Jared R Gallaher1, Wone Banda2, Anne M Lachiewicz3, Robert Krysiak3, Bruce A Cairns4, Anthony G Charles5,6,7,8. 1. Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC, USA. 2. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi. 3. Department of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA. 4. North Carolina Jaycee Burn Center, Department of Surgery, School of Medicine, University of North Carolina, 4008 Burnett Womack Building, CB# 7600, Chapel Hill, NC, USA. 5. Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC, USA. anthony_charles@med.unc.edu. 6. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi. anthony_charles@med.unc.edu. 7. North Carolina Jaycee Burn Center, Department of Surgery, School of Medicine, University of North Carolina, 4008 Burnett Womack Building, CB# 7600, Chapel Hill, NC, USA. anthony_charles@med.unc.edu. 8. School of Medicine, University of North Carolina, 4008 Burnett Womack Building, CB 7228, Chapel Hill, USA. anthony_charles@med.unc.edu.
Abstract
BACKGROUND: Multidrug-resistant (MDR) bacteria are an emerging international concern in low- and middle-income countries that threaten recent public health gains. These challenges are exacerbated in immunocompromised hosts, such as those with burn injury. This study sought to describe the epidemiology and associated clinical outcomes of burn wound colonization in a Malawian tertiary burn center. METHODS: This is a prospective analysis of burn patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, within 72 h of burn injury. A swab of each patient's primary wound was collected at admission and each subsequent week. The primary exposure was burn wound colonization with MDR bacteria, particularly Enterobacteriaceae. The primary outcome was in-hospital mortality. A log binomial model estimated the association between the exposure and outcome, adjusted for confounders. RESULTS: Ninety-nine patients were enrolled with a median age of 4 years (IQR 2-12) and a male preponderance (54%). Median total body surface area burn (TBSA) was 14% (IQR 9-25), and crude in-hospital mortality was 19%. Enterobacteriaceae were the most common MDR bacteria with 36% of patients becoming colonized. Wound colonization with MDR Enterobacteriaceae was associated with increased in-hospital mortality with a risk ratio of 1.86 (95% CI 1.38, 2.50, p < 0.001) adjusted for TBSA, burn type (scald vs. flame), sex, age, length of stay, and methicillin-resistant Staphylococcus aureus colonization. CONCLUSION: MDR bacteria, especially Enterobacteriaceae, are common and are associated with worse burn injury outcomes. In resource-poor environments, a greater emphasis on prevention of MDR bacterial colonization, improved isolation precautions, affordable diagnostics, and antibiotic stewardship are imperative.
BACKGROUND: Multidrug-resistant (MDR) bacteria are an emerging international concern in low- and middle-income countries that threaten recent public health gains. These challenges are exacerbated in immunocompromised hosts, such as those with burn injury. This study sought to describe the epidemiology and associated clinical outcomes of burn wound colonization in a Malawian tertiary burn center. METHODS: This is a prospective analysis of burn patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, within 72 h of burn injury. A swab of each patient's primary wound was collected at admission and each subsequent week. The primary exposure was burn wound colonization with MDR bacteria, particularly Enterobacteriaceae. The primary outcome was in-hospital mortality. A log binomial model estimated the association between the exposure and outcome, adjusted for confounders. RESULTS:Ninety-nine patients were enrolled with a median age of 4 years (IQR 2-12) and a male preponderance (54%). Median total body surface area burn (TBSA) was 14% (IQR 9-25), and crude in-hospital mortality was 19%. Enterobacteriaceae were the most common MDR bacteria with 36% of patients becoming colonized. Wound colonization with MDR Enterobacteriaceae was associated with increased in-hospital mortality with a risk ratio of 1.86 (95% CI 1.38, 2.50, p < 0.001) adjusted for TBSA, burn type (scald vs. flame), sex, age, length of stay, and methicillin-resistant Staphylococcus aureus colonization. CONCLUSION: MDR bacteria, especially Enterobacteriaceae, are common and are associated with worse burn injury outcomes. In resource-poor environments, a greater emphasis on prevention of MDR bacterial colonization, improved isolation precautions, affordable diagnostics, and antibiotic stewardship are imperative.
Authors: Nana Ama Amissah; Lieke van Dam; Anthony Ablordey; Opoku-Ware Ampomah; Isaac Prah; Caitlin S Tetteh; Tjip S van der Werf; Alexander W Friedrich; John W Rossen; Jan Maarten van Dijl; Ymkje Stienstra Journal: PLoS One Date: 2017-07-13 Impact factor: 3.240
Authors: Kiran Dyamenahalli; Kevin Choy; Daniel N Frank; Kevin Najarro; Devin Boe; Kathryn L Colborn; Juan-Pablo Idrovo; Anne L Wagner; Arek J Wiktor; Majid Afshar; Ellen L Burnham; Rachel H McMahan; Elizabeth J Kovacs Journal: J Burn Care Res Date: 2022-09-01 Impact factor: 1.819