Morbidity and mortality of bloodstream infections in patients with severe burn injury

Objective: To evaluate the effects of bloodstream infections [BSI] in patients with severe burn injuries. Methods: Retrospective (1992-2006), pairwise-matched (ratio 1:1 to 1:2), risk-adjusted cohort study in a 6-bed burn unit. A comparison was made between ‘exposed’ patients with microbiologically documented BSI (n=76) and non-exposed subjects (n=103) matched on burn severity (identical Belgian Outcome in Burn Injury [BOBI] score) and length of hospitalization (equivalent or longer than the time-to-event in the exposed patient). Main outcome measures were length of hospitalization and mortality. Results: Predominant pathogens were Staphylococcus aureus, enterococci, Pseudomonas aeruginosa, Escherichia coli, coagulase-negative staphylococci, and Candida spp. Median age was 42 years (interquartile range [IQR] 31-52y). Median total burned surface area was 40% (IQR: 25-50%). Fifty-four percent experienced an inhalation injury. The median BOBI score was 4 (IQR: 2-5). The median ICU stay before onset of bacteremia was 11 days (IQR: 5.3-19.8d). Appropriate antimicrobial therapy was initiated within the first 48h in 76.3%. The exposed group had a higher need for vasopressive/inotropic support (57.9% vs. 39.8%, p=0.017), whereas need for ventilatory assistance and renal replacement therapy were not significantly higher. Hospital mortality did not differ (11.8% vs. 17.5%, p=0.298). However, BSI was associated with an additional length of hospitalization of 25 days (61 vs. 36d; p<0.001), and an excess length of mechanical ventilation of 11 days (21 vs. 10d; p