title: Timeline of health care-associated infections and pathogens after burn injuries.
abstract: Infections are an important cause of morbidity and mortality after burn injuries. Here, we describe the time line of infections and pathogens after burns.
  
  
  
  A retrospective study was performed in a large tertiary care burn center from 2004-2013. Analyses were performed on health care-associated infections (HAIs) meeting Centers for Disease Control and Prevention criteria and on all positive cultures. Incidence rates per 1,000 days were calculated for specific HAI categories and pathogens and across hospitalization time (week 1, weeks 2-3, and week ≥4).
  
  
  
  Among 5,524 patients, the median burn size was 4% of total body surface area (interquartile range, 2%-10%). Of the patients, 7% developed an HAI, of whom 33% had >1 HAI episode. Gram-positive bacteria were isolated earlier, and gram-negative bacteria were isolated later during hospitalization. Of 1,788 bacterial isolates, 44% met criteria for multidrug resistance, and 23% met criteria for extensive drug resistance. Bacteria tended to become increasingly resistant to antibiotics as time from admission increased.
  
  
  
  We observed differences in infection type, pathogen, and antibiotic-resistant bacterium risk across time of hospitalization. These results may guide infection prevention in various stages of the postburn admission.
authors.affiliation: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC. Electronic address: david_vanduin@med.unc.edu.
authors.forename: David
authors.initials: D
authors.lastname: van Duin
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, NC.
authors.forename: Paula D
authors.initials: PD
authors.lastname: Strassle
authors.affiliation: Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: DiBiase
authors.affiliation: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Lachiewicz
authors.affiliation: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC; Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC.
authors.forename: William A
authors.initials: WA
authors.lastname: Rutala
authors.affiliation: North Carolina Jaycee Burn Center, Chapel Hill, NC; Host Defense Discovery Performance Unit, Glaxosmithkline, Research Triangle Park, NC.
authors.forename: Timothy
authors.initials: T
authors.lastname: Eitas
authors.affiliation: Host Defense Discovery Performance Unit, Glaxosmithkline, Research Triangle Park, NC.
authors.forename: Robert
authors.initials: R
authors.lastname: Maile
authors.affiliation: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC; Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC.
authors.forename: Hajime
authors.initials: H
authors.lastname: Kanamori
authors.affiliation: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC; Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC.
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.affiliation: North Carolina Jaycee Burn Center, Chapel Hill, NC; Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.affiliation: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC; Department of Epidemiology, University of North Carolina, Chapel Hill, NC.
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.affiliation: North Carolina Jaycee Burn Center, Chapel Hill, NC; Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Samuel W
authors.initials: SW
authors.lastname: Jones
mesh_terms: D000328:Adult; D001419:Bacteria / Q000145:classification* / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000382:microbiology* / Q000473:pathology*; D002056:Burns / Q000150:complications*; D003428:Cross Infection / Q000382:microbiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012969:Sodium Fluoride; D062606:Tertiary Care Centers; D014520:Urethane / Q000031:analogs & derivatives
chemical_list: C069856:TimeLine; D014520:Urethane; D012969:Sodium Fluoride
keywords: Bloodstream infection; Burn; Health care–associated infection; Intensive care unit; Pneumonia; Timing