The impact of nosocomially-acquired resistant Pseudomonas aeruginosa infection in a burn unit.
BACKGROUND
Nosocomially-acquired Pseudomonas aeruginosa remains a serious cause of infection and septic mortality in burn patients. This study was conducted to quantify the impact of nosocomially-transmitted resistant P. aeruginosa in a burn population.


METHODS
Using a TRACS burn database, 48 patients with P. aeruginosa resistant to gentamicin were identified (Pseudomonas group). Thirty-nine were case-matched to controls without resistant P. aeruginosa cultures (control group) for age, total body surface area, admission year, and presence of inhalation injury. Mortality and various morbidity endpoints were examined, as well as antibiotic costs.


RESULTS
There was a significantly higher mortality rate in the Pseudomonas group (33% vs. 8%, p < 0.001) compared with in the control group. Length of stay was increased in the Pseudomonas group (73.4 +/- 11.6 vs. 58.3 +/- 8.3 days). Ventilatory days (23.9 +/- 5.4 vs. 10.8 +/- 2.4, p < 0.05), number of surgical procedures (5.2 +/- 0.6 vs. 3.4 +/- 0.4, p < 0.05), and amount of blood products used (packed cells 51.1 +/- 8.0 vs. 21.1 +/- 3.4, p < 0.01; platelets 11.9 +/- 3.0 vs. 1.4 +/- 0.7, p < 0.01) were all significantly higher in the Pseudomonas group. Cost of antibiotics was also significantly higher ($2,658.52 +/- $647.93 vs. $829.22 +/- $152.82, p < 0.01).


CONCLUSIONS
Nosocomial colonization or infection, or both, of burn patients with aminoglycoside-resistant P. aeruginosa is associated with significantly higher morbidity, mortality, and cost of care. Increased resource consumption did not prevent significantly higher mortality rates when compared with that of control patients. Thus, prevention, identification, and eradication of nosocomial Pseudomonas contamination are critical for cost-effective, successful burn care.
Armour
Alexis D
AD
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada.
Shankowsky
Heather A
HA
Swanson
Todd
T
Lee
Jonathan
J
Tredget
Edward E
EE
D000328:Adult; D000416:Alberta; D000900:Anti-Bacterial Agents / Q000191:economics / Q000494:pharmacology; D002056:Burns / Q000191:economics / Q000382:microbiology* / Q000401:mortality; D016022:Case-Control Studies; D003428:Cross Infection; D018568:Crown-Rump Length; D005260:Female; D005839:Gentamicins / Q000494:pharmacology; D006801:Humans; D008297:Male; D011552:Pseudomonas Infections / Q000191:economics / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012121:Respiration, Artificial
D000900:Anti-Bacterial Agents; D005839:Gentamicins