title: Surveillance of antibiotic susceptibility in a Swedish Burn Center 1994-2012.
abstract: Patients with burn trauma are at risk for infections caused by antibiotic resistant bacteria (ABR) with subsequent increase in morbidity and mortality. As part of the Swedish strategic program against antibiotic resistance in intensive care (ICU-Strama), we have surveyed the distribution of species and ABR in isolates from patients admitted to a Swedish burn center at Linköping University Hospital from 1994 through 2012. In an international comparison Strama has been successful in reducing the antibiotic consumption among animals and humans in primary care. The aim of this study was to investigate the antibiotic consumption pressure and resistance rates in a Swedish burn unit.
  
  
  METHODS
  Microbiology data, total body surface area (TBSA), patient days, and mortality were collected from a hospital database for all patients admitted to the Burn Center at the University Hospital of Linköping from April 1994 through December 2012.
  
  
  RESULTS
  A total of 1570 patients were admitted with a mean annual admission rate of 83 patients (range: 57-152). 15,006 microbiology cultures (approximately 10 per patient) were collected during the study period and of these 4531 were positive (approximately 3 per patient). The annual mean total body surface area (TBSA) was 13.4% (range 9.5-18.5) with an annual mortality rate of 5.4% (range 1-8%). The MRSA incidence was 1.7% (15/866) which corresponds to an MRSA incidence of 0.34/1000 admission days (TAD). Corresponding figures were for Escherichia coli resistant to 3(rd) generation cephalosporins (ESBL phenotype) 8% (13/170) and 0.3/TAD, Klebsiella spp. ESBL phenotype 5% (6/134) and 0.14/TAD, carbapenem resistant Pseudomonas aeruginosa 26% (56/209) and 1.28/TAD, and carbapenem resistant Acinetobacter spp. 3% (2/64) and 0.04/TAD.
  
  
  CONCLUSIONS
  Our results show a sustained low risk for MRSA and high, although not increasing, risk for carbapenem resistant P. aeruginosa.
authors.affiliation: Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden. Electronic address: jian.fransen@gmail.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Fransén
authors.affiliation: Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden; Department of Plastic- and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Fredrik R M
authors.initials: FR
authors.lastname: Huss
authors.affiliation: Department of Clinical and Experimental Medicine, Clinical Microbiology, Linköping University, Linköping, Sweden.
authors.forename: Lennart E
authors.initials: LE
authors.lastname: Nilsson
authors.affiliation: Institution of Clinical and Experimental Medicine, Infectious Diseases, Linköping University, Linköping, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Rydell
authors.affiliation: Institution of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Folke
authors.initials: F
authors.lastname: Sjöberg
authors.affiliation: Institution of Clinical and Experimental Medicine, Infectious Diseases, Linköping University, Linköping, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Hanberger
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000187:drug effects; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology*; D002053:Burn Units; D002056:Burns / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D015780:Carbapenems / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007709:Klebsiella / Q000187:drug effects; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000453:epidemiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D013548:Sweden / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology*; D014946:Wound Infection / Q000453:epidemiology / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Antibacterial therapy; Antibiotic susceptibility; Burn mortality; Burn wound colonization; Burn wound infection