The Impact of Multidrug-Resistant Organisms Infection on Outcomes in Burn Injury Patients at Sanglah General Hospital, Bali
DOI:
https://doi.org/10.3889/oamjms.2021.6523Keywords:
Multi-drug resistant organism, Burn, Morbidity, MortalityAbstract
BACKGROUND: Research related to the impact of multidrug resistant organisms (MDRO) infection on clinical outcomes in burns is still limited.
AIM: This study evaluated the effect of MDRO infection on morbidity and mortality of burn patients.
METHODS: A single-center retrospective cohort study was conducted on burn patients admitted to the burn unit of Sanglah General Hospital, Bali, between 2018 and 2020. MDRO patients were described as those who had at least one positive MDRO culture. All other patients were included in the non-MDRO group. Measurement and analysis included mortality and five indicators of morbidity: length of stay, duration of antibiotic therapy, sepsis, pneumonia, and acute kidney injury (AKI).
RESULTS: Significant associations of MDRO infection were found for duration of antibiotic therapy (0 vs. 7 days), sepsis (odds ratio [OR] 13.90 [95% Confidence interval (CI) 95% 2.88–67.10]), pneumonia (OR 12,67 [95% CI 3.26–49.23]), and mortality (OR 9.75 [95% CI 2.00–47.50]). No significant association was found for the length of stay and the incidence of AKI. Multivariate analysis found that MDRO infection increased risk of sepsis (OR 36.53 [95% CI 2.05–652.45], pneumonia (OR 10.75 [95% CI 1.87–61.86]) and mortality (OR 57.09 [95% CI 1.41–2318.87]). Multivariate analysis of MDRO infection with duration of antibiotic therapy found no independent variables that were significantly related.
CONCLUSION: These research findings suggest that MDRO infections are associated with increasing length of antibiotic treatment, sepsis, pneumonia, and mortality in burn patients.Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Miller SF. Response to: Cause of death and correlation with autopsy findings in burns patient. Burns. 2013;39(8):1649. https://doi.org/10.1016/j.burns.2013.07.017 PMid:24041513 DOI: https://doi.org/10.1016/j.burns.2013.07.017
American Burn Association, Committee NBRA. National burn repository 2017 update. Am Burn Assoc. 2017;60606(312):1- 141. Available from: http://www.ameriburn.org/wp-content/uploads/2018/05/2017_aba_nbr_annual_report-1.pdf. https://doi.org/10.18411/a-2017-023. [Last accessed on 2021 Jan 20] DOI: https://doi.org/10.18411/a-2017-023
Alp E, Coruh A, Gunay GK, Yontar Y, Doganay M. Risk factors for nosocomial infection and mortality in burn patients: 10 years of experience at a university hospital. J Burn Care Res. 2012;33(3):379-85. https://doi.org/10.1097/bcr.0b013e318234966c PMid:22079911 DOI: https://doi.org/10.1097/BCR.0b013e318234966c
Brusselaers N, Monstrey S, Snoeij T, Vandijck D, Lizy C, Hoste E, et al. Morbidity and mortality of bloodstream infections in patients with severe burn injury. Am J Crit Care. 2010;19(6):81-8. https://doi.org/10.4037/ajcc2010341 PMid:21041189 DOI: https://doi.org/10.4037/ajcc2010341
Neely CJ, Kartchner LB, Mendoza AE, Linz BM, Frelinger JA, Wolfgang MC, et al. Flagellin treatment prevents increased susceptibility to systemic bacterial infection after injury by inhibiting anti-inflammatory IL-10+ IL-12-neutrophil polarization. PLoS One. 2014;9(1):e85623. https://doi.org/10.1371/journal.pone.0085623 PMid:24454904 DOI: https://doi.org/10.1371/journal.pone.0085623
Schultz L, Walker SA, Elligsen M, Walker SE, Simor A, Mubareka S, et al. Identification of predictors of early infection in acute burn patients. Burns. 2013;39(7):1355-66. https://doi.org/10.1016/j.burns.2013.04.009 PMid:23664774 DOI: https://doi.org/10.1016/j.burns.2013.04.009
Daniel JC, Gallagher JJ, Norbury WB, Finnerty CC, Herndon DN, Culnan DM. Treatment of infection in burn patients. In: Total Burn Care. 8th ed. Galveston: Elsevier; 2018. p. 93-113. https://doi.org/10.1016/b978-0-323-47661-4.00011-3 DOI: https://doi.org/10.1016/B978-0-323-47661-4.00011-3
van Duin D, Strassle PD, DiBiase LM, Lachiewicz AM, Rutala WA, Eitas T, et al. Timeline of health care-associated infections and pathogens after burn injuries. Am J Infect Control. 2016;44(12):1511-6. https://doi.org/10.1016/j.ajic.2016.07.027 PMid:27742146 DOI: https://doi.org/10.1016/j.ajic.2016.07.027
D’Abbondanza JA, Shahrokhi S. Burn infection and burn sepsis. Surg Infect (Larchmt). 2020;22(1):58-64. https://doi.org/10.1089/sur.2020.102 PMid:32364824 DOI: https://doi.org/10.1089/sur.2020.102
Lachiewicz AM, Hauck CG, Weber DJ, Cairns BA, van Duin D. Bacterial infections after burn injuries: Impact of multidrug resistance. Clin Infect Dis. 2017;65(12):2130-6. https://doi.org/10.1093/cid/cix682 PMid:29194526 DOI: https://doi.org/10.1093/cid/cix682
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81. https://doi.org/10.1111/j.1469-0691.2011.03570.x PMid:21793988 DOI: https://doi.org/10.1111/j.1469-0691.2011.03570.x
Greenhalgh DG, Saffle JR, Holmes JH, Gamelli RL, Palmieri TL, Horton JW, et al. American burn association consensus conference to define sepsis and infection in burns. J Burn Care Res. 2007;28(6):776-90. https://doi.org/10.1097/bcr.0b013e3181599bc9 PMid:17925660 DOI: https://doi.org/10.1097/BCR.0b013e3181599bc9
Kieninger AN, Lipsett PA. Hospital-acquired pneumonia: Pathophysiology, diagnosis, and treatment. Surg Clin North Am. 2009;89(2):439-61. https://doi.org/10.1016/j.suc.2008.11.001 PMid:19281893 DOI: https://doi.org/10.1016/j.suc.2008.11.001
Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM, et al. Acute kidney disease and renal recovery: Consensus report of the Acute Disease Quality Initiative (ADQI) 16 workgroup. Nat Rev Nephrol. 2017;13(4):241-57. https://doi.org/10.1038/nrneph.2017.2 PMid:28239173 DOI: https://doi.org/10.1038/nrneph.2017.2
Havey TC, Fowler RA, Pinto R, Elligsen M, Daneman N. Duration of antibiotic therapy for critically ill patients with bloodstream infections: A retrospective cohort study. Can J Infect Dis Med Microbiol. 2013;24(3):129-37. https://doi.org/10.1155/2013/141989 PMid:24421823 DOI: https://doi.org/10.1155/2013/141989
van Langeveld I, Gagnon RC, Conrad PF, Gamelli RL, Martin B, Choudhry MA, et al. Multiple-drug resistance in burn patients: A retrospective study on the impact of antibiotic resistance on survival and length of stay. J Burn Care Res. 2017;38(2):99- 105. https://doi.org/10.1097/bcr.0000000000000479 PMid:27984411 DOI: https://doi.org/10.1097/BCR.0000000000000479
Weber J, McManus A. Infection control in burn patients. Burns. 2004;30(8):A16-24. https://doi.org/10.1016/j.burns.2004.08.003 PMid:15555784 DOI: https://doi.org/10.1016/j.burns.2004.08.003
Norbury W, Herndon DN, Tanksley J, Jeschke MG, Finnerty CC. Infection in burns. Surg Infect (Larchmt). 2016;17(2):250-5. PMid:26978531 DOI: https://doi.org/10.1089/sur.2013.134
Atilla A, Tomak L, Katrancı AO, Ceylan A, Kılıç SS. Mortality risk factors in burn care units considering the clinical significance of acinetobacter infections. Ulus Travma Acil Cerrahi Derg. 2015;21(1):34-8. https://doi.org/10.5505/tjtes.2015.76814 PMid:25779710 DOI: https://doi.org/10.5505/tjtes.2015.76814
Theodorou P, Thamm OC, Perbix W, Phan VT. Pseudomonas aeruginosa bacteremia after burn injury: The impact of multiple-drug resistance. J Burn Care Res. 2013;34(6):649-58. https://doi.org/10.1097/bcr.0b013e318280e2c7 PMid:23817000 DOI: https://doi.org/10.1097/BCR.0b013e318280e2c7
Peña C, Suarez C, Gozalo M, Murillas J, Almirante B, Pomar V, et al. Prospective multicenter study of the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa bloodstream infections. Antimicrob Agents Chemother. 2012;56(3):1265-72. https://doi.org/10.1128/aac.05991-11 PMid:22155832 DOI: https://doi.org/10.1128/AAC.05991-11
Downloads
Published
How to Cite
License
Copyright (c) 2021 Gede Wara Samsarga, I Made Suka Adnyana, Ni Nyoman Sri Budayanti, I Gusti Putu Hendra Sanjaya, Agus Roy Rusly Hariantana Hamid, I Made Darmajaya, I Gusti Ayu Putri Purwanthi (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0