PR114

THE CHANGING EPIDEMIOLOGY OF INFECTION IN A BURN UNIT

C. Marques1,*, J. Carneiro1, M. Luis1, E. Almeida1, F. Xambre1

Anesthesia, Centro hospitalar Lisboa Norte - hospital Santa Maria, Lisboa, Portugal
1

Background & Objectives: Infection is a major problem in burn care and its management
remains a major challenge(1). The purpose of this study is to access the prevalence of pathogens,
including methicilin-resistant Staphylococus Aureus (MRSA), extended-spectrum B-lactamase
(ESBL)-producing and carbapenem-resistant members of the Enterobacteriaceae family and
imipenem-resistant Pseudomonas Aeruginosa, causing infection in patients of a major burn
unit of a university hospital.

Materials & Methods: We performed a retrospective study. Microbiological data was collected
and analyzed from patients admitted to a major burn unit from January 2011 to December
2014.

Results: From January 2011 to December 2014, 205 patients were admitted in the burn unit.
The average age was 53 years old, 60% were male, the median of TBSA was 20,8% and the
average length of stay was 32,5 days. A total of 6526 cultures were evaluated. The micro-
biological analysis revealed a total positivity rate of 19,3%. The most prevalent agents were
Pseudomonas Aeruginosa (23,8%), Candida Albicans (15%), Staphylococus Aureus (17,7%) and
Enterococus Faecalis (8,2%). The graph shows the evolution of the prevalence of antimicrobial-
resistant pathogens.

Conclusion: Diagnosis of infection in burn patient is not easy, because clinical and biological
infection criteria are poorly relevant, especially in major burn patients. A serious burn trig-
gers a systemic inflammatory response syndrome, which mimics usual clinical and biological
signs of infection(1). An antibiotic therapy based on those usual infection criteria may lead to
the prescription of useless antibiotics. Therefore, cultures are important to the diagnosis of
infection. We observed an increased prevalence of antimicrobial-resistant pathogens, includ-
ing ESBL-producing and carbapenem-resistant members of the Enterobacteriaceae family and
imipenem-resistant Pseudomonas Aeruginosa. This was not the case for Staphylococus Aureus

September 2016 • Volume 123 • Number 3 Supplement

MRSA. Also, we noted that the most prevalent agents were Gram-negative bacilli, namely
Pseudomonas Aeruginosa (23,8%). These results can be explained by selective pressure
exerted by prolonged use of broad-spectrum antibiotics. In addition, the burn unit receives
patients transferred from other hospitals. These factors require us to adjust our care manage-
ment. Thus, data on the epidemiology of infections in burn units can be used to monitor the
effects of preventive measures and implement changes in policy and procedures.

References:
1. Burns. 2011 Feb;37(1):16–26

Disclosure of Interest: None declared

DOI: 10.1213/01.ane.0000492520.81576.89

September 2016 • Volume 123 • Number 3 Supplement