Microbiological findings in burn patients treated in a general versus a designated intensive care unit: Effect on length of stay

Burns. 2016 Dec;42(8):1805-1818. doi: 10.1016/j.burns.2016.06.019.

Andrea C Issler-Fisher, Richard M Fakin, Oliver M Fisher, Genevieve McKew, Riccardo Gazzola, Ann-Kathrin Rauch, Thomas Gottlieb, Peter Haertsch, Merlin Guggenheim, Pietro Giovanoli, Peter K M Maitz
Burns Unit, Concord Repatriation General Hospital, Sydney, Australia.

Abstract

BACKGROUND: Infection is one of the most common causes of mortality and morbidity in burn patients. The incidence and frequency of microbiological micro-organisms are known to vary across different models of intensive care units. To date, no study has attempted to describe the different findings in burn patients treated in an open, general intensive care unit (GICU) versus a dedicated burns intensive care unit (BICU). Only limited data is available on the effect of these microbiological micro-organisms on patients' length of stay.

AIM: To characterize and compare the microbiological flora and antibiotic resistance patterns encountered in two different models of burn intensive care and to determine the effect of specific microbiological types on length of intensive care unit (ICU) and overall stay.

METHODS: A retrospective case-control study of 209 burn patients treated in two highly specialized, Western burn referral centres between September 2009 and March 2014.

RESULTS: 9710 culture results were analysed, of which 2590 (26.7%) yielded positive results (1537 in the GICU and 1050 in the BICU). Gram-positive cultures were more frequently found in the GICU, whereas Gram-negative and yeast cultures were more prevalent in the BICU. The most frequently encountered micro-organisms in both units were similar and included Staphylococcus aureus, Pseudomonas aeruginosa, coagulase-negative staphylococci (CoNS) and Candida albicans. Significantly more resistant bacteria were detected in the BICU. Testing positive across all types of microbiological isolates, as well as for both Gram-positive and -negative bacteria significantly prolonged patient length of stay. This effect was even more pronounced if the micro-organisms were resistant to antimicrobial therapy.

CONCLUSIONS: There are notable differences in the microbiological isolate and antibiotic resistance patterns between burn patients treated in a GICU compared to a designated BICU. In both units, testing positive for resistant microbiological micro-organisms is significantly associated with longer hospital stay.