MORBIDITY AND MORTALITY OF BLOODSTREAM INFECTIONS IN PATIENTS WITH SEVERE BURN INJURY

Background Bloodstream infections are common in burn patients. Objective To evaluate the effects of bloodstream infections in patients with severe burn injuries. Methods A retrospective, pairwise-matched, risk-adjusted cohort study in a 6-bed burn unit was done. Exposed patients with microbiological evidence of bloodstream infections (n = 76) were compared with nonexposed patients (n = 103) matched for burn severity (identical Belgian Outcome in Burn Injury score) and length of hospitalization (= time-to-event in exposed patients). Main outcome measures were length of hospitalization and mortality. Results Predominant pathogens were Staphylococcus aureus, enterococci, Pseudomonas aeruginosa, Escherichia coli, coagulase-negative staphylococci, and Candida species. Median patient age was 42 years (interquartile range [IQR], 31-52). Median total burned surface area was 40% (IQR, 25%-50%). Inhalation injury occurred in 54%. Median burn injury score was 4 (IQR, 2-5). Median length of stay before onset of bacteremia was 11 days (IQR, 5.3-19.8). Appropriate antimicrobial therapy was initiated within the first 48 hours in 76%. The exposed group had a higher need for vasopressive/inotropic support (P = .02); need for ventilatory assistance and renal replacement therapy did not differ significantly between groups. Hospital mortality did not differ (P = .30). However, bloodstream infection was associated with longer durations of hospitalization (P < .001) and mechanical ventilation (P < .001). Conclusions In this cohort of burn patients, bloodstream infections did not adversely affect survival, but greater durations of ventilator dependency and hospital stay increased costs of care. (American Journal of Critical Care. 2010;19:e81-e87)