062 The Impact of Nosocomial Resistant Pseudomonas Infections in a Burn Unit

Abstract

Introduction: Pseudomonas aeruginosa, remains a serious cause of nosocomial infection and septic mortality in burn patients particularly when nosocomially acquired. Our purpose is to investigate the morbidity and mortality associated with nosocomial infection with an aminoglycoside resistant Pseudomonas and associated costs compared to a group of patients with similar severity of burn injury that did not acquire resistant Pseudomonas during hospitalization. Methods: Using a TRACS burn database, patients treated at our institution with Pseudomonas resistant to gentamicin were identified and case‐matched to controls for age (±5 years), TBSA(±5%), admission year (±5 years) and presence of inhalation injury. Patients who died <48 hours after injury were excluded. Data examined included demographics, number of days to onset of positive Pseudomonas culture and gentamicin resistance, as well as antibiotic use and cost. Results: 42 patients admitted to our unit between 1980 and 2001 were identified with gentamicin resistant Pseudomonas. Patients in the resistant Pseudomonas(Ps) group were similar in age (39.2 ± 3.2 vs 40.4 ± 3.3 years), TBSA (47.5 ± 3.7 vs 48.9 ± 3.7%), extent of full thickness injury (37.0 ± 3.9 vs 30.3 ± 3.2%) and presence of inhalation injury (62.8% vs 55.0%) compared to controls. There was a significant increase in the mortality rate in the Ps group (39.5 vs 5.0%, p < 0.001)(paired t test) compared to controls and the morbidity in terms of length of stay, increased in the Ps group (73.1 ± 13.2 vs 55.8 ± 8.1 days). Ventilatory days (22.6 ± 5.1 vs 8.2 ± 2.4, p < 0.05), number of surgical procedures (4.5 ± 0.6 vs 2.9 ± 2.5, p < 0.05), and amount of blood products used (packed cells 47.9 ± 7.8 vs 18.6 ± 3.3, p < 0.01)(platelets 10.5 ± 2.9 vs 0.5 ± 0.3, p < 0.01) were all significantly higher in the Ps group compared to control. Costs associated with antibiotic requirements were also significantly higher in the Ps group ($3,191.90 ± 848.00 vs $613.60 ± 145.50, p < 0.01). Conclusions: Our data demonstrate that nosocomial infection in burn patients with aminoglycoside‐resistant Pseudomonas is associated with significantly higher morbidity and mortality and cost of care. Increased resource consumption in terms of length of stay, number of surgical procedures, amount of blood products, and antibiotic costs did not prevent significantly higher mortality rates when compared to control patients who avoided infection with the resistant organism. Thus, prevention, identification and eradication of nosocomial Pseudomonas infection are critical for cost‐effective, successful burn care.