title: Predictors of infectious complications after burn injuries in children.
abstract: BACKGROUND
  Infections are the major life-threatening complication of burn injury and occur with the greatest frequency in children. Knowledge of their occurrence and management, however, is extrapolated from studies in adults. We performed a prospective study of infectious complications in burned children.
  
  
  OBJECTIVE
  To delineate epidemiology, risk factors and microbiology of infections in burned children where burn care and surgical interventions are optimal.
  
  
  METHODS
  Children hospitalized for burns were entered into prospective study. Characteristics of the burn injury were assessed, and active surveillance for infections was performed.
  
  
  RESULTS
  Seventy patients were entered [mean age, 42 months; mean total body surface area (TBSA), burn 15%]. Twenty-seven percent of patients developed 39 infections: 13 involved the burn wound (burn wound sepsis, 6; graft loss, 5; and cellulitis, 2); 13 were catheter-associated septicemia; 13 involved other sites (i.e. pneumonia, 4; urinary tract infection, 3; bacteremia, 2; endocarditis, 1; myocardial abscess, 1; toxin-mediated syndrome, 1; and otitis media, 1). Twenty-three infections were caused by a single organism, 9 infections by more than 1 organism and in 7 infections defined by CDC criteria no organism was recovered. Organisms causing infection were: Staphylococcus aureus, 19; Candida albicans, 4; Pseudomonas aeruginosa, 4; coagulase-negative Staphylococcus, 4; Enterococcus sp., 3; Escherichia coli, 1; Klebsiella oxytoca, 1; Serratia marcescens, 1; Streptococcus pneumoniae, 1; Streptococcus pyogenes, 1; Aspergillus fumigatus, 1; and Candida parapsilosis, 1. Burn mechanism (flame and inhalation), extent (TBSA >30%) and depth (full thickness) were risk factors for infection; young age and site of burn were not.
  
  
  CONCLUSIONS
  The most common infections occurring in burn children are burn wound infections and catheter-associated septicemia. Characteristics of burn injury predict risk of infection. Children with flame and inhalation injury, TBSA burned >30% and full thickness burns are at high risk of infectious complications.
authors.affiliation: Section of Infectious Disease, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
authors.forename: G L
authors.initials: GL
authors.lastname: Rodgers
authors.forename: J
authors.initials: J
authors.lastname: Mortensen
authors.forename: M C
authors.initials: MC
authors.lastname: Fisher
authors.forename: A
authors.initials: A
authors.lastname: Lo
authors.forename: A
authors.initials: A
authors.lastname: Cresswell
authors.forename: S S
authors.initials: SS
authors.lastname: Long
mesh_terms: D002056:Burns / Q000150:complications*; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000209:etiology* / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors