Larger burn injuries associated with HAIs

Inhalational injuries and larger burns were both linked with health care-associated infections, or HAIs, among patients being treated for burn injuries, study data showed.

“It has been estimated that infections cause half of all burn deaths,” David van Duin, MD, PhD, associate professor of medicine at the University of North Carolina, Chapel Hill, and colleagues wrote. “Despite the tremendous impact of infections in the burn patient population, risk factors beyond burn size and inhalational injury are unclear, and whether burn size impacts the effect of risk factors on HAI incidence remains unknown.”

Van Duin and colleagues conducted a retrospective cohort study of 4,426 adult patients who were treated for burns at a tertiary burn center between 2004 and 2013. All patients received treatment for at least 2 days. Infection preventionists diagnosed HAIs in real time using CDC criteria, and the researchers used multivariable Cox proportional hazards regression to evaluate how various risk factors affected time to HAI.

Three hundred forty-nine (7.9%) patients experienced at least one HAI within 60 days of being admitted to the hospital, the researchers reported. Of these, skin and soft tissue infections were the most common (n = 125; 35.8%), followed by respiratory infections (n = 85; 24.4%). One hundred seventy-two patients died within 60 days, 68 of whom (39.5%) died following an HAI.

Patients whose burns constituted 5% to 10% of total body surface area were nearly three times as likely to have an HAI compared with those whose burns covered less than 5% (HR = 2.92; 95% CI, 1.63-5.23). Those with burns of 10% to 20% of total body surface area were more than six times more likely to develop an HAI (HR = 6.38; 95% CI, 3.64-11.17), van Duin and colleagues wrote, whereas those with burns of more than 20% total body surface area faced more than a 10-fold likelihood of acquiring an HAI (HR = 10.33; 95% CI, 5.74-18.6).

Burn mechanism also played a role, the researchers reported. Flame and electrical burns demonstrated the highest incidence of HAI among burns with a total body surface area of less than 20%, whereas in patients with larger burns, scald and contact burns had a higher incidence of HAI.

Patients who had inhalation injuries were 1.5 times more likely to develop an infection compared with those who did not (HR = 1.61; 95% CI, 1.17-2.22), the researchers reported. This effect appeared to increase in patients with burns of more than 20% of total body surface area (P = .09).

“Larger burns and inhalational injuries are associated with [an} increased incidence of HAIs; moreover, the effects of burn mechanism and inhalational injury on time to HAI are different among patients with larger burns,” van Duin and colleagues wrote. “Clinicians and infection preventionists may use these risk factors to identify potential interventions and increased surveillance systems to reduce the burden of infection among burn patients and to reduce morbidity and mortality. – by Andy Polhamus

Disclosures: Van Duin reports advisory roles with Actavis, Astellas, Medimmune, Sanofi-Pasteur and Shionogi. Please see the study for a complete list of all other authors’ relevant financial disclosures.