Outcomes of Bacteremia in Burn Patients Involved in Combat Operations Overseas

Abstract

Burn patients constitute approximately 5% of casualties injured in support of US military operations in Iraq (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]). Since the onset of these conflicts, there have been numerous casualties infected with multidrug-resistant bacteria. It is currently unclear if bacteremia with these multidrug-resistant organisms in OIF/OEF burn casualties is associated with increased mortality. We performed a retrospective cohort study of all patients admitted to the US Army Institute of Surgical Research burn center from January 2003 to May 2006 to evaluate bacteremia in our burn-patient population. One hundred twenty-nine of 1,258 patients admitted to the burn center became bacteremic during their hospitalization. Of these, 92 had bacteremia with the top four pathogens in our burn center, ie, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter calcoaceticus-baumannii complex, and Staphylococcus aureus. Presence of any bacteremia was associated with mortality and increased ventilator days. Bacteremia with K pneumoniae was associated with a statistically increased mortality and a prolonged ventilator course relative to all other pathogens. Casualties of OIF/OEF with burn injuries did not have different outcomes than patients whose burns were not associated with military operations. Bacteremia, especially with a multidrug-resistant organism, causes increased mortality in burn patients. Of all the pathogens causing bacteremia, K pneumonia appears to have the greatest impact on mortality.