Pathogenic Characteristics and Risk Factors for ESKAPE Pathogens Infection in Burn Patients

Abstract

Objective

This study aimed to determine the clinical manifestations, antimicrobial resistance, molecular characteristics, and risk factors for ESKAPE pathogens infection in burn patients.

Methods

A retrospective study of 187 burn patients infected with ESKAPE pathogens was conducted at the Department of Plastic and Burn Surgery of the Affiliated Hospital of Southwest Medical University (Luzhou, China) from October 2018 to June 2021. All strains were identified using a MicroScan WalkAway 96 Plus System, and antimicrobial susceptibilities were determined using the VITEK system or the disk diffusion method. The antimicrobial resistance genes of multi-drug resistant ESKAPE (MDR-ESKAPE) were detected by polymerase chain reaction (PCR). The multivariable logistic regression analysis was used to estimate the risk factors for ESKAPE infection and MDR-ESKAPE infection.

Results

A total of 255 strains were isolated in various types of clinical specimens from 187 burn patients, of which 47.5% were ESKAPE pathogens (121/255). Among these, MDR-ESKAPE pathogens accounted for 55% (67/121). Additionally, aph3ʹIII, mecA, bla_SHV, bla_TEM, bla_PDC, and bla_SHV were the most prevalent genes detected in Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp., respectively. The independent risk factors for ESKAPE infection were total body surface area (TBSA) >30–50% (odds ratio [OR] = 10.428; 95% confidence interval [CI], 2.047 to 53.108), TBSA >50% (OR = 15.534; 95% CI, 1.489 to 162.021), and parenteral nutrition (OR = 3.597; 95% CI, 1.098 to 11.787). No independent risk factors were found for MDR-ESKAPE infection.

Conclusion

Clinical staff should be alert to the risk of nosocomial infection with ESKAPE pathogens in burn patients receiving parenteral nutrition and under TBSA >30%. Full attention should also be paid to the ESKAPE resistance, strict adherence to infection control protocols for the rational use of antimicrobial agents, and enhanced clinical standardization of antimicrobial agents management.

Keywords:

• burn
• ESKAPE pathogens infection
• antimicrobial resistance
• risk factors

Abbreviations

TBSA, total body surface area; CHINET, China Antimicrobial Surveillance Network; IDSA, Infectious Disease Society of America; MDR-ESKAPE, multi-drug resistant ESKAPE; WHO, the World Health Organization; WBC, white blood cell count; NEU%, percentage of neutrophils; Hb, hemoglobin; PLT,platelets; A/G ratio, albumin-globulin ratio.

Data Sharing Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

This study was approved by the Institutional Review Board of affiliated hospital of southwest medical university in accordance with the Declaration of Helsinki (KY2020043). Written informed consent was obtained from all participants.

Author Contributions

ZL and JX contributed to conceive this study, analyze the data, and write the manuscript. JH, YD and ZZ collected the data. JY, ZD, and SL performed the experiments. ZL edited and confirmed final manuscript. JL provided the financial support. All authors contributed to manuscript revision, read, and approved the submitted version.

Disclosure

The authors declare that they have no conflicts of interest in this work.