Epidemiology, prevalence and risk factors for infections in burn patients: results from a regional burn centre’s analysis

Abstract

Burn patients are at high risk of infections due to severe impairment of immunity and loss of skin barrier function. We aimed to describe the epidemiology, incidence and risk factors for infection in a cohort of burns patients. Two hundred patients were retrospectively enrolled and subdivided into infected (N = 81) and uninfected groups (N = 119). The cumulative prevalence of infections was 27% on day 7 and 43.8% on day 28. Skin and soft tissue infections (32%) were the most frequent. Carbapenem-resistant Acinetobacter baumannii (28%), Pseudomonas aeruginosa (26%) and methicillin-resistant Staphylococcus aureus (25%) infections were most prevalent. An indwelling central venous catheter (CVC; sub-hazard ratio [SHR] 7.41, 95% confidence interval [CI] 3.78–14.62) and revised Baux score (RBS; SHR 2.08, 95% CI 0.98–4.42) were associated with higher incremental infection rate while surgical treatment resulted in a protective factor (SHR 0.45, 95% CI 0.29–0.75). RBS may be useful to stratify the infection risk: a strict collaboration between surgeons and infectious disease specialists is needed to implement source control and antimicrobial surveillance.

Keywords:

• Burns
• Revised Baux score (RBS)
• antimicrobial stewardship
• multidrug-resistant organisms (MDROs)
• epidemiology
• infections

Acknowledgments

The authors wish to thank Dr. G. Ciccone for the valuable help in drafting the manuscript and the support in the statistical analysis.

Declarations

Ethics approval and consent to participate: Informed consent was waived due to the retrospective nature of the study. The study was performed by ICH-GCP guidelines and the declaration of Helsinki. (:036515)

Availability of data and material

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

Conflict of interest

The authors declare that they have no competing interests or conflicts of interest.

Authors’ contributions

SC and FGDR conceived the study, AP, MR, MS, TL collected, analyzed and interpreted the data, and elaborated the manuscript. MRR performed the enrollment of patients in the study. BB assisted in data collection. MS, FGDR supervised the study, corrected the final version of the manuscript. AC prepares all the statistical analysis. All authors read and approved the final version of the manuscript. We state that the results presented in this paper have not been published previously in whole or part, except in abstract format.

Additional information

Notes on contributors

Silvia Corcione

Silvia Corcione, M.D., PhD. Infectious Diseases, AOU Città della Salute e della Scienza, Molinette Hospital,Turin, ITALY. Adjunct Assistant Professor of Medicine, Tufts University School of Medicine, Boston, MA, USA Research Interests: Antimicrobials, Antibiotic Resistance, Antibiotics, Nosocomial Infection, Gram-Negative Bacteria.

Anna Pensa

Anna Pensa, M.D. Research fellow in Burn Centre of Turin, Italy. A.O.U. Città della Salute e della Scienza, Turin, Italy. Research Interests: burn surgery, antimicrobial stewardship

Anna Castiglione

Anna Castiglione, Master of Science. SSD Epidemiologia Clinica e Valutativa, Department of Medical Sciences, University of Turin. Research interests: epidemiology, clinical epidemiology.

Tommaso Lupia

Tommaso Lupia, M.D. The University of Turin, Department of Medical Sciences, Turin Research Interests: pneumonia, bloodstream infections, hepatitis, infections in internal medicine.

Barbara Bortolaso

Barbara Bortolaso, Technician coordinator of biomedical laboratory, A.O.U. Città della Salute e della Scienza, Turin, Italy. Research Interests: chemistry and biochemistry.

Maria Rosa Romeo

Mariarosa Romeo, M.D. M.D. in Burn Centre of Turin, Italy. A.O.U. Città della Salute e della Scienza, Turin, Italy. Research Interests: plastic surgery, burn and reconstructive surgery.

Maurizio Stella

Maurizio Stella, M.D. Chief of the Burn Centre of Turin, Italy. A.O.U. Città della Salute e della Scienza, Turin, Italy. Research Interests: plastic surgery, burn and reconstructive surgery.

Francesco Giuseppe De Rosa

Francesco Giuseppe De Rosa, M.D. Associate Professor, Department of Medical Sciences, University of Turin Director, Infectious Diseases City of Health & Science Turin & Asti, Italy. Research Interests: Infection, Infectious Disease Epidemiology, Infectious Diseases, Antibiotics, Diagnosis, Fungal Infection, Infection Control.