Invasive Infection and Outcomes in a Humanitarian Surgical Burn Program in Haiti

Compare to high-income settings, survival in burn units in low-income settings is lower with invasive infections one leading cause of death. M,decins Sans FrontiSres is involved in the treatment of large burns in adults and children in Haiti. In 2014, we performed a review of 228 patients admitted consecutively with burn injury during a 6-month period to determine patient outcomes and infectious complications. Microbiology was available through a linkage with a Haitian organization. Regression analysis was performed to determine covariates associated with bloodstream infection and mortality. 102 (45 %) patients were male, the median age was 8 years (IQR, 2-28), and the majority of patients (60 %) were admitted to the unit within 6 h of injury. There were 20 patients (9 %) with culture-proven bacteremia. Among organisms in blood, common isolates were Staphylococcus aureus (42 %), Pseudomonas aeruginosa (23 %), and Acinetobacter baumannii (15 %). Among patients with burns involving < 40 % total body area, 4 (2 %) of 192 died and 20 (65 %) of 31 with a parts per thousand yen40 % body surface area involvement died. Factors associated with mortality included involvement of a parts per thousand yen40 % of body surface, depth, and flame as the mechanism. Multidrug-resistant infections were common; 18 % of S. aureus isolates were methicillin resistant, and 83 % of P. aeruginosa isolates were imipenem resistant. A low mortality rate was observed in a humanitarian burn surgery project in patients with burns involving < 40 % of total body surface. Invasive infection was common and alarming rates of antibiotic resistance were observed, including infections not treatable with antibiotics available locally.