title: Risk factors for, and the effect of MRSA colonization on the clinical outcomes of severely burnt patients.
abstract: BACKGROUND
  MRSA is an on-going problem for burn patients.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.affiliation: Burns Unit, Concord Repatriation General Hospital, Sydney, Australia. Electronic address: andrea.issler@gmail.com.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Issler-Fisher
authors.affiliation: Department of Microbiology and Infectious Diseases, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
authors.forename: Genevieve
authors.initials: G
authors.lastname: McKew
authors.affiliation: St. Vincent's Centre for Applied Medical Research, Sydney, Australia.
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Fisher
authors.affiliation: Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
authors.forename: Varun
authors.initials: V
authors.lastname: Harish
authors.affiliation: Department of Microbiology and Infectious Diseases, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gottlieb
authors.affiliation: Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
authors.forename: Peter K M
authors.initials: PK
authors.lastname: Maitz
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D001830:Body Surface Area; D002056:Burns / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D015897:Comorbidity; D062109:Dermatologic Surgical Procedures / Q000706:statistics & numerical data; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015208:Smoke Inhalation Injury / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D015599:Trauma Severity Indices; D016896:Treatment Outcome
keywords: Burns; MRSA; Outcome; Risk factors