Dimension of nosocomial infections in a burn care centre: analysis of 7year active surveillance

Abstract number: P1451

Oncul O., Ulkur E., Acar A., Yuksel F., Cavuslu S., Gorenek L.

Objectives: To determine the trends of nosocomial infection (NI), aetiological agents and risk factors in burned patients.

Methods: Data were collected prospectively from 456 burned patients admitted to a Turkish Burn Care Unit (BCU) between 2001 to 2008. A researched assistant reviewed the medical record for each patients by active surveillance according to CDC and NNIS criteria.

Results: Among 456 burned patients, 329 cases acquired 436 NI (11.0% pneumonia, 52.0% burn wound infection (BWI), 5.5% urinary tract infection and 31.5% bloodstream infection) for an overall NI rate of 25.8 per 1,000 patient-days. The mean age (42.1±9.7), the mean hospitalisation time (46.2±14) and the mean body surface area burned (BSAB) (37.4±11) of the patients with NI were higher than those with non-NI (22.3±9.3), (25.8±9.1) and (16.4±4.7) (P = 0.001, P = 0.01, P = 0.001) respectively. Of all the patients, 81 (17.8%) died. By multiple logistic regression analysis, BSAB (odds ratio (OR: 3.5), comorbidities (OR: 1.8), transfer from another hospital (OR: 2.7), broad spectrum antibiotic usage (OR:2.3) and invasive devices (OR: 1.9) were significantly related to acquisition of NI. No difference was seen in mortality between years, whereas panresistant Acinetobacter baumannii and Pseudomonas aeruginosa rates increased after 2004 (P = 0.001). P. aeruginosa (44.7%), A. baumannii (35.9%) and Staphylococcus aureus (11.4%) were most common bacteria identified in 396 strains. The most effective antibacterial agents for P. aeruginosa was meropenem (75%) and, that for A. baumannii was neutromycin (93%) respectively. Thirteen (7.3%) strains of P. aeruginosa and 16 (11.3%) strains of A. baumannii were panresistant to all antibiotics. In S. aureus strains, 38.6% were methicillin resistant.

Conclusions: Considering the high incidence of BWI, high mortality rate and panresistant strains in our BCU, more strictly infection control policies and comprehensive education campaing are required.