title: Universal contact precautions do not change the prevalence of antibiotic resistant organisms in a tertiary burn unit.
abstract: OBJECTIVE
  The prevalence of antibiotic-resistant organisms (ARO) in burn units is increasing worldwide and contributes significantly to morbidity and mortality. Study aims are to describe the burden of AROs in burn patients admitted to a tertiary burn unit, to evaluate the impact of contact precautions implemented after an outbreak of antibiotic-resistant Acinetobacter baumannii, and to identify possible predictors of ARO acquisition.
  
  
  METHODS
  Data of burn inpatients between 2006 and 2010 were retrospectively reviewed. The antibiotic susceptibility profiles of ARO colonization/infection at or after admission were reviewed in detail. Organisms of interest included: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum beta-lactamase-producing Escherichia coli, and carbapenem-resistant Pseudomonas and Acinetobacter. Univariate and multivariate logistic regression analysis was employed with the p-value set at 0.05.
  
  
  RESULTS
  Complete data analysis was available for 340 patients. The mean age was 41.8 years with male predominance. Among the AROs, the most prevalent was MRSA from clinical specimens. Prior to contact precaution implementation, the prevalence of all AROs was 27.9%, compared to 27.6% afterwards. There was an increase in Pseudomonas and VRE isolates and a disappearance of Acinetobacter. The most common isolate sites were the burn wounds. ICU stay, burns >20% TBSA, and surgical management were significant predictors of ARO acquisition.
  
  
  CONCLUSIONS
  This study describes the ARO profile of burn patients admitted to a tertiary burn unit. The results suggest that implementation of unit-wide contact precautions may not significantly reduce the frequency of AROs among burn patients. Contact precautions for patients transferred from the ICU, undergoing surgery, and large burns may be of benefit.
authors.affiliation: UBC Division of Plastic Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors.forename: Adelyn L
authors.initials: AL
authors.lastname: Ho
authors.affiliation: Division of Plastic Surgery, University of Ottawa, Ontario, Canada.
authors.forename: Reid
authors.initials: R
authors.lastname: Chambers
authors.affiliation: Division of Plastic Surgery, University of Ottawa, Ontario, Canada.
authors.forename: Claudia
authors.initials: C
authors.lastname: Malic
authors.affiliation: UBC Division of Plastic Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada. Electronic address: anthony.papp@gmail.com.
authors.forename: Anthony
authors.initials: A
authors.lastname: Papp
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D040981:Acinetobacter baumannii; D000328:Adult; D002053:Burn Units; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D015995:Prevalence; D011552:Pseudomonas Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D062606:Tertiary Care Centers; D016635:Universal Precautions / Q000379:methods*; D065507:Vancomycin-Resistant Enterococci; D055815:Young Adult
keywords: Antibiotic-resistant organisms; Burns; Colonization; Contact precautions; Infection