Open AccessColonization with Multidrug‐Resistant Enterobacteriaceae is Associated with Increased Mortality Following Burn Injury in Sub‐Saharan Africa
Author(s) -
Gallaher Jared R.,
Banda Wone,
Lachiewicz Anne M.,
Krysiak Robert,
Cairns Bruce A.,
Charles Anthony G.
Publication year - 2018
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-018-4633-7
Subject(s) - medicine , epidemiology , total body surface area , enterobacteriaceae , colonization , burn injury , surgery , microbiology and biotechnology , biology , biochemistry , escherichia coli , gene
Background Multidrug‐resistant (MDR) bacteria are an emerging international concern in low‐ and middle‐income countries that threaten recent public health gains. These challenges are exacerbated in immunocompromised hosts, such as those with burn injury. This study sought to describe the epidemiology and associated clinical outcomes of burn wound colonization in a Malawian tertiary burn center. Methods This is a prospective analysis of burn patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, within 72 h of burn injury. A swab of each patient’s primary wound was collected at admission and each subsequent week. The primary exposure was burn wound colonization with MDR bacteria, particularly Enterobacteriaceae . The primary outcome was in‐hospital mortality. A log binomial model estimated the association between the exposure and outcome, adjusted for confounders. Results Ninety‐nine patients were enrolled with a median age of 4 years (IQR 2–12) and a male preponderance (54%). Median total body surface area burn (TBSA) was 14% (IQR 9–25), and crude in‐hospital mortality was 19%. Enterobacteriaceae were the most common MDR bacteria with 36% of patients becoming colonized. Wound colonization with MDR Enterobacteriaceae was associated with increased in‐hospital mortality with a risk ratio of 1.86 (95% CI 1.38, 2.50, p < 0.001) adjusted for TBSA, burn type (scald vs. flame), sex, age, length of stay, and methicillin‐resistant Staphylococcus aureus colonization. Conclusion MDR bacteria, especially Enterobacteriaceae , are common and are associated with worse burn injury outcomes. In resource‐poor environments, a greater emphasis on prevention of MDR bacterial colonization, improved isolation precautions, affordable diagnostics, and antibiotic stewardship are imperative.