust | Adjust | Unadjust | Adjust | |||||
OR (95% CI) | p-value | OR (95% CI) | p-value | HR (95% CI) | p-value | HR (95% CI) | p-value | |
Total body surface area (every 10%) | 3.6 (1.6–8.2) | .003 | 17.57 (1.47–21.0) | .024 | 1.31 (1.01–1.56) | .003 | 2.58 (1.71–3.88) | < .001 |
Third burn-degree severity (every 10%) | 1.79 (1.2–2.6) | .002 | 0.26 (0.05–1.41) | .118 | 1.14 (0.99–1.32) | .076 | 0.53 (0.38–0.73) | < .001 |