P. H. Chang1,2,3, P. H. Chang1,2,3 1Shriners Hospitals For Children-Boston,Boston, MA, USA 2Massachusetts General Hospital,Boston, MA, USA 3Harvard Medical School,Boston, MA, USA
Introduction:
The proliferation of multiple drug resistant gram negative bacteria (MDR-GNB) species is a concern in the pediatric burn patient population. Sepsis continues to be the leading cause of death in this population. The consequences of cross-infection across patients by these organisms can be dire.
Methods:
A retrospective review of a single pediatric burn institution's experience with MDR-GNB colonization and infection in children with burns was performed. The definition of multiple drug resistance was set as resistance to three or more antimicrobial classes of medications. The definition of pan drug resistance was set as resistance to all antimicrobial classes of medications except for colistimethate. Data collected on patents by the infection control coordinator included demographics, burn clinical data, MDR-GNB speciation, source of positive culture, hospital length of stay, and survival.
Results:
3,359 children were admitted from January 1994 to December 2013 for management of acute burns or open wounds to the single pediatric burn institution. 220 of the 3,359 patients (6.5%) had MDR-GNB identified in cultures collected from wounds, sputum, urine, or blood during their admission. MDR-GNB incidence significantly increased over the 2 decade period of the study from 2.5% of admission in the first decade to 8.6% of admissions in the second decade.
Demographics of the patients included an average age of 8.8 years (+/- 5.3 years) and an average burn size of 42.9% TBSA (+/- 22.8%).
MDR-GNB infections included bacteremia in 80 (36.4%) patients, invasive wound infection in 46 (20.9%) patients, pneumonia in 19 (8.6%) patients, and UTI in 46 (20.9%) patients. The 3 most common bacterial species identified included Pseudomonas aeruginosa (116 total, 33 PAN), Acinetobacter baumannii (127 total, 41 PAN), and Klebsiella pneumoniae (84 total, 2 PAN). 14 patients died (6.4%) with the cause of death in all 14 children attributable to MDR-GNB sepsis. Cross-contamination was suspected in 22 (10%) patients. No statistically significant effect was noted on rates of graft loss or number of operations needed per patient.
Conclusions:
Pediatric burn patients face the risk of MDR-GNB infections which can lead to life-threatening sepsis. The incidence of MDR-GNB identification in this institution has increased over 2 decades. This may be due to inappropriate common use of broad-spectrum antibiotics. Fortunately, most MDR-GNB isolates were still susceptible to colistimethate. Stringent infection control adherence is even more important than ever to prevent cross-contamination of MDR-GNB across patients.
