K. Mahendraraj1, R. S. Chamberlain1,2,3 1Saint Barnabas Medical Center,Department Of Surgery,Livingston, NJ, USA 2New Jersey Medical School,Department Of Surgery,Newark, NJ, USA 3St. George’s University School Of Medicine,Department Of Surgery,St. George’s, St. George’s, Grenada
Introduction:
Thermal burns are associated with intestinal barrier failure, bacterial translocation, intestinal infections (IF) and sepsis. While the mechanisms for increased gut permeability have been extensively studied, the risk factors for developing IF are poorly understood. This study examines a large cohort of burn patients to assess the demographics and clinical outcomes of patients who develop burn-related IF compared to those who do not.
Methods:
Data on 95,472 patients with third degree flame burn injuries was abstracted from the Nationwide Inpatient Sample (NIS) Database over a ten year period (2001-2010). IF was defined as any intestinal infection due to any Gram negative Enterobacteriaceae sp., Enterococcus sp., Campylobacter sp, Yersinia spand Clostridium difficile. Standard statistical methodology was used.
Results:
541 (0.6 %) of burn patients were diagnosed with IF post-burn. Patients who developed IF were significantly older than those without IF (54.7 vs. 40 years old, p<0.001). Males (57.1%) and Caucasians (48.6%) developed IF more often. More extensive third degree burns were more common among IF patients, p<0.005). Length of stay (27.6 vs. 7.9 days), and overall inpatient mortality were significantly higher in IF patients. (6.3% vs. 2.6%), p<0.001. The most common comorbidities associated with developing IF were hypertension (31.7%), chronic respiratory illness (17.3%), and diabetes (14.8%), p<0.001. IF patients more often had fluid and electrolyte disorders (44.8%), sepsis (13.3%), burn wound infection (7.4%), and skin graft failure (2%). Multivariate analysis identified age over 60 (OR 1.0), fluid and electrolyte disorders (OR 3.1), peripheral vascular disease (OR 1.7), and multiple burn sites (OR 1.8) as independently associated with IF development, p<0.005. Conversely, TBSA under 10% (OR 0.5) and active smoking habit (OR 0.4) were associated with a lower risk of developing IF, p<0.005. Risk factors for mortality in IF patients included sepsis (OR 2.4), septic shock (OR 1.8) and acute DVT (OR 2.6), p<0.005.
Conclusion:
IFs in burn patients is associated with longer hospitalization, increased mortality, graft failure, sepsis and other adverse events. The strongest risk factors for IF are fluid and electrolyte disorders, peripheral vascular disease, and multiple severe burn sites IF is more common in Caucasian males with 3rd degree burns >20% TBSA, and older patients with multiple co-morbidities. Clinicians should be cognizant of these IF risk factors when assessing and monitoring high-risk burn patients in order to decrease morbidity and mortality. Additional research into IF preventions strategies in high risk burn patients such as the use of probiotics are already underway.
