title: Multiple-Drug Resistance in Burn Patients: A Retrospective Study on the Impact of Antibiotic Resistance on Survival and Length of Stay.
abstract: Despite improvements in early treatment, survival following burn injury remains challenged by sepsis and multiple organ dysfunction syndrome (MODS). Additionally, susceptibility to infections and growing antibiotic resistance places burn patients at increased risk for infections with multiple-drug resistant organisms (MDROs). We therefore aimed to evaluate the impact of MDRO infections on survival and hospital length of stay, as well as examine the role of these organisms in the development of complications, such as acute kidney injury, sepsis, and MODS. To study this, we included all burn patients with infections, admitted between January 1, 2012, and December 31, 2013. Patients were divided into two groups: patients with infections caused by MDROs and patients with infections caused by susceptible organisms. Data were collected on all available cultures, as well as demographic, injury, and treatment-related variables from the medical record. The number of operative procedures (median: 2 vs 1, P < .0001), ventilator days (21 vs 0 days, P < .0001), total antibiotic days (21 vs 7days, P < .0001), and length of hospitalization (39 vs 14 days, P < .0001) were significantly different in the MDRO group vs the nonresistant group. While MDRO infection was not associated with patient mortality, univariable logistic regression analyses demonstrated >20% TBSA (odds ratio [OR] = 4.30, 95% confidence interval [CI]: 1.14-16.29, P = .03), acute kidney injury (OR = 10.93, 95% CI: 2.74-43.57, P = .001), sepsis (OR = 19.20, 95% CI: 3.79-97.27, P < .001), and MODS (OR = 85.49, 95% CI: 12.97-563.28, P < .0001) significantly increased the odds of patient mortality. These findings suggest that infections with MDROs are associated with a greater number of surgical procedures, longer duration of mechanical ventilation, more antibiotic days, and longer hospitalization.
authors.affiliation: From the *Department of Surgery, Burn and Shock Trauma Research Institute, Loyola University Chicago Health Sciences Division, Maywood, Illinois; †Alcohol Research Program, Loyola University Chicago Health Sciences Division, Maywood, Illinois; ‡Department of Surgery, Loyola Burn Center, Loyola University Chicago Health Sciences Division, Maywood, Illinois; and §Clinical Research Office, Loyola University Chicago Health Sciences Division, Maywood, Illinois.
authors.forename: Ilse
authors.initials: I
authors.lastname: van Langeveld
authors.forename: Robin C
authors.initials: RC
authors.lastname: Gagnon
authors.forename: Peggie F
authors.initials: PF
authors.lastname: Conrad
authors.forename: Richard L
authors.initials: RL
authors.lastname: Gamelli
authors.forename: Brendan
authors.initials: B
authors.lastname: Martin
authors.forename: Mashkoor A
authors.initials: MA
authors.lastname: Choudhry
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mosier
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D002053:Burn Units; D002056:Burns / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy; D004352:Drug Resistance, Microbial; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult