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Veronica R, Nelwan E, Kumalawati J, Rumende C, Chen K, Simadibrata M, Shatri H, Yunir E. THE EFFECT OF MULTIDRUG-RESISTANT ORGANISM INFECTION ON MORTALITY OF BURN PATIENTS AT RSUPN DR. CIPTO MANGUNKUSUMO. ANNALS OF BURNS AND FIRE DISASTERS 2024; 37:159-168. [PMID: 38974796 PMCID: PMC11225273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/20/2023] [Indexed: 07/09/2024]
Abstract
Susceptibility to infection and increased antibiotic resistance place burn patients at risk of infection caused by multidrug-resistant organisms (MDRO). This condition can progress to sepsis, which can increase morbidity and mortality. A retrospective cohort study using medical record data of patients treated at RSUPN dr. Cipto Mangunkusumo in the period January 2020 to June 2022 was conducted. Of a total 160 subjects in the study period, 82.5% were aged <60 years, 16.88% had comorbidities, the most common cause of burns was fire (86.25%), the use of medical devices was 90.63%, with a median length of stay of 14 days. The most common Gram-negative MDRO pathogens were K. pneumoniae (29.91%), Enterobacter sp (22.32%) and Acinetobacter (20.54%): 45% of MDRO infected patients died. Bivariate analysis was conducted to find the effect of MDRO infection on burn patient mortality (RR 1,103; 95% CI 1,004-1,211, p=0.046). After adjusting for the role variables, namely: age, comorbidities, TBSA, use of medical devices, length of stay and multivariate analysis, it was found that the variables that had an effect on MDRO infection mortality were length of stay and age. MDRO infection has an effect on the mortality rate of burn patients. Mortality of burn patients due to MDRO infection is greater (45%) compared to non MDRO (21.43%). The most common Gram-negative MDRO pathogen is K. pneumoniae.
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Affiliation(s)
- R.M. Veronica
- University of Indonesia / RS dr. Cipto Mangunkusumo, Jakarta, Indonesia
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Wang Y, Zhang J, Chen X, Sun M, Li Y, Wang Y, Gu Y, Cai Y. Development and Validation of a Nomogram Prediction Model for Multidrug-Resistant Organisms Infection in a Neurosurgical Intensive Care Unit. Infect Drug Resist 2023; 16:6603-6615. [PMID: 37840828 PMCID: PMC10573443 DOI: 10.2147/idr.s411976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
Objective To develop a predictive model for assessing the risk of multidrug-resistant organisms (MDROs) infection and validate its effectiveness. We conducted a study on a total of 2516 patients admitted to the neurosurgery intensive care unit (NICU) of a Grade-III hospital in Nantong City, Jiangsu Province, China, between January 2014 and February 2022. Patients meeting the inclusion criteria were selected using convenience sampling. The patients were randomly divided into modeling and validation groups in a 7:3 ratio. To address the category imbalance, we employed the Synthetic Minority Over-sampling Technique (SMOTE) to adjust the MDROs infection ratio from 203:1558 to 812:609 in the training set. Univariate analysis and logistic regression analysis were performed to identify risk factors associated with MDROs infection in the NICU. A risk prediction model was developed, and a nomogram was created. Receiver operating characteristic (ROC) analysis was used to assess the predictive performance of the model. Patients and Methods Results Logistic regression analysis revealed that sex, hospitalization time, febrile time, invasive operations, postoperative prophylactic use of antibiotics, mechanical ventilator time, central venous catheter indwelling time, urethral catheter indwelling time, ALB, PLT, WBC, and L% were independent predictors of MDROs infection in the NICU. The area under the ROC curve for the training set and validation set were 0.880 (95% CI: 0.857-0.904) and 0.831 (95% CI: 0.786-0.876), respectively. The model's prediction curve closely matched the ideal curve, indicating excellent predictive performance. Conclusion The prediction model developed in this study demonstrates good accuracy in assessing the risk of MDROs infection. It serves as a valuable tool for neurosurgical intensive care practitioners, providing an objective means to effectively evaluate and target the risk of MDROs infection.
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Affiliation(s)
- Ya Wang
- Neurosurgical Intensive Care Unit, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Jiajia Zhang
- Neurosurgery Section Two, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Xiaoyan Chen
- Neurosurgical Intensive Care Unit, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Min Sun
- Department of Geriatrics Section Three, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Yanqing Li
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Yanan Wang
- Respiratory and Critical Care Medicine Intensive Care Unit, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Yan Gu
- Infection Management Office, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Yinyin Cai
- Neurosurgical Intensive Care Unit, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
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Dunbar C, Santorelli JE, Marshall WA, Haines LN, Box K, Lee JG, Strait E, Costantini TW, Smith AM, Doucet JJ, Berndtson AE. Cross-Border Antibiotic Resistance Patterns in Burn Patients. Surg Infect (Larchmt) 2023; 24:327-334. [PMID: 37036781 DOI: 10.1089/sur.2022.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
Background: Antimicrobial resistance (AMR) is a growing problem worldwide, with differences in regional resistance patterns partially driven by local variance in antibiotic stewardship. Trauma patients transferring from Mexico have more AMR than those injured in the United States; we hypothesized a similar pattern would be present for burn patients. Patients and Methods: The registry of an American Burn Association (ABA)-verified burn center was queried for all admissions for burn injury January 2015 through December 2019 with hospital length-of-stay (LOS) longer than seven days. Patients were divided into two groups based upon burn location: United States (USA) or Mexico (MEX). All bacterial infections were analyzed. Results: A total of 73 MEX and 826 USA patients were included. Patients had a similar mean age (40.4 years MEX vs. 42.2 USA) and gender distribution (69.6% male vs. 64.4%). The MEX patients had larger median percent total body surface area burned (%TBSA; 11.1% vs. 4.3%; p ≤ 0.001) and longer hospital LOS (18.0 vs. 13.0 days; p = 0.028). The MEX patients more often had respiratory infections (16.4% vs. 7.4%; p = 0.046), whereas rates of other infections were similar. The MEX patients had higher rates of any resistant organism (47.2% of organisms MEX vs. 28.1% USA; p = 0.013), and were more likely to have resistant infections on univariable analysis; however, on multivariable analysis country of burn was no longer significant. Conclusions: Antimicrobial resistance is more common in burn patients initially burned in Mexico than those burned in the United States, but location was not a predictor of resistance compared to other traditional burn-related factors. Continuing to monitor for AMR regardless of country of burn remains critical.
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Affiliation(s)
- Chance Dunbar
- School of Medicine, UC San Diego, San Diego, California, USA
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - William A Marshall
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Laura N Haines
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Kevin Box
- Department of Pharmacology, UC San Diego, San Diego, California, USA
| | - Jeanne G Lee
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Eli Strait
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Alan M Smith
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Jay J Doucet
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Allison E Berndtson
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
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Ellithy M, Mitwally H, Saad M, Mathias R, Shaukat A, Elzeer H, Hassan Koya S, Mahmood Z, Gazwi K. Mortality incidence among critically ill burn patients infected with multidrug-resistant organisms: A retrospective cohort study. Scars Burn Heal 2021; 7:20595131211015133. [PMID: 34104480 PMCID: PMC8155764 DOI: 10.1177/20595131211015133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Many risk factors have been reported to increase mortality among burn patients. Previously, a higher mortality incidence was reported in acute burn patients infected with multidrug-resistant organisms (MDROs) when compared to patients infected with non-MDROs. However, considering this as an independent risk factor for mortality in acute burn patients is not yet confirmed. METHODS We conducted an observational retrospective study in Qatar. We included adult patients admitted to the surgical intensive care unit (ICU) between January 2015 and December 2017 with burn injuries involving either at least 15% of the total body surface area (TBSA) or less than 15% with facial involvement. All patients developed infection with a positive culture of either MDRO or non-MDRO. The primary outcome was in-hospital mortality. Other outcomes included days of mechanical ventilation, ICU, length of stay in hospital, and requirement of vasoactive agents. RESULTS Fifty-eight patients were included in the final analysis: 33 patients in the MDRO group and 25 patients in the non-MDRO group. Six patients (18.2%) died in the MDRO group versus four patients (16%) in the non-MDRO group (P = 1). No significant difference was observed between the two groups with regard to the ICU length of stay. However, there was a trend towards increased median length of stay in hospital in the MDRO group: 62 days versus 45 days in the non-MDRO group (P = 0.057). No significant differences were observed in the other outcomes. CONCLUSION In severely burned patients, infection with MDRO was not associated with increased mortality. There was a trend towards increased hospitalisation in MDRO-infected patients. Further studies with a larger sample size are needed to confirm these results. LAY SUMMARY Many factors affect mortality in burn patients admitted to the intensive care unit, such as age, total body surface area involved in the injury, and others. In this retrospective study, we evaluated whether wound infection with a bacterial organism resistant to multiple classes of antibiotics (multidrug-resistant) is considered an independent risk factor for mortality in critically ill burn patients. We included 58 patients requiring intensive care admission with burn injuries involving 15% or more of the total body surface area or less than 15% but with facial involvement. A total of 33 patients were infected with multidrug-resistant organisms (MDROs) and 25 patients with non-MDROs. Six patients (18.2%) from the MDRO group died versus four (16%) in the non-MDRO group. The MDRO group required a longer stay in hospital and an average of one more day on a mechanical ventilator. We concluded that wound infection with MDROs might not increase mortality when compared to wound infection with non-MDROs, although other studies with a larger number of patients involved need to be conducted to validate these results.
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Affiliation(s)
- Moustafa Ellithy
- Department of Critical Care, Hazm
Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Mitwally
- Department of Pharmacy,
Al-Wakra-Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Saad
- Department of Pharmacy,
Al-Wakra-Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ranjan Mathias
- Department of Anesthesiology/Critical
Care, Al-Wakra-Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Adila Shaukat
- Department of Medicine-Infectious
Diseases, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hani Elzeer
- Critical Care Departement, Al-Wakra
Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sunil Hassan Koya
- Critical Care Departement, Al-Wakra
Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zia Mahmood
- Department of Anesthesiology/Critical
Care, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khaled Gazwi
- Critical Care Departement, Al-Wakra
Hospital, Hamad Medical Corporation, Doha, Qatar
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