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Risk Factors for Healthcare-Associated Infections in Adult Burn Patients

Published online by Cambridge University Press:  30 October 2017

Paula D. Strassle ,
Felicia N. Williams ,
David J. Weber ,
Emily E. Sickbert-Bennett ,
Anne M. Lachiewicz ,
Sonia Napravnik ,
Samuel W. Jones ,
Bruce A. Cairns  and
David van Duin
Paula D. Strassle
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Felicia N. Williams
Affiliation:
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
Emily E. Sickbert-Bennett
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
Anne M. Lachiewicz
Affiliation:
Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
Sonia Napravnik
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
Samuel W. Jones
Affiliation:
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
Bruce A. Cairns
Affiliation:
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
David van Duin*
Affiliation:
Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
*
Address correspondence to David van Duin, MD, PhD, Division of Infectious Diseases, Department of Medicine, University of North Carolina, 130 Mason Farm Road, Mail code CB #7030, Chapel Hill, NC 27599-7030 ([email protected]).
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Abstract

OBJECTIVE

Burn patients are particularly vulnerable to infection, and an estimated half of all burn deaths are due to infections. This study explored risk factors for healthcare-associated infections (HAIs) in adult burn patients.

DESIGN

Retrospective cohort study.

SETTING

Tertiary-care burn center.

PATIENTS

Adults (≥18 years old) admitted with burn injury for at least 2 days between 2004 and 2013.

METHODS

HAIs were determined in real-time by infection preventionists using Centers for Disease Control and Prevention criteria. Multivariable Cox proportional hazards regression was used to estimate the direct effect of each risk factor on time to HAI, with inverse probability of censor weights to address potentially informative censoring. Effect measure modification by burn size was also assessed.

RESULTS

Overall, 4,426 patients met inclusion criteria, and 349 (7.9%) patients had at least 1 HAI within 60 days of admission. Compared to <5% total body surface area (TBSA), patients with 5%–10% TBSA were almost 3 times as likely to acquire an HAI (hazard ratio [HR], 2.92; 95% CI, 1.63–5.23); patients with 10%–20% TBSA were >6 times as likely to acquire an HAI (HR, 6.38; 95% CI, 3.64–11.17); and patients with >20% TBSA were >10 times as likely to acquire an HAI (HR, 10.33; 95% CI, 5.74–18.60). Patients with inhalational injury were 1.5 times as likely to acquire an HAI (HR, 1.61; 95% CI, 1.17–2.22). The effect of inhalational injury (P=.09) appeared to be larger among patients with ≤20% TBSA.

CONCLUSIONS

Larger burns and inhalational injury were associated with increased incidence of HAIs. Future research should use these risk factors to identify potential interventions.

Infect Control Hosp Epidemiol 2017;38:1441–1448

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 12 , December 2017 , pp. 1441 - 1448
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Burn incidence and treatment in the United States: 2016. American Burn Association website. http://www.ameriburn.org/resources_factsheet.php. Accessed March 3, 2017.Google Scholar
2. Mason, ST, Esselman, P, Fraser, R, Schomer, K, Truitt, A, Johnson, K. Return to work after burn injury: a systematic review. J Burn Care Res 2012;33:101–109.CrossRefGoogle ScholarPubMed
3. Mayhall, CG. The epidemiology of burn wound infections: then and now. Clin Infect Dis 2003;37:543–550.Google ScholarPubMed
4. Rafla, K, Tredget, EE. Infection control in the burn unit. Burns 2011;37:5–15.CrossRefGoogle ScholarPubMed
5. Cairns, B, Maile, R, Barnes, CM, Frelinger, JA, Meyer, AA. Increased Toll-like receptor 4 expression on T cells may be a mechanism for enhanced T cell response late after burn injury. J Trauma 2006;61:293–299.CrossRefGoogle Scholar
6. Moore, CB, Medina, MA, van Deventer, HW, et al. Downregulation of immune signaling genes in patients with large surface burn injury. J Burn Care Res 2007;28:879–887.CrossRefGoogle ScholarPubMed
7. Neely, CJ, Maile, R, Wang, MJ, Vadlamudi, S, Meyer, AA, Cairns, BA. Th17 (IFNgamma- IL17+) CD4+ T cells generated after burn injury may be a novel cellular mechanism for postburn immunosuppression. J Trauma 2011;70:681–690.Google ScholarPubMed
8. D’Avignon, LC, Hogan, BK, Murray, CK, et al. Contribution of bacterial and viral infections to attributable mortality in patients with severe burns: an autopsy series. Burns 2010;36:773–779.CrossRefGoogle Scholar
9. Carolina Data Warehouse for Health. The North Carolina Translational and Clinical Sciences (NC TraCS) Institute at the Univeristy of North Carolina at Chapel Hill website. https://tracs.unc.edu/index.php/services/biomedical-informatics/cdw-h. Accessed March 3, 2017.Google Scholar
10. Weber, DJ, Sickbert-Bennett, EE, Brown, V, Rutala, WA. Completeness of surveillance data reported by the National Healthcare Safety Network: an analysis of healthcare-associated infections ascertained in a tertiary care hospital, 2010. Infect Control Hosp Epidemiol 2012;33:94–96.CrossRefGoogle Scholar
11. Osler, T, Glance, LG, Hosmer, DW. Simplified estimates of the probability of death after burn injuries: extending and updating the baux score. J Trauma 2010;68:690–697.Google ScholarPubMed
12. Deyo, RA, Cherkin, DC, Ciol, MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–619.CrossRefGoogle ScholarPubMed
13. Lau, B, Cole, SR, Gange, SJ. Competing risk regression models for epidemiologic data. Am J Epidemiol 15 2009;170:244–256.CrossRefGoogle ScholarPubMed
14. Cole, SR, Hernan, MA. Constructing inverse probability weights for marginal structural models. Am J Epidemiol 2008;168:656–664.CrossRefGoogle ScholarPubMed
15. Issler-Fisher, AC, McKew, G, Fisher, OM, Harish, V, Gottlieb, T, Maitz, PK. Risk factors for, and the effect of MRSA colonization on the clinical outcomes of severely burnt patients. Burns 2015;41:1212–1220.CrossRefGoogle ScholarPubMed
16. Pham, TN, Kramer, CB, Klein, MB. Risk factors for the development of pneumonia in older adults with burn injury. J Burn Care Res 2010;31:105–110.CrossRefGoogle ScholarPubMed
17. Schultz, L, Walker, SA, Elligsen, M, et al. Identification of predictors of early infection in acute burn patients. Burns 2013;39:1355–1366.CrossRefGoogle ScholarPubMed
18. Masud, D, Norton, S, Smailes, S, Shelley, O, Philp, B, Dziewulski, P. The use of a frailty scoring system for burns in the elderly. Burns 2013;39:30–36.CrossRefGoogle ScholarPubMed
19. Rimmer, RB, Bay, RC, Foster, KN, et al. Thermal injury in patients with seizure disorders: an opportunity for prevention. J Burn Care Res 2007;28:318–323.CrossRefGoogle ScholarPubMed
20. van Duin, D, Strassle, PD, DiBiase, LM, et al. Timeline of health care-associated infections and pathogens after burn injuries. Am J Infect Control 2016;44:1511–1516.CrossRefGoogle ScholarPubMed
21. Lachiewicz, AM, van Duin, D, DiBiase, LM, et al. Rates of hospital-associated respiratory infections and associated pathogens in a regional burn center, 2008–2012. Infect Control Hosp Epidemiol 2015;36:601–603.CrossRefGoogle Scholar
22. van Duin, D, Jones, SW, Dibiase, L, et al. Reduction in central line-associated bloodstream infections in patients with burns. Infect Control Hosp Epidemiol 2014;35:1066–1068.CrossRefGoogle ScholarPubMed
23. Weber, DJ, van Duin, D, DiBiase, LM, et al. Healthcare-associated infections among patients in a large burn intensive care unit: incidence and pathogens, 2008–2012. Infect Control Hosp Epidemiol 2014;35:1304–1306.CrossRefGoogle Scholar