Contribution of bacterial and viral infections to attributable mortality in patients with severe burns: An autopsy series (original) (raw)

Attributable Mortality Due to Bacterial Infections Following Severe Burns: An Autopsy Series

Background: Bacterial infections are a common cause of mortality in burn patients with wound infection (WI), pneumonia and bloodstream infection (BSI) frequently cited as the most common clinical presentations. This study evaluates mortality attributable to bacterial WI, pneumonia and BSI as well as to specific organisms. Methods: A retrospective review of all autopsy reports from patients with thermal burns treated at the US Army Institute of Surgical Research (USAISR) Burn Unit over 12 years. Cause of death was determined by the same pathologist at autopsy for all patients. Results: Of the 3751 admissions, 228 (6%) died with autopsies performed on 97 (43%). Death was attributed to a bacterial cause in 27 (28%). Attributable mortality was associated with Pseudomonas aeruginosa (33%), Escherichia coli (15%), Klebsiella pneumoniae (11%) and Staphylococcus aureus (26%). This association was independent of % total body surface area burn, % full-thickness burn, inhalation injury, and da...

Management of burn injuries – recent developments in resuscitation, infection control and outcomes research

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2009

Introduction: Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve remote organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage soft tissue problems outside thermal injury including soft tissue infection and Toxic Epidermal Necrolysis.

Outcome following burns from 1985 to 2004 in the Centre for Severely Burned Patients, Ghent University Hospital, Belgium

2005

Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ® . A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality.

A 10-year experience with major burns from a non-burn intensive care unit

Burns, 2014

Major burns are injuries with necrosis at the epidermis and the dermis, resulting from thermic, chemical, electric or radiation exposure , with children and the elderly being the most affected . Although scalding injury is the most common mechanism of injury in adults at emergency departments, direct fire is the most common mechanism in hospitalised cases, especially in men, which is associated with greater mortality . The main risk factors associated with mortality identified so far are age, inhalation injury and total burn surface area (%TBSA) . Age contributes significantly to mortality, as survival in most paediatric population series is around 90-100%. Airway injury is reported in up to 43% of all hospitalised patients with major burns, giving an 8-10-fold risk of death . In addition, there is a marked correlation between %TBSA and death rising considerably from >20% TBSA . In a systematic review with >186,500 patients in Europe, Brusselaers reports a mortality rate from 1.4% to 18% (maximum 34%) in major burn patients ; however, much of these data come from reference centres, patients with a mean %TBSA between 11% and 24%, with less strict admission criteria, and patients not necessarily critically ill. On the other b u r n s x x x ( 2 0 1 4 ) x x x -x x x

Mortality rate associated with hospital acquired infections among burn patients

Biomedical Research and Therapy, 2016

Introduction: Hospital acquired infections (HAIs) are the major contributors of mortality associated with burn injuries. The aim of this research was to document the antecedents affiliated with major burn injuries, hospitalization and mortality in burn patients. Methods: We performed a single center prospective study of patients admitted during 3 months period (April-June 2014) in burn wards of government hospital. There were 100 patients in this investigation which were observed weekly. The inclusion criterion was based on the shifting of patients from emergency to the wards after initial treatment of more than 24 h. Variables included were age and gender of the patient, the percent total body surface area (%TBSA) burn, the cause of the burn. Results: Mean age of patients was 30.29 years. More females (55.67%) were admitted than males (44.32%). The total body surface area (%TBSA) burnt were from 15%-95% respectively moreover children were more sensitive to hospital acquired infections (HAIs) and mortality rate was 34% in children with mean age of 5 years and disability of body parts were 42% among 75% were females. Whereas the most common (HAIs) were primary bloodstream (PBS) with mean value of 30.50, wound infections (WIS) were at second prevalence with mean value of 27.50, followed by sepsis (S) and pneumonia (P) 10.33, eye infections (EIs) 4.833 and urinary tract infections (UTIs) 2.667. Factors significantly (p-value= 0.000) associated with increased duration of hospitalization caught HAIs mortality include the age and gender of the patient, the cause of burn, inhalation injury, the region affected and %TBSA burnt. Conclusion: It concluded that the mortality was very much dependent on age and gender of the patient, burn causes, affected area as well as % TBSA burnt are considerable factors in determining the relationship of HAIs and whether the patients will survive or knuckle to injuries. Better compliance techniques, stricter control over disinfection and sterilization practices and usage of broad spectrum antibiotics, and reduction of the environmental contamination are required to reduce the HAIs rates among burn patients.

Burn and scald injuries

2005

Burns are one of the most harmful physical and psychological traumas. Infection is the major cause of morbidity and mortality in burns. Infections acquired from hospital or from the patient's own endogenous flora have a significant prevalence after burns. Pseudomonas aeruginosa and Staphylococcus aureus are the most frequent colonizing agents whereas group A beta-haemolytic streptococci are the most virulent bacteria. Anaerobic bacteria and fungi are also prevalent. Viral infection is less frequent. Aggressive resuscitation, nutritional support, thorough surgical excision of infected wounds, early wound closure, grafting and the development of effective topical and systemic chemotherapy have largely improved morbidity and mortality rates of burn patients.

Clinical Outcome of Patients With Severe Burns Presenting to the Emergency Department

Journal of Current Surgery, 2012

Background: Burns are a leading cause of morbidity and mortality worldwide. Although a local burn covering a limited surface area can heal readily, deep or extensive burns can result in systemic damage and even death. This study evaluated the clinical characteristics of the patients presenting with severe burns and investigated the factors influencing mortality. Methods: The data for 1003 patients who presented with symptoms of severe burn to a tertiary care university hospital in Turkey between 2006 and 2007 were evaluated retrospectively. Results: The overall patient mortality was 7.7% (n = 78). The effect of male gender and age on mortality was significant. The highest mortality rate was in the group aged > 40 years. A burned area larger than 21% of the body surface conferred a high risk of mortality. A hospital stay for longer than 10 days, the presence of delirium at the time of presentation, hyperuricemia, the need for debriding, grafting, or fasciotomy, sepsis, hypovolemic shock, and a positive blood culture were significant predictors of mortality. Conclusions: Severe burns have to be treated in a burn unit or burn center. As the prevention of burns is important, it is important to identify the region-specific causes of burns and the risk factors that influence mortality.

Epidemiology and outcome analysis of burn patients admitted to an Intensive Care Unit in a University Hospital

Burns, 2016

Methods: A longitudinal retrospective study was conducted, involving patients admitted to the Intensive Care Unit of the Burn Center from January 2010 to December 2012. Demographic and diagnostic data including the diagnosis of the extent and causes of the burns, complications resulting from the burns and the need for specific surgical interventions were collected, together with data for the calculation of the Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), Therapeutic Intervention Scoring System (TISS-28) and Abbreviated Burn Severity Index (ABSI). Data were collected at admission and daily until discharge from the burn Intensive Care Unit. Risk factors for death and the prognostic performance of scores to predict mortality were analyzed. The level of significance was set at 5%. Results: Two hundred ninety-three patients were analyzed in the study; 68.30% were men, with a median age of 38 years (interquartile range: 28-52). The mean total body surface area burned was 26.60 AE 18.05%. Home incidents were the most frequent cause, occurring in 53.90% of the cases. Fire was the most common cause, found in 77.10% of patients. Liquid alcohol was the most common agent and was associated with 51.50% of the cases. The ABSI presented a median of 7, and the area under the ROC curve was 0.890. In multivariate analysis, age (p < 0.001), female gender (p = 0.02), total body surface area burned (p < 0.001), mechanical ventilation (p < 0.001) and acute renal failure (p < 0.001) were all associated with mortality. ICU mortality was 32.80%, and hospital mortality was 34.10%. Conclusion: Burns most often occurred in young adult men in our study. The most common cause was a direct flame. Liquid alcohol was the most frequent accelerating agent. Patients