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Predicting mortality in burn patients with bacteraemia

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Abstract

Objective

To determine factors associated with mortality in burn patients with bacteraemia.

Background

Previous studies have shown the negative impact of bacteraemia on the prognosis of burn patients, but only a few of these have analysed variables intervening in the clinical progress of these patients.

Methods

A retrospective study of adult burn patients (n = 73) with bacteraemia (103 episodes) in a Burns Unit during the 2000–2013 period. The study collected demographic variables, and comorbidity, injury-related and clinical data related to bacteraemia. Variables related to hospital mortality were analysed using a multiple logistic regression model.

Results

The cumulative incidence of bacteraemia was 4.4 episodes/100 patients. The mean age was 53.3 ± 19.2 years (65.8 % male). The median total body surface area (TBSA) was 35 %, while 50.7 % of the population had inhalation syndrome. The mean SOFA score at the onset of bacteraemia was 2.7 ± 3.8. The most common pathogen was Pseudomonas aeruginosa (17.5 %). The mortality rate was 24.7 %. The variables that were significantly associated with mortality were age (OR = 1.13), TBSA (OR = 1.05), SOFA score at the onset of bacteraemia (OR = 1.53) and recurrent bacteraemia (OR = 41.6).

Conclusion

In addition to conventional risk factors, recurrence and organ dysfunction at the onset of bacteraemia are also associated with mortality, while the pathogen involved is not a prognostic factor.

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References

  1. Rafla K, Tredget EE. Infection control in the burn unit. Burns. 2011;37:5–15.

    Article  PubMed  Google Scholar 

  2. Mann EA, Baun MM, Meininger JC, Wade CE. Comparison of mortality associated with sepsis in the burn, trauma, and general intensive care unit patient: a systematic review of the literature. Shock. 2012;37:4–16.

    Article  PubMed  Google Scholar 

  3. Patel BM, Paratz JD, Mallet A, Lipman J, Rudd M, Muller MJ, et al. Characteristics of bloodstream infections in burn patients: An 11-year retrospective study. Burns. 2012;38:685–90.

    Article  PubMed  Google Scholar 

  4. Mahar P, Padiglione AA, Cleland H, Paul E, Hinrichs M, Wasiak J. Pseudomonas aeruginosa bacteraemia in burns patients: risk factors and outcomes. Burns. 2010;36:1228–33.

    Article  PubMed  Google Scholar 

  5. Fitzwater J, Purdue GF, Hunt JL, O’Keefe GE. The risk factors and time course of sepsis and organ dysfunction after burn trauma. J Trauma. 2003;54:959–66.

    Article  PubMed  Google Scholar 

  6. 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;34:649–58.

    Article  PubMed  Google Scholar 

  7. Theodorou P, Lefering R, Perbix W, Spanholtz TA, Maegele M, Spilker G, et al. Staphylococcus aureus bacteremia after thermal injury: the clinical impact of methicillin resistance. Burns. 2013;39:404–12.

    Article  PubMed  Google Scholar 

  8. Chow JW, Yu VL. Combination antibiotic therapy versus monotherapy for gram-negative bacteraemia: a commentary. Int J Antimicrob Agents. 1999;11:7–12.

    Article  CAS  PubMed  Google Scholar 

  9. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10.

    Article  CAS  PubMed  Google Scholar 

  10. Bang RL, Sharma PN, Sanyal SC, Bang S, Ebrahim MK. Burn septicaemia in Kuwait: associated demographic and clinical factors. Med Princ Pract. 2004;13:136–41.

    Article  PubMed  Google Scholar 

  11. Polk HC. Supportive therapy in burn care. Consensus summary on infection. J Trauma. 1979;19:894–6.

    CAS  PubMed  Google Scholar 

  12. Donati L, Scamazzo F, Gervasoni M, Magliano A, Stankov B, Fraschini F. Infection and antibiotic therapy in 4000 burned patients treated in Milan, Italy, between 1976 and 1988. Burns. 1993;19:345–8.

    Article  CAS  PubMed  Google Scholar 

  13. Pereira CT, Barrow RE, Sterns AM, Hawkins HK, Kimbrough CW, Jeschke MG, et al. Age-dependent differences in survival after severe burns: a unicentric review of 1,674 patients and 179 autopsies over 15 years. J Am Coll Surg. 2006;202:536–48.

    Article  PubMed  Google Scholar 

  14. Smith DL, Cairns BA, Ramadan F, Dalston JS, Fakhry SM, Rutledge R, et al. Effect of inhalation injury, burn size, and age on mortality: a study of 1447 consecutive burn patients. J Trauma. 1994;37:655–9.

    Article  CAS  PubMed  Google Scholar 

  15. Ryan CM, Schoenfeld DA, Thorpe WP, Sheridan RL, Cassem EH, Tompkins RG. Objective estimates of the probability of death from burn injuries. N Engl J Med. 1998;338:362–6.

    Article  CAS  PubMed  Google Scholar 

  16. O’Keefe GE, Hunt JL, Purdue GF. An evaluation of risk factors for mortality after burn trauma and the identification of gender-dependent differences in outcomes. J Am Coll Surg. 2001;192:153–60.

    Article  PubMed  Google Scholar 

  17. Galeiras R, Lorente JA, Pertega S, Vallejo A, Tomicic V, de la Cal MA, et al. A model for predicting mortality among critically ill burn victims. Burns. 2009;35:201–9.

    Article  PubMed  Google Scholar 

  18. Lionelli GT, Pickus EJ, Beckum OK, Decoursey RL, Korentager RA. A three decade analysis of factors affecting burn mortality in the elderly. Burns. 2005;31:958–63.

    Article  CAS  PubMed  Google Scholar 

  19. Edelman DA, White MT, Tyburski JG, Wilson RF. Factors affecting prognosis of inhalation injury. J Burn Care Res. 2006;27:848–53.

    Article  PubMed  Google Scholar 

  20. Thombs BD, Singh VA, Halonen J, Diallo A, Milner SM. The effects of preexisting medical comorbidities on mortality and length of hospital stay in acute burn injury: evidence from a national sample of 31,338 adult patients. Ann Surg. 2007;245:629–34.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Baux S, Mimoun M, Saade H, Lioret N, Esteve M, Nolland XB, et al. Burns in the elderly. Burns. 1989;15:239–40.

    Article  CAS  PubMed  Google Scholar 

  22. Holmes T. A system of surgery: theoretical and practical. 1st ed. London: JW Parker and Sons; 1860.

  23. Bull JP, Squire JR. A study of mortality in a burns unit: standards for the evaluation of alternative methods of treatment. Ann Surg. 1949;130:160–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Hollingsed TC, Saffle JR, Barton RG, Craft WB, Morris SE. Etiology and consequences of respiratory failure in thermally injured patients. Am J Surg. 1993;166:592–6 (discussion 6–7.).

    Article  CAS  PubMed  Google Scholar 

  25. Regules JA, Glasser JS, Wolf SE, Hospenthal DR, Murray CK. Endocarditis in burn patients: clinical and diagnostic considerations. Burns. 2008;34:610–6.

    Article  PubMed  Google Scholar 

  26. Gang RK, Bang RL, Sanyal SC, Mokaddas E, Lari AR. Pseudomonas aeruginosa septicaemia in burns. Burns. 1999;25:611–6.

    Article  CAS  PubMed  Google Scholar 

  27. Raz-Pasteur A, Hussein K, Finkelstein R, Ullmann Y, Egozi D. Blood stream infections (BSI) in severe burn patients–early and late BSI: a 9-year study. Burns. 2013;39:636–42.

    Article  PubMed  Google Scholar 

  28. Mallolas J, Gatell JM, Miró JM, Marco F, Bisbe J, Jiménez de Anta MT, et al. Analysis of prognostic factors in 274 consecutive episodes of Pseudomonas aeruginosa bacteremia. Antibiot Chemother. 1971;1991:106–14.

    Google Scholar 

  29. Kuikka A, Valtonen VV. Factors associated with improved outcome of Pseudomonas aeruginosa bacteremia in a Finnish university hospital. Eur J Clin Microbiol Infect Dis. 1998;17:701–8.

    Article  CAS  PubMed  Google Scholar 

  30. Baskin TW, Rosenthal A, Pruitt BA. Acute bacterial endocarditis: a silent source of sepsis in the burn patient. Ann Surg. 1976;184:618–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Correspondence to Rita Galeiras.

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Ceniceros, A., Pértega, S., Galeiras, R. et al. Predicting mortality in burn patients with bacteraemia. Infection 44, 215–222 (2016). https://doi.org/10.1007/s15010-015-0847-x

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  • DOI: https://doi.org/10.1007/s15010-015-0847-x

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