Bloodstream Infections in Severe Burn Patients: Epidemiology, Microbiology, Laboratory Features, and Risk Factors Associated with Mortality

Introduction: Bloodstream infections (BSI) are a major cause of morbidity and mortality in burn patients. Early empiric antibiotic treatment directed against pathogens is critical. Studies on BSI are limited in burn patients. This study aimed to investigate the epidemiological, clinical, and laboratory features of cases with BSI detected in the burn unit and the factors affecting mortality. Materials and Methods: Herein, we retrospectively studied sixty-eight inpatients diagnosed with BSI in the burn unit of our hospital during 2014-2018. Results: Among the sixty-eight cases included in the study, 73.5% were male, and the median age was 38. We observed that 25% of the cases had two-degree burns and 75% had third-degree burns, and the median total burn surface area (TBSA) was 36%. Eighty-six bacteremia episodes were detected in sixty-eight cases. The most common isolated bacteria were (75.5%) Gram-negative bacilli (Pseudomonas spp. and Acinetobacter spp.). Carbapenem resistance was detected in 63% of Gram-negative bacteria. The overall mortality was 35.3% (24/68). In the deceased cases, the median time between bacteremia and mortality was 3.5 days. In addition, the mortality was statistically significantly higher in cases with a TBSA of >40% and thrombocytopenia (p<0.05). The mortality in non-fermenting Gram-negative bacteria and Enterobacteriaceae was 42.1% and 30.8%, respectively; it was higher mainly in non-fermenters and Pseudomonas spp. than in others (48%). Conclusion: Burn patients are at high risk for infection. Unfortunately, if an infection develops, antibiotic treatment options are also limited due to the high resistance of microbial pathogens to carbapenem. High TBSA and thrombocytopenia appear to be significant prognostic factors for mortality. Therefore, infection control measures should be at a higher level, and the antibiotics to be started empirically should be broad spectrum.

Automated summary

Detection of BSI in burn patients is crucial for reducing mortality rates. High TBSA and thrombocytopenia are significant factors associated with mortality risk.