Epidemiology and Outcomes of Bloodstream Infections in Patients in a Burns Intensive Care Unit: An 8-Year Retrospective Study.

BACKGROUND: Burns intensive care units (BICUs) have reduced mortality in patients with burns, but infections and sepsis remain the leading causes of death. Infections with multidrug-resistant (MDR) bacteria increase the risk of death in patients with burns, whose risk of acquiring such infections is higher due to various factors, including prolonged hospitalization and invasive procedures. METHODS: A retrospective study was performed in a French BICU over 8 years to analyze the epidemiology and risk factors for bloodstream infections (BSIs). RESULTS: In total, 1402 patients were admitted to the BICU. Thermal burns were the most common cause of injury, and the median total body surface area burned was 10%. Patients had various comorbid conditions, particularly smoking and hypertension. BSI occurred in 303 (21%) patients. When compared with patients without BSI, patients with BSI were older, had higher severity scores and a larger total body surface area burned, and were more likely to develop complications. The prevalence of monomicrobial and polymicrobial BSI remained stable during hospitalization, with gram-positive pathogens such as Staphylococcus aureus most common during the first week but with gram-negative pathogens, particularly MDR Pseudomonas aeruginosa, becoming more prevalent after 15 days. The distribution of microorganisms remained stable throughout the study, except for a significant decrease in Acinetobacter baumannii rates and an increase in MDR P aeruginosa rates after 2015. CONCLUSIONS: An understanding of the epidemiology of BSI-causing microorganisms over time is crucial for sepsis management to ensure the selection of appropriate empirical antimicrobial therapy and to highlight the need for infection prevention and antimicrobial stewardship.