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Morbidity and mortality of bloodstream infections in patients with severe burn injury

Nele Brusselaers (UGent) , Stan Monstrey (UGent) , Thomas Snoeij (UGent) , Dominique Vandijck (UGent) , Christelle Lizy (UGent) , Eric Hoste (UGent) , STEFAAN LAUWAERT (UGent) , Kirsten Colpaert (UGent) , Linos Vandekerckhove (UGent) , Dirk Vogelaers (UGent) , et al.
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Abstract
Objective: To evaluate the effects of bloodstream infections [BSI] in patients with severe burn injuries. Methods: Retrospective (1992-2006), pairwise-matched (ratio 1:1 to 1:2), risk-adjusted cohort study in a 6-bed burn unit. A comparison was made between ‘exposed’ patients with microbiologically documented BSI (n=76) and non-exposed subjects (n=103) matched on burn severity (identical Belgian Outcome in Burn Injury [BOBI] score) and length of hospitalization (equivalent or longer than the time-to-event in the exposed patient). Main outcome measures were length of hospitalization and mortality. Results: Predominant pathogens were Staphylococcus aureus, enterococci, Pseudomonas aeruginosa, Escherichia coli, coagulase-negative staphylococci, and Candida spp. Median age was 42 years (interquartile range [IQR] 31-52y). Median total burned surface area was 40% (IQR: 25-50%). Fifty-four percent experienced an inhalation injury. The median BOBI score was 4 (IQR: 2-5). The median ICU stay before onset of bacteremia was 11 days (IQR: 5.3-19.8d). Appropriate antimicrobial therapy was initiated within the first 48h in 76.3%. The exposed group had a higher need for vasopressive/inotropic support (57.9% vs. 39.8%, p=0.017), whereas need for ventilatory assistance and renal replacement therapy were not significantly higher. Hospital mortality did not differ (11.8% vs. 17.5%, p=0.298). However, BSI was associated with an additional length of hospitalization of 25 days (61 vs. 36d; p<0.001), and an excess length of mechanical ventilation of 11 days (21 vs. 10d; p<0.001). Conclusions: In this cohort of burn patients, BSI did not adversely affect survival, but contributes to a substantial economic burden through excess length of ventilator dependency and hospital stay.
Keywords
mortality, outcome, burns, bacteremia, infection

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Chicago
BRUSSELAERS, NELE, Stan Monstrey, Thomas Snoeij, Dominique Vandijck, CHRISTELLE LIZY, Eric Hoste, STEFAAN LAUWAERT, et al. 2010. “Morbidity and Mortality of Bloodstream Infections in Patients with Severe Burn Injury.” American Journal of Critical Care 19 (6): e81–e87.
APA
BRUSSELAERS, N., Monstrey, S., Snoeij, T., Vandijck, D., LIZY, C., Hoste, E., LAUWAERT, S., et al. (2010). Morbidity and mortality of bloodstream infections in patients with severe burn injury. AMERICAN JOURNAL OF CRITICAL CARE, 19(6), e81–e87.
Vancouver
1.
BRUSSELAERS N, Monstrey S, Snoeij T, Vandijck D, LIZY C, Hoste E, et al. Morbidity and mortality of bloodstream infections in patients with severe burn injury. AMERICAN JOURNAL OF CRITICAL CARE. 2010;19(6):e81–e87.
MLA
BRUSSELAERS, NELE, Stan Monstrey, Thomas Snoeij, et al. “Morbidity and Mortality of Bloodstream Infections in Patients with Severe Burn Injury.” AMERICAN JOURNAL OF CRITICAL CARE 19.6 (2010): e81–e87. Print.
@article{859158,
  abstract     = {Objective: To evaluate the effects of bloodstream infections [BSI] in patients with severe burn injuries.
Methods: Retrospective (1992-2006), pairwise-matched (ratio 1:1 to 1:2), risk-adjusted cohort study in a 6-bed burn unit. A comparison was made between {\textquoteleft}exposed{\textquoteright} patients with microbiologically documented BSI (n=76) and non-exposed subjects (n=103) matched on burn severity (identical Belgian Outcome in Burn Injury [BOBI] score) and length of hospitalization (equivalent or longer than the time-to-event in the exposed patient). Main outcome measures were length of hospitalization and mortality.
Results: Predominant pathogens were Staphylococcus aureus, enterococci, Pseudomonas aeruginosa, Escherichia coli, coagulase-negative staphylococci, and Candida spp. Median age was 42 years (interquartile range [IQR] 31-52y). Median total burned surface area was 40\% (IQR: 25-50\%). Fifty-four percent experienced an inhalation injury. The median BOBI score was 4 (IQR: 2-5). The median ICU stay before onset of bacteremia was 11 days (IQR: 5.3-19.8d). Appropriate antimicrobial therapy was initiated within the first 48h in 76.3\%. The exposed group had a higher need for vasopressive/inotropic support (57.9\% vs. 39.8\%, p=0.017), whereas need for ventilatory assistance and renal replacement therapy were not significantly higher. Hospital mortality did not differ (11.8\% vs. 17.5\%, p=0.298). However, BSI was associated with an additional length of hospitalization of 25 days (61 vs. 36d; p{\textlangle}0.001), and an excess length of mechanical ventilation of 11 days (21 vs. 10d; p{\textlangle}0.001). 
Conclusions: In this cohort of burn patients, BSI did not adversely affect survival, but contributes to a substantial economic burden through excess length of ventilator dependency and hospital stay.},
  author       = {Brusselaers, Nele and Monstrey, Stan and Snoeij, Thomas and Vandijck, Dominique and Lizy, Christelle and Hoste, Eric and LAUWAERT, STEFAAN and Colpaert, Kirsten and Vandekerckhove, Linos and Vogelaers, Dirk and Blot, Stijn},
  issn         = {1062-3264},
  journal      = {AMERICAN JOURNAL OF CRITICAL CARE},
  keyword      = {mortality,outcome,burns,bacteremia,infection},
  language     = {eng},
  number       = {6},
  pages        = {e81--e87},
  title        = {Morbidity and mortality of bloodstream infections in patients with severe burn injury},
  url          = {http://dx.doi.org/10.4037/ajcc2010341},
  volume       = {19},
  year         = {2010},
}

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