Infections In Burn Patients Research Articles

Evaluasi Kejadian Infeksi pada Pasien Luka Bakar yang Dirawat Inap di RSUD dr. Zainoel Abidin

This study examines the prevalence of infection in burn patients as represented by the clinical spesimen culture results. The purpose of this study was to obtain data on the prevalence, distribution and susceptibility pattern of microbes isolated from clinical spesimens of burn patients hospitalized at RSUD dr. dr. Zainoel Abidin. This study is descriptive observational. The retrospective data obtained from the Plastic Surgery Department and the Clinical Microbiology Laboratory. The results showed the prevalence of infection in burn patients who were hospitalized at RSUD dr. Zainoel Abidin based on clinical spesimen culture of 4.7%. Microbial patterns isolated from burn patients were Gram positive bacteria (37.5%) consisting of Staphylococcus aureus and Staphylococcus hominis. Gram negatif bacteria (62.5%) isolated consisted of Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae. The clinical spesimens that showed the most bacterial growth were pus followed by blood and joint fluid. Patients with less than 40% wound area, showed the growth of Staphylococcus aureus, Acinetobacter baumannii and Klebsiella pneumoniae. Patients with wound area above 40%, showed the growth of Staphylococcus aureus, Staphylococcus hominis, Acinetobacter baumannii and Pseudomonas aeruginosa was found. The group of Gram positive bacteria had good sensitivity to the antibiotics vancomycin (100%), linezolid (100%), tigecycline (100%), clindamycin (66.7%), tetracycline (66.7%) and trimethoprim-sulfamethoxazole (66, 7%). The group of Gram negatif bacteria showed high sensitivity to Amikacin (100%).

Clinical epidemiology and a novel predicting nomogram of central line associated bloodstream infection in burn patients.

Burn patients are at high risk of central line-associated bloodstream infection (CLABSI). However, the diagnosis of such infections is complex, resource-intensive, and often delayed. This study aimed to investigate the epidemiology of CLABSI and develop a prediction model for the infection in burn patients. The study analysed the infection profiles, clinical epidemiology, and central venous catheter (CVC) management of patients in a large burn centre in China from January 2018 to December 2021. In total, 222 burn patients with a cumulative 630 CVCs and 5,431 line-days were included. The CLABSI rate was 23.02 CVCs per 1000 line-days. The three most common bacterial species were Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa; 76.09% of isolates were multidrug resistant. Compared with a non-CLABSI cohort, CLABSI patients were significantly older, with more severe burns, more CVC insertion times, and longer total line-days, as well as higher mortality. Regression analysis found longer line-days, more catheterisation times, and higher burn wounds index to be independent risk factors for CLABSI. A novel nomogram based on three risk factors was constructed with an area under the receiver operating characteristic curve (AUROC) value of 0.84 (95% CI: 0.782-0.898) with a mean absolute error of calibration curve of 0.023. The nomogram showed excellent predictive ability and clinical applicability, and provided a simple, practical, and quantitative strategy to predict CLABSI in burn patients.

1378. Fungal infections in burn patients during Northern California wildfires

Abstract Background Wildfires are an increasing human health concern. In 2020 there were nearly 10,000 fires in California including 5 of the 6 largest wildfires recorded in the state, burning 4.1million acres. In addition to the known risks of direct burn and inhalation injury, extreme heat exposure, and psychological stress, there are unrecognized infection risks associated with smoke exposure. Fungal elements travel great distances in the air, and smoke significantly alters the number and diversity of fungal particles in affected geographical regions. Aims: To analyze the incidence and contributing factors for mould infections in hospitalized burn patients in the fall of 2020, during the peak of wildfire season. Methods We reviewed the electronic medical records for all patients admitted with burns in the fall of 2020 and recorded demographics, treatment, and outcomes. Data was stored in a secure electronic database. Results Of the 10 patients admitted with wildfire related burns, 4 developed mould infections. Two additional cases were diagnosed in patients burned in a plane crash and one in a house fire. Five of the 7 patients (71%) were men; patients had a mean age of 37.7 years (range 24-56 years); mechanism in 4 of the 7 was direct wildfire exposure (57.1%); mean total body surface area (TBSA) burned was 69% (range 44-90%). Mould infection was identified on or after hospital day 14 in all patients. A total of 5 mould genera were isolated, with Aspergillus mould genus isolated from 6 patients (85.7%). All 7 patients (100%) were treated with at least 2 days of antibacterials before identification of mould infection; 4 (57.1%) of the patients died before leaving the hospital. Following this period, mould cases decreased to baseline low levels of < 10% for all burn sizes. Conclusion Wildfires in the western United States have had a devastating effect on the ecosystem and human health. We suspect that wildfires may increase the risk of invasive mold infections in burn patients with ambient wildfire smoke exposure. We observed a disproportionate number of invasive mould infections in hospitalized burn patients during large wildfires, which may have a significant impact on the seasonal treatment of burn patients. The relationship between wildfires and fungal infection warrants future investigation. Disclosures All Authors: No reported disclosures.

Evaluating the impact of de-escalating antimicrobial therapy in burn patients: a retrospective cohort study.

Antimicrobials should be used appropriately to minimise the risk of resistant strains arising in association with overuse. De-escalation of antimicrobial therapy is one strategy used to ensure appropriate use, but its safety and efficacy in burn patients are unclear. The aim of this study was to evaluate the safety and efficacy of de-escalation therapy for treating infections in burn patients. This retrospective cohort study investigated patients admitted to our intensive care unit with burns and treated for infection between October 1, 2013, and September 30, 2020. Patients were classified into a de-escalation group (Group D) comprising patients treated with empiric antimicrobial therapy followed by de-escalation and a non-de-escalation group (Group ND) comprising patients who did not undergo de-escalation. Characteristics and outcomes were compared between groups. Forty-three patients met the inclusion criteria, including 15 patients in Group D and 28 patients in Group ND. Bacterial species commonly detected in these patients were Corynebacterium spp. (17.3%), Pseudomonas aeruginosa (16.1%), and Staphylococcus aureus (9.6%) . No inter-group difference was seen in 28-day mortality (6.7% vs 21.4%, p =0.391). Multidrug-resistant strains were detected significantly less frequently in Group D (13.0%) than in Group ND (26.1%, p =0.003). De-escalation was associated with use of two or more antimicrobials as empiric antimicrobial therapy. As the use of de-escalation in infection treatment did not impact 28-day mortality, de-escalation might be safe for treating infections in burn patients.

Features of nosocomial infections in patients with severe burn injury

Nosocomial infections in patients with burn injury is one of the leading problems of modern healthcare. In terms of prevalence, they exceed those in patients with any other pathology. In the conditions of man-made disasters and in everyday life, violation of safety rules leads to burn injury.
 To study the prevalence of nosocomial infections in patients with burns, identify risk factors and evaluate the effectiveness of the existing system of epidemiological surveillance of these infections, an analysis of publications on this topic on several information resources was carried out: eLibrary.ru, Google Scholar, PubMed and NCBI.
 It was found that the most common form of nosocomial infections in burn patients is a burn wound infection, which is treated by 38.8%, lower respiratory tract infections, including those associated with ventilation aids (19.7%), are in the second position, and bloodstream infections (8.1%) are in the third position. Urinary tract infections do not occupy such a significant place, however, their significant prevalence among patients outside the intensive care and intensive care units has been noted in foreign literature. Despite the available data on the prevalence of certain clinical forms of nosocomial infections, data on risk factors and a number of problematic issues that may be the subject of discussion and require their solution remain controversial. The risks of death are high due to the specifics of burn injury, with its frequent combination with inhalation trauma.
 The system of epidemiological surveillance of nosocomial infections in burn centers, including in the intensive care and intensive care units, has some differences in approaches to identifying, recording, registering, and collecting information about the place and time of the greatest risk.

Infections in Burn Patients: A Retrospective View over Seven Years.

Backgroundand objectives: Burn patients represent a challenging cohort because the injuries entail a vulnerability to colonisation by microorganisms. The ensuing infections can lead to serious complications and, in many cases, to the death of the burn patient. Surgical intervention and wound dressings, as well as antibiotic treatment, are crucial for optimising the treatment of the patient. Material and Methods: In this retrospective analysis, we analysed the treatment course, antibiotic therapy, and general complications of 252 burn patients with second- or third-degree burns over a time span of 7 years. Results: Patients who developed infections tended to have, on average, a higher total body surface area (TBSA), higher abbreviated burn severity index (ABSI) scores, and longer hospital stays. Patients who were admitted to the burn unit after 2006 had significantly shorter stays in the burn unit. TBSA and ABSI scores were lower in the patient cohort admitted after 2006. Patients exhibiting a TBSA greater than 30% had significantly longer hospital stays and antibiotic treatment periods. TBSA and ABSI scores were significantly higher in patients who died. The results of binary logistic regression indicate that a higher ABSI score increases the odds ratio of developing an infection. Bacteria number had no significant effect on the odds of patient death but positively influenced the odds ratio of developing an infection. TBSA was negatively associated with the risk of developing an infection and was an insignificant predictor of mortality. Conclusions: To gauge the optimal treatment for a burn patient, it is crucial for practitioners to correctly select, dose, and time antibiotics for the patient. Monitoring bacterial colonisation is vital to nip rising infection in the bud and ensure the correct antibiotic selection. This will help prevent the development of multi-resistant bacteria.

Evaluation of the Epidemiology, Risk Factors, Predictors and Fatality Associated with Extremely Drug-Resistant Infections in Burn Patients

Evaluation of the Epidemiology, Risk Factors, Predictors and Fatality Associated with Extremely Drug-Resistant Infections in Burn Patients

CHARACTERIZATION OF STAPHYLOCOCCUS AUREUS ISOLATED FROM BURN WOUND; STRONG ANTIBACTERIAL ACTIVITY OF PHAGE COCKTAIL AGAINST VANCOMYCIN INTERMEDIATE-RESISTANT STAPHYLOCOCCUS AUREUS

A universal problem is about spread of Staphylococcus aureus infections in burn patients. The present study aimed to learn about the molecular characteristics and the resistance pattern of S. aureus strains isolated from burn patients. In this cross-sectional study, we investigated 100 unique S. aureus isolated from burn patients by antimicrobial activity and biofilm formation and evaluated the effect of Complex Pyobacteriophage, a commercial bacteriophage cocktail, against the isolates mentioned above. Methicillin-resistant Staphylococcus aureus (MRSA) comprised 76%, and methicillin-susceptible Staphylococcus aureus (MSSA) comprised 24% of 100 S. aureus strains. The resistance rate among MRSA isolates was higher than compared of MSSA. Mupirocin resistance was found in 30% of isolates, with 28 (93.3%) and 2 (6.7%) strains of MRSA and MSSA, respectively, found. Vancomycin intermediate resistance in S. aureus (VISA) was 13% of MRSA strains. Two isolates were confirmed as vancomycin-resistant S. aureus (VRSA) strains and carried vanA. 31 and 62% of the total isolates showed inducible and constitutive resistance phenotypes. The rate of inducible and constitutive clindamycin resistance among MRSA strains was higher than MSSA strains. Biofilm production was detected in 66% of isolates. Strong, moderate, and weak producers accounted for 25%, 17%, and 24% of isolates. Phage analysis showed that 81% were susceptible to the phage cocktail, and only 19% were resistant to the phage cocktail. Our data indicated that VISA strains prevalence in the burn unit was mainly from S. aureus infections. Present work recommended that vancomycin treatment be closely monitored to prevent the spread of VISA and VRSA strains. Observations also highlighted the role of bacteriophage cocktails in eradicating S. aureus-related infections.

Effect of Standardized Guidelines on Nurses' Knowledge and Practices Regarding Prevention of Infection in Burn Patients

Background: Burn injuries bear a considerable public health issue all over the world and it is considered among the most distressful and painful injuries. Objectives: To assess the effect of standardized guidelines on nurse's knowledge and practices regarding the prevention of infection among burn patients. Methodology: This cross sectional study was carried out in the burn unit of BVH Bahawalpur in collaboration to the University of Lahore from July 2021 to March 2022 on stastically calculated sample of 95 nurses. After taking the ethical approval and informed consent a questionnaire was used to collect the data. Then an educational intervention was provided to all the participants by dividing in groups three days a week in total 16 weeks. Post-intervention data was collected by using the same questionnaire. Data was entered and analyzed by using SPSS. Results: A total of 95 nurses were included in present study consisting of 15 (15.8%) male nurses and 80 (84.2%) female nurses in this study. Overall mean age of nurses remained to be 37.14±8.51 years. A poo knowledge and practices were revealed in pre-intervention group while significant improvement (p<0.05) was observed for both in post-intervention group. Conclusion: At present poor knowledge and unsatisfactory practices of nurses were revealed in a tertiary care hospital however, a great improvement was observed after intervention in a kind of educational intervention and practical observation. Keywords: Knowledge, Practices, Nurses’, Healthcare, Tertiary care, Burn patients.

115 Analyzing Temporal Trends and Outcomes Associated with High Prevalence Bacterial Infections in Burn Patients

IntroductionBacterial infections are a leading cause of complications in burn patients. However, ambiguity remains around the most common infectious etiologies and their resulting complications. Our study identifies which bacterial infections will lead to specific complications and tracks infection rates of these bacteria over time.MethodsBurn patients diagnosed with a bacterial infection within 6 months of burn were identified in the TriNetX database using ICD-10 codes; those with bacterial infections prior to injury were excluded. Occurrence of the following outcomes within 12 months of injury were compared for those with bacterial infections and those without, including acute kidney injury (AKI), congestive heart failure (CHF), hypertrophic scarring, sepsis, and death. The top 4 bacterial infections, by incidence, were then identified and analyzed for the outcomes. Lastly, infection rates were stratified by year from 2010-2020. Data was analyzed using chi-square with p < .05 considered significant, and regressions.ResultsWe identified 457,383 burn patients, of whom 4,688 (1.0%) were diagnosed with a bacterial infection within 6 months of injury. The bacteria that constituted the highest proportion of infected patients were Staph aureus (51.1%), E. Coli (20.2%), Pseudomonas (17.6%), and Enterococcus (9.6%). When outcomes were stratified by bacteria, Enterococcus infection was associated with the highest incidence of AKI (23.1%), sepsis (25.2%), and mortality (16.03%). E. Coli was associated with the highest incidence of CHF (17.7%) and Pseudomonas was associated with the highest incidence of hypertrophic scarring (13.3%). All data was found to be statistically significant (p< .05). Time trend data from 2010 to 2020 stratified by bacterial infection is displayed in Figure 1. Of note, Pseudomonas infection rates increased by 90% (r2 = 0.6717) while E. Coli infection rates increased by 33%. (r2 = 0.7223). In contrast, Staph Aureus infection rates have decreased since 2013. Lastly, Enterococcus infection rates displayed a fluctuating pattern with an increasing trend since 2017.ConclusionsSpecies identification of a post-burn bacterial infection is an important step in outcome management. Despite its low incidence, Enterococcus infection was associated with the highest incidence of AKI, sepsis, and mortality, and has displayed recent increases in infection rates. Pseudomonas has shown a similar increasing trend and is notable for hypertrophic scar formation.

Antibacterial Activity of Essential Oil from Ripe Berries of Juniperus oxycedrus L. Against Multi-drug Resistant Pathogens Responsible for Skin Infections in Burn Patients

This study aimed to investigate the phytochemical composition and antibacterial activity of essential oil of ripe berries of Juniperus oxycedrus L. against multi-drug resistant (MDR) strains, which were isolated from wound infections among burn patients. The isolation of essential oil was carried out by hydrodistillation and analyzed by gas chromatography-mass spectrometry (GC-MS). In vitro antibacterial activity was determined by the disc diffusion method against the bacterial isolates. The chromatographic analysis revealed that the chemical composition of the essential oil is dominated by monoterpenes (75.40%), among which α-pinene was detected at 56.39%. The predominant strains of bacteria isolated from the infected wounds included Staphyloccocus aureus (35.29%), followed by Pseudomonas aeruginosa (17.64%), Proteus mirabilis (14.70%), Klebsiella pneumoniae and Staphylococcus epidermidis at the same level (11.76%), while Acinetobacter baumannii was found to be the least with only at 6.67%. These isolates showed high resistance to at least three different classes of the challenged antibiotics. J. oxycedrus L. essential oil has strong antibacterial activity against all the tested strains. The lowest minimal inhibitory concentration (MIC) was observed for Staphylococcus epidermidis (1.25 μL/mL), while the highest MIC was observed for Pseudomonas aeruginosa and Acinetobacter baumanii (5 μL/mL). These findings confirm that essential oil isolated from J. oxycedrus could be used to treat or prevent infections in patients suffering from burns.

Limb Salvage through Intermediary Wound Coverage with Acellular Dermal Matrix Template after Persistent Pseudomonas Aeruginosa Infection in a Burn Patient

Secondary infections of skin grafts pose a continuous problem in burn patients, very often leading to loss of transplanted skin grafts and making multiple surgical revisions necessary. We present a case report about persisting Pseudomonas aeruginosa infection in burn patients with known diabetes. The burn wounds in lower extremities required repeated debridements, multiple skin grafting attempts and finally an application of the dermal scaffold NovoSorb BTM. With these measures, we managed to undertake a successful reconstruction of infected burn defects and pre-vent an amputation. We concluded that the NovoSorb BTM could be seen as an additional promising tool in a burn surgery armamentarium. In cases where radical surgical wound decontamination is not possible without risking the loss of the limb, the application of NovoSorb BTM over a contaminated field can win extra time for topical infection treatment and additionally provide an excellent skin grafting ground.

Preparation of Silver Ion Antimicrobial Dressings and Prevention and Treatment of Central Venous Catheter-Related Infection on Burn Wounds of Critically Burned Patients

To further understand the characteristics of Ag+ antimicrobial dressings and its application value in the prevention and treatment of infections in burn patients, in the study, the Ag+ gel dressings were prepared and their physical and chemical characteristics were analyzed, and relationship between the gel dressing and central venous catheter (CVC)-related infections was further explored. The results showed that silver nitrate was made into nano silver particles, and its structure was clearly visible under microscope, and nano silver was further applied to preparation of Ag+ antibacterial dressings. Fibrocytes were clearly visible in Ag+ gel dressing and arranged uniformly, which indicated that Ag+ gel dressing had good compatibility with biological materials and had no obvious toxicity. Further clinical trials showed that Ag+ gel dressing can effectively reduce CVC-related infections. From 1 to 4 weeks of the experiment, the bacterial infection rate in burn wounds and blood of the treatment group (TG), which applied Ag+ gel dressing, was lower than the control group (P &lt; 0.05). During the treatment, the burn healing rate of the TG was also greatly higher than the control group (P &lt; 0.05). In addition, the burn wound exudate in the TG was greatly less than the control group (P &lt; 0.05). In summary, the Ag+ gel dressing prepared has good biological and physical and chemical properties, which have bright prospects in the prevention and treatment of burn wounds and CVC-related infections. This study provides an experimental basis for clinical application of Ag+ gel dressing.

Reducing Biofilm Infections in Burn Patients' Wounds and Biofilms on Surfaces in Hospitals, Medical Facilities and Medical Equipment to Improve Burn Care: A Systematic Review.

Biofilms in burns are major problems: bacterial communities rapidly develop antibiotic resistance, and 60% of burn mortality is attributed to biofilms. Key pathogens are Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and multidrug-resistant Acinetobacter baumanii. Purpose: identify current and novel interventions to reduce biofilms on patients’ burns and hospital surfaces and equipment. Medline and Embase were searched without date or language limits, and 31 possible interventions were prioritised: phages, nano-silver, AgSD-NLs@Cur, Acticoat and Mepilex silver, acetic acid, graphene-metal combinations, CuCo2SO4 nanoparticles, Chlorhexidene acetate nanoemulsion, a hydrogel with moxifloxacin, carbomer, Chitosan and Boswellia, LED light therapy with nano-emodin or antimicrobial blue light + Carvacrol to release reactive oxygen species, mannosidase + trypsin, NCK-10 (a napthalene compound with a decyl chain), antimicrobial peptide PV3 (includes two snake venoms), and polypeptides P03 and PL2. Most interventions aimed to penetrate cell membranes and reported significant reductions in biofilms in cfu/mL or biofilm mass or antibiotic minimal inhibitory concentrations or bacterial expression of virulence or quorum sensing genes. Scanning electron microscopy identified important changes in bacterial surfaces. Patients with biofilms need isolating and treating before full admission to hospital. Cleaning and disinfecting needs to include identifying biofilms on keyboards, tablets, cell phones, medical equipment (especially endoscopes), sinks, drains, and kitchens.

Bacteriophages PɸEn-CL and PɸEn-HO can eliminate MDR Enterobacter cloacae and Enterobacter hormaechei isolated from burn wound infections without toxicity for human skin cells.

The prevalence of multidrug-resistant (MDR) strains has caused serious problems in the treatment of burn infections. MDR Enterobactercloacae and Enterobacterhormaechei have been defined as the causative agents of nosocomial infections in burn patients. In this situation, examination of phages side effects on human cell lines before any investigation on human or animal that can provide beneficial information about the safety of isolated phages. The aim of this study was to isolate and identify the specific bacteriophages on MDR E. cloacae and E. hormaechei isolated from burn wounds and to analyze the efficacy, cell viability and cell cytotoxicity of phages on A-375 and HFSF-PI cell lines by MTT (3-(4, 5-dimethylthiazol-2-yl)2,5-diphenyl-tetrazolium bromide) colorimetric assay and lactate dehydrogenase (LDH) release assay. Phages were isolated from urban sewage Isfahan, Iran. Enterobactercloacae strain Iau-EC100 (GenBank accession number: MZ314381) and E. hormaechei strain Iau-EHO100 (GenBank accession number: MZ348826) were sensitive to the isolated phages. Transmission electron microscopy (TEM) results revealed that PɸEn-CL and PɸEn-HO that were described had the morphologies of Myovirus and Inovirus, respectively. Overall, MTT and LDH assays showed moderate to excellent correlation in the evaluation of cytotoxicity of isolated phages. The results of MTT and LDH assays showed that, phages PɸEn-CL and PɸEn-HO had no significant toxicity effect on A375 and HFSF-PI 3 cells. Phage PɸEn-HO had a better efficacy on the two tested cell lines than other phage. Our results indicated that, there were significant differences between the two cytotoxicity assays in phage treatment compared to control.

Infections in Patients With Major Burns: A Retrospective Study of a Burn Intensive Care Unit.

Burn-related infections are challenging conditions to manage and can cause several complications entailing a complicated treatment. In this study, infection in burn patients hospitalized in burn intensive care unit (ICU) of a tertiary care hospital is investigated. This retrospective study was conducted between January 1, 2018 and December 31, 2020 in burn ICU of a tertiary care hospital. Patients with an ICU stay less than 48 hours and survival less than 72 hours were not included in the study. The demographic and clinical data as well as referral status, the type of infections and the isolated microorganisms, antibiotics used for prophylaxis, outcomes, and the mortality rate are evaluated retrospectively from patient files and the hospital registries. A total of 311 patients were included in our study cohort with a mean age of 22.11 ± 20.9 years. The burned TBSA was 28.07 ± 17.1 and abbreviated burn severity index was 5.76 ± 2.3. There were 155 patients with 283 infections and the infection rate was 45.8 per 1000 patient days. The most commonly isolated microorganisms were Candida species in bloodstream and urinary tract infections, Pseudomonas aeruginosa in burn wound infections. Most of the deaths (86.7%) occurred in patients with infections. In major burns strict adherence to isolation procedures, avoiding delays in referrals, early excision, and early wound closure are important measures to reduce infections. Each burn center should develop appropriate antibiotic strategies due to their culture results and prophylaxis with broad-spectrum antibiotics should be avoided.

Pathogenic Characteristics and Risk Factors for ESKAPE Pathogens Infection in Burn Patients

ObjectiveThis study aimed to determine the clinical manifestations, antimicrobial resistance, molecular characteristics, and risk factors for ESKAPE pathogens infection in burn patients.MethodsA retrospective study of 187 burn patients infected with ESKAPE pathogens was conducted at the Department of Plastic and Burn Surgery of the Affiliated Hospital of Southwest Medical University (Luzhou, China) from October 2018 to June 2021. All strains were identified using a MicroScan WalkAway 96 Plus System, and antimicrobial susceptibilities were determined using the VITEK system or the disk diffusion method. The antimicrobial resistance genes of multi-drug resistant ESKAPE (MDR-ESKAPE) were detected by polymerase chain reaction (PCR). The multivariable logistic regression analysis was used to estimate the risk factors for ESKAPE infection and MDR-ESKAPE infection.ResultsA total of 255 strains were isolated in various types of clinical specimens from 187 burn patients, of which 47.5% were ESKAPE pathogens (121/255). Among these, MDR-ESKAPE pathogens accounted for 55% (67/121). Additionally, aph3ʹIII, mecA, blaSHV, blaTEM, blaPDC, and blaSHV were the most prevalent genes detected in Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp., respectively. The independent risk factors for ESKAPE infection were total body surface area (TBSA) >30–50% (odds ratio [OR] = 10.428; 95% confidence interval [CI], 2.047 to 53.108), TBSA >50% (OR = 15.534; 95% CI, 1.489 to 162.021), and parenteral nutrition (OR = 3.597; 95% CI, 1.098 to 11.787). No independent risk factors were found for MDR-ESKAPE infection.ConclusionClinical staff should be alert to the risk of nosocomial infection with ESKAPE pathogens in burn patients receiving parenteral nutrition and under TBSA >30%. Full attention should also be paid to the ESKAPE resistance, strict adherence to infection control protocols for the rational use of antimicrobial agents, and enhanced clinical standardization of antimicrobial agents management.

Scoping review on prevention of central venous catheter-related bloodstream infection in burn patients

Objective: To investigate the research trend and scope of prevention of central venous catheter-related bloodstream infection (CRBSI) in burn patients. Methods: The scoping review method was adopted. Pre-retrieval was carried out with search terms of ", , " and "central venous catheter, infection, catheter-related bloodstream infection, burn". On the basis of pre-retrieval, different retrieval formulas were formulated to retrieve researches related to central venous CRBSI in burn patients in China National Knowledge Internet, Wanfang Database, VIP Database, PubMed, Embase, CINAHL, and Cochrane Library from the establishment of each database to August 2020. Data were extracted from the included literature, including the first author, research publication time, research country, research type, diagnosis basis and intervention measures of central venous CRBSI, research sample selection, incidence related to infection, and research conclusion. Results: A total of 20 randomized controlled trials, quasi-experimental studies, case-control studies, cohort studies, and implementation researches published in 1990-2020 were included in this study with the first authors from China, the United States of America, or Argentina. The diagnostic bases for central venous CRBSI in burn patients were not uniform in the included literature, including adopting the Guidelines of American Centers for Disease Control and Prevention, Diagnostic Criteria for Nosocomial Infection, and other diagnostic criteria without specifying the source. The intervention measures included the use of new materials such as antibiotics coated catheter and ethanol impregnated port protectors, multidisciplinary cooperation, and comprehensive preventive measures. The sample size in the included literature was small, and the sample selection was different, including the number of patients and the the number of placement of central venous catheter. The outcome indicators for infection in the included literature were diversified. The incidence per 1 000 days of central venous CRBSI was 20.41‰-29.1‰ of patients in control group in China, the incidence per 1 000 days of central venous CRBSI was mostly <16.6‰ in control group in foreign countries, and the incidence of central venous CRBSI was decreased to varying degrees after implementing the corresponding intervention measures. Related research conclusions showed that new materials, multidisciplinary cooperation, and comprehensive preventive measures had good effects on prevention of central venous CRBSI in burn patients. Conclusions: The researches on prevention of central venous CRBSI in burn patients in China start early and the research types are diversified. The diagnostic criteria of central venous CRBSI in burn patients are not uniform, intervention measures have shifted from standardizing relevant operational measures to exploring the prevention effects of new materials, multidisciplinary cooperation, and multiple measures, and the latter has good effects on preventing central venous CRBSI in burn patients.

Diagnosis and Management of Invasive Fungal Wound Infections in Burn Patients

Invasive fungal wound infection (FWI) after burn injury, while uncommon, is associated with significant morbidity and mortality. There are numerous risk factors for FWI, including large burn size and incomplete excision of burn wounds. FWI can be challenging to diagnose. Close attention to changes in the physical examination and, in particular, to the appearance of burn wounds leads the burn team to be suspicious of FWI. Once FWI is suspected, histopathological evaluation of an incisional biopsy provides definitive diagnosis, while tissue culture enables identification of the causative organism to the species level and facilitates targeted antifungal therapy. Management of FWI focuses largely on aggressive surgical intervention, in addition to adjunctive systemic and topical antifungals and nonpharmacologic therapies. Treatment of FWI involves a multifaceted approach, which requires expertise from the entire multidisciplinary burn team.

Microbial Air Monitoring in the Pediatric Burn Ward: Experience at the University Hospital of Mashhad, Iran

Background The aim of this study was to investigate the density and type of bacterial and fungal bioaerosols in the air of the pediatric burn ward. Materials and Methods In this cross-sectional study, two active and passive sampling methods were used simultaneously to evaluate the density and type of bacterial and fungal bioaerosols. In 2019, sampling was performed once every six days, according to the sampling guideline developed by the 2019 United States Environmental Protection Agency (EPA). Data were analyzed using SPSS software (version 22.0). Results According to the EU GMP standard, in the active method, bacterial and fungal contaminations in the indoor air of the burn ward were in grades C and D, respectively. According to this standard, in the active method, bacterial and fungal contaminations in the outdoor air of the burn ward were in grade C. According to the EU GMP standard, in the passive method, bacterial and fungal contaminations in the indoor air of the pediatric burn ward were in grade C. According to this standard, in the passive method, bacterial and fungal contaminations in the outdoor air of the burn ward were in grade C. Conclusion Given the importance of preventing infection in patients with burns and preventing deaths caused by infections in these patients, especially in children with burns, it is necessary to pay attention to the role of bioaerosols in developing nosocomial infections in burn patients.