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Abstract
Considerable advancements in shock resuscitation and wound management have extended
the survival of burned patients, increasing the risk of serious infection. We performed
a 6-year review of bacteria identification and antibiotic susceptibility records at
the US Army Institute of Surgical Research Burn Center between January 2003 and December
2008. The primary goal was to identify the bacteria recovered from patients with severe
burns and determine how the bacteriology changes during extended hospitalization as
influenced by population and burn severity. A total of 460 patients were admitted
to the burn ICU with 3507 bacteria recovered from 13,727 bacteriology cultures performed.
The most prevalent organisms recovered were Acinetobacter baumannii (780), Pseudomonas
aeruginosa (703), Klebsiella pneumoniae (695) and Staphylococcus aureus (469). A.
baumannii was most often recovered from combat-injured (58%) and S. aureus the most
frequent isolate from local (46%) burn patients. Culture recovery rate of A. baumannii
and S. aureus was highest during the first 15 hospital days (73% and 71%); while a
majority of P. aeruginosa and K. pneumoniae were recovered after day 15 (63% and 53%).
All 4 pathogens were recovered throughout the course of hospitalization. A. baumannii
was the most prevalent pathogen recovered from patients with total body surface area
(TBSA) burns less than 30% (203) and 30-60% (338) while P. aeruginosa was most prevalent
in patients with burns greater than 60% TBSA (292). Shifting epidemiology of bacteria
recovered during extended hospitalization, bacteriology differences between combat-injured
and local burn patients, and impact of % TBSA may affect patient management decisions
during the course of therapy.
(c) 2009 Elsevier Ltd and ISBI. All rights reserved.