Nasser S, Alnasser Z, Aljuhani O, Alharbi A, Rice J, Alharthi A F, Kensara R, Al Mutairi F E, Zaabee D, Alowais S A, Damfu N, Alsohimi S, Alshehri A A, Alotaibi S, Bin Abdulqader M, Almarhoun S, Waggas N, Alajmi M, Alrashidi N, Alharbi M, Al Asiri M, Hadadi A A, Alhaidal H A, Alahmari G, Almutairi A H, Alwadani F A, Musally A M, Mahboob R A, Bakor D T, Vishwakarma R, Al Sulaiman K A
Department of Nursing, College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia; Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.
Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
J Hosp Infect. 2025 May 31;162:186-196. doi: 10.1016/j.jhin.2025.05.010.
Despite the widespread incidence of multi-drug-resistant organisms (MDROs) within burn centres, there is a lack of research investigating the risk of infection with MDROs in critically ill burn patients. This study aimed to identify the risk factors associated with the acquisition of MDROs among critically ill burn patients admitted to burn intensive care units (BICUs), and to determine the prevalence of MDROs in this population.
This multi-centre observational case-control study included adult patients (age ≥18 years) admitted to BICUs between January 2015 and December 2022. Patients were excluded if the burn injury affected <10% of the body surface area, they died within 24 h of ICU admission, the timing of the burn injury was unknown, and they had a history of MDRO infection within 1 year prior to admission or antibiotic use 3 months prior to admission. Risk factors for acquiring MDROs, prevalence of MDROs, ICU length of stay (LOS), hospital LOS, 30-day mortality and in-hospital mortality rates were identified as the study outcomes. An exact matching approach with a 1:1 ratio was used to match the two groups based on age, gender and admission year. Stepwise forward selection logistic and linear regression analyses were used when appropriate.
In total, 173 patients were included, of which 168 patients were matched: 84 patients in the case group (MDRO group) and 84 patients in the control group (non-MDRO group). Patients in the MDRO group had lower Glasgow Coma Scale (GCS) baseline scores [unadjusted odds ratio (OR) 0.88, 95% confidence interval (CI) 0.827-0.944], higher baseline Sequential Organ Failure Assessment (SOFA) scores (unadjusted OR 1.19, 95% CI 1.069-1.329), higher APACHE II scores (unadjusted OR 1.11, 95% CI 1.054-1.161), invasive mechanical ventilation (MV) status at admission (unadjusted OR 3.76, 95% CI 1.96-7.20), and a greater proportion of total body surface area (TBSA) affected (unadjusted OR 1.04, 95% CI 1.024-1.058]) compared with the non-MDRO group. However, regression analysis showed that those with lower baseline GCS scores [adjusted OR (aOR) 0.904, 95% CI 0.828-0.987], a greater proportion of TBSA affected (aOR 1.023, 95% CI 1.002-1.045), and urinary tract infections (aOR 7.198, 95% CI 1.973-26.259) were significantly more prone to MDRO infections. The most common isolated pathogen in the MDRO group was Acinetobacter baumannii (57%), and the most common infection was pneumonia (52.4%). The duration of MV and ICU LOS were significantly longer in the MDRO group compared with the non-MDRO group. No significant differences in the other outcomes were observed between the groups.
This study showed a significantly increased risk of MDRO infection in patients who had burns affecting a greater proportion of TBSA, lower GCS scores, and higher SOFA and APACHE II scores. Future studies with larger sample sizes are needed to confirm these results.
尽管烧伤中心多重耐药菌（MDROs）的发病率普遍较高，但缺乏对重症烧伤患者感染MDROs风险的研究。本研究旨在确定烧伤重症监护病房（BICUs）收治的重症烧伤患者中与获得MDROs相关的危险因素，并确定该人群中MDROs的患病率。
这项多中心观察性病例对照研究纳入了2015年1月至2022年12月期间入住BICUs的成年患者（年龄≥18岁）。如果烧伤面积小于体表面积的10%、在ICU入院后24小时内死亡、烧伤时间不明，以及入院前1年内有MDRO感染史或入院前3个月内使用过抗生素，则排除这些患者。获得MDROs的危险因素、MDROs的患病率、ICU住院时间（LOS）、医院住院时间、30天死亡率和住院死亡率被确定为研究结果。采用1:1比例的精确匹配方法，根据年龄、性别和入院年份对两组进行匹配。在适当的时候使用逐步向前选择逻辑回归和线性回归分析。
总共纳入了173例患者，其中168例患者进行了匹配：病例组（MDRO组）84例患者和对照组（非MDRO组）84例患者。与非MDRO组相比，MDRO组患者的格拉斯哥昏迷量表（GCS）基线评分较低[未调整比值比（OR）0.88，95%置信区间（CI）0.827 - 0.944]，基线序贯器官衰竭评估（SOFA）评分较高（未调整OR 1.19，95% CI 1.069 - 1.329），急性生理与慢性健康状况评分系统II（APACHE II）评分较高（未调整OR 1.11，95% CI 1.054 - 1.161），入院时的有创机械通气（MV）状态（未调整OR 3.76，95% CI 1.96 - 7.20），以及受影响的体表面积（TBSA）比例更大（未调整OR 1.04，95% CI 1.024 - 1.058）。然而，回归分析显示，基线GCS评分较低者[调整后OR（aOR）0.904，95% CI 0.828 - 0.987]、受影响的TBSA比例更大（aOR 1.023，95% CI 1.002 - 1.045）以及尿路感染（aOR 7.198，95% CI 1.973 - 26.259）的患者明显更容易发生MDRO感染。MDRO组中最常见的分离病原体是鲍曼不动杆菌（57%），最常见的感染是肺炎（52.4%）。与非MDRO组相比，MDRO组的MV持续时间和ICU住院时间明显更长。两组在其他结果方面未观察到显著差异。
本研究表明，烧伤面积比例更大、GCS评分较低、SOFA和APACHE II评分较高的患者发生MDRO感染的风险显著增加。需要更大样本量的未来研究来证实这些结果。
