Andrea C Issler-Fisher1, Genevieve McKew2, Oliver M Fisher3, Varun Harish4, Thomas Gottlieb2, Peter K M Maitz4. 1. Burns Unit, Concord Repatriation General Hospital, Sydney, Australia. Electronic address: andrea.issler@gmail.com. 2. Department of Microbiology and Infectious Diseases, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia. 3. St. Vincent's Centre for Applied Medical Research, Sydney, Australia. 4. Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
Abstract
BACKGROUND: MRSA is an on-going problem for burn patients. AIM: To analyze risk factors for, and the effect of MRSA colonization on burn patients' outcome. METHODS: During 21 months burn patients' details and MRSA isolates were analyzed, and a case-control study performed. RESULTS: Of 357 burn patients, 57 (16%) tested positive for MRSA. Compared to the MRSA negative group, MRSA positive patients had a higher median total burn surface area (15%[IQR 5-17%] vs. 5%[IQR 2-8%]; p<0.001), more admissions to ICU (54% vs. 26%; p<0.001), longer ICU length of stay (4.3 vs. 1.0 days; p<0.001), required more operations (1.6 vs. 0.8; p<0.001), and had longer total hospital length of stay (25.5 vs. 8.0 days; p<0.001). MRSA positivity was a significant independent predictor of increased length of stay (6.0 days, 95%CI 2.39-9.6 days; p=0.001) in a multivariable regression model correcting for patients TBSA and co-morbidities. Cardiac comorbidities (OR 5.14, 95%CI 1.76-15.62; p<0.001) and a longer exposure to the hospital environment (OR 1.05, 95%CI 1.02-1.09, p=0.005) increased the likelihood for MRSA positivity. CONCLUSION: The negative impact of MRSA positivity on burn patients outcome indicates the need for improved screening procedures for early identification and further efforts toward MRSA infection control to prevent cross-infection as this may significantly impair patients' outcome.
BACKGROUND:MRSA is an on-going problem for burn patients. AIM: To analyze risk factors for, and the effect of MRSA colonization on burn patients' outcome. METHODS: During 21 months burn patients' details and MRSA isolates were analyzed, and a case-control study performed. RESULTS: Of 357 burn patients, 57 (16%) tested positive for MRSA. Compared to the MRSA negative group, MRSA positive patients had a higher median total burn surface area (15%[IQR 5-17%] vs. 5%[IQR 2-8%]; p<0.001), more admissions to ICU (54% vs. 26%; p<0.001), longer ICU length of stay (4.3 vs. 1.0 days; p<0.001), required more operations (1.6 vs. 0.8; p<0.001), and had longer total hospital length of stay (25.5 vs. 8.0 days; p<0.001). MRSA positivity was a significant independent predictor of increased length of stay (6.0 days, 95%CI 2.39-9.6 days; p=0.001) in a multivariable regression model correcting for patients TBSA and co-morbidities. Cardiac comorbidities (OR 5.14, 95%CI 1.76-15.62; p<0.001) and a longer exposure to the hospital environment (OR 1.05, 95%CI 1.02-1.09, p=0.005) increased the likelihood for MRSA positivity. CONCLUSION: The negative impact of MRSA positivity on burn patients outcome indicates the need for improved screening procedures for early identification and further efforts toward MRSA infection control to prevent cross-infection as this may significantly impair patients' outcome.
Authors: Paula D Strassle; Felicia N Williams; David J Weber; Emily E Sickbert-Bennett; Anne M Lachiewicz; Sonia Napravnik; Samuel W Jones; Bruce A Cairns; David van Duin Journal: Infect Control Hosp Epidemiol Date: 2017-10-30 Impact factor: 3.254