title: Invasive Infection and Outcomes in a Humanitarian Surgical Burn Program in Haiti.
abstract: BACKGROUND
  Compare to high-income settings, survival in burn units in low-income settings is lower with invasive infections one leading cause of death. Médecins Sans Frontières is involved in the treatment of large burns in adults and children in Haiti.
  
  
  METHODS
  In 2014, we performed a review of 228 patients admitted consecutively with burn injury during a 6-month period to determine patient outcomes and infectious complications. Microbiology was available through a linkage with a Haitian organization. Regression analysis was performed to determine covariates associated with bloodstream infection and mortality.
  
  
  RESULTS
  102 (45 %) patients were male, the median age was 8 years (IQR, 2-28), and the majority of patients (60 %) were admitted to the unit within 6 h of injury. There were 20 patients (9 %) with culture-proven bacteremia. Among organisms in blood, common isolates were Staphylococcus aureus (42 %), Pseudomonas aeruginosa (23 %), and Acinetobacter baumannii (15 %). Among patients with burns involving <40 % total body area, 4 (2 %) of 192 died and 20 (65 %) of 31 with ≥40 % body surface area involvement died. Factors associated with mortality included involvement of ≥40 % of body surface, depth, and flame as the mechanism. Multidrug-resistant infections were common; 18 % of S. aureus isolates were methicillin resistant, and 83 % of P. aeruginosa isolates were imipenem resistant.
  
  
  CONCLUSIONS
  A low mortality rate was observed in a humanitarian burn surgery project in patients with burns involving <40 % of total body surface. Invasive infection was common and alarming rates of antibiotic resistance were observed, including infections not treatable with antibiotics available locally.
authors.affiliation: Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1000 W. Carson St, Box 466, Torrance, CA, 90509, USA. ramurphy@gmail.com.
authors.forename: Richard A
authors.identifier: http://orcid.org/0000-0003-2249-7452
authors.initials: RA
authors.lastname: Murphy
authors.affiliation: Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France.|Rowan University School of Osteopathic Medicine, One Medical Center Drive, Stratford, NJ, 08084-1501, USA.
authors.forename: Luba
authors.initials: L
authors.lastname: Nisenbaum
authors.affiliation: Epicentre, 55 Rue Crozatier, Paris, France.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Labar
authors.affiliation: Division of Burns, Massachusetts General Hospital, 55 Blossom St., Boston, MA, 02114, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sheridan
authors.affiliation: Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Ronat
authors.affiliation: Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France.
authors.forename: Kelly
authors.initials: K
authors.lastname: Dilworth
authors.affiliation: Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France.
authors.forename: Jade
authors.initials: J
authors.lastname: Pena
authors.affiliation: Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France.
authors.forename: Erin
authors.initials: E
authors.lastname: Kilborn
authors.affiliation: Epicentre, 55 Rue Crozatier, Paris, France.
authors.forename: Carrie
authors.initials: C
authors.lastname: Teicher
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy*; D002056:Burns / Q000150:complications / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006205:Haiti; D006801:Humans; D008297:Male; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents