Staphylococcus aureus carriage at admission predicts early-onset pneumonia after burn trauma.
Early-onset pneumonia (EOP) is frequent after burn trauma, increasing morbidity in the critical resuscitation phase, which may preclude early aggressive management of burn wounds. Currently, however, preemptive treatment is not recommended. The aim of this study was to identify predictive factors for EOP that may justify early empirical antibiotic treatment. Data for all burn patients requiring ≥4 h mechanical ventilation (MV) who were admitted between January 2001 and October 2012 were extracted from the hospital's computerized information system. We reviewed EOP episodes (≤7 days) among patients who underwent endotracheal aspiration (ETA) within 5 days after admission. Univariate and multivariate analyses were performed to identify independent factors associated with EOP. Logistic regression was used to identify factors predicting EOP development. During the study period, 396 burn patients were admitted. ETA was performed within 5 days in 204/290 patients receiving ≥4 h MV. One hundred and eight patients developed EOP; 47 cases were caused by Staphylococcus aureus, 37 by Haemophilus influenzae, and 23 by Streptococcus pneumoniae. Among the 33 patients showing S. aureus positivity on ETA samples, 16 (48.5 %) developed S. aureus EOP. Among the 156 S. aureus non-carriers, 16 (10.2 %) developed EOP. Staphylococcus aureus carriage independently predicted EOP (p < 0.0001). We identified S. aureus carriage as an independent and strong predictor of EOP. As rapid point-of-care testing for S. aureus is readily available, we recommend testing of all patients at admission for burn trauma and the consideration of early preemptive treatment in all positive patients. Further studies are needed to evaluate this new strategy.
Pharmacy Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.|School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
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http://orcid.org/0000-0003-3813-1199
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Fournier
Pharmacy Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.|School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
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Voirol
Adult Intensive Medicine Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Krähenbühl
Adult Intensive Medicine Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Bonnemain
Adult Intensive Medicine Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Fournier
Unit of Population Epidemiology, Department of Community Medicine, Primary Care, and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
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Dupuis-Lozeron
Adult Intensive Medicine Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Pantet
Adult Intensive Medicine Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Pagani
Adult Intensive Medicine Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Revelly
Pharmacy Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.|School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
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Sadeghipour
Adult Intensive Medicine Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Eggimann
Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland. yok-ai.que@insel.ch.
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D000328:Adult; D002056:Burns / Q000150:complications*; D002353:Carrier State / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011023:Pneumonia, Staphylococcal / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D014947:Wounds and Injuries / Q000150:complications*