An epidemiological analysis of MDRO acquisition in critically ill burn patients in western Pennslyvania

Rationale: The growing public health concern of antibiotic resistance is becoming more critical and urgent. Multi-drug resistant organisms (MDROs) are becoming increasingly prevalent in healthcare settings and physicians are faced with the reality that treatment options are becoming scarcer. Burn patients are a special case within the hospitalized population as they are potentially exposed to pathogens internally through inhalation injury, effectively placing them at a higher risk for infection. As the first line of defense is compromised, burn injuries must be especially monitored as they are highly susceptible to subsequent infection. There is no set standard of infection prevention for burn patients currently. Identifying potential factors for acquiring an infection in a sample may allow healthcare workers to better prevent transmission among high-risk, densely populated healthcare settings. A thorough review and breakdown of a select group impacted with burn injuries will help elucidate factors behind population at increased risk. Methods: Data was collected from burn patients admitted to the UPMC Mercy Burn ICU in 2018 that fit set inclusion criteria. Variables of interest include age, gender, total body surface area (TBSA) of burn, length of stay (LOS), previous history of MDRO, identified MDRO during hospitalization, and documented inhalational injury presence. The four MDROs of interest are methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase-producing bacteria (ESBL), Vancomycin-resistant enterococci (VRE) and carbapenem-resistant Enterobacteriaceae (CRE). Results: Of the roughly three thousand burn patients evaluated for admission, 225 were admitted and 48 passed the exclusion criteria. There was a large disparity between gender, nine females and 39 males, in patients with critical burns. 12 of the 48 patients had a positive result for an MDRO during their stay and the majority (7) had a documented inhalation injury. Of the four evaluated MDROs, MRSA was present in nearly every case of a positive MDRO result. Patients with higher levels of burns were associated with having a longer LOS duration. There is also a statistically significant relationship between MDRO acquisition and LOS. Conclusions: The results of this analysis reinforce previous findings regarding the epidemiology of burn patients, but also demonstrate the need for increased surveillance in healthcare settings to prevent the onset and spread of MDROs. The large proportion of MDROs are attributed to MRSA, supporting previous conclusions and indicating the high transmission potential as well as the need to focus on preventative measures