Risk factors for infection in burn in children and adolescents: a cohort study

LIMA, JOYCE DE SOUSA FIORINI; OLIVEIRA, EDUARDO ARAÚJO DE; ARAÚJO, ANA CAROLINA RIBEIRO ASSIS; OLIVEIRA, MATHEUS MOURA DE

doi:10.5935/2177-1235.2016RBCP0090

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Revista Brasileira de Cirurgia Plástica

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Original Article • Rev. Bras. Cir. Plást. 31 (04) • 2016 • https://doi.org/10.5935/2177-1235.2016RBCP0090 copy

Risk factors for infection in burn in children and adolescents: a cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Prevention of infection in burned patients poses great challenges such as infection, which constitutes the most common cause of mortality after burn injury. An analysis of burned patients younger than 20 years-old was performed prospectively to identify the incidence of nosocomial infection (NI) and risk factors for N. We included in the study those admitted and treated from January 2012 to December 2012 at a public burn unit in Brazil.

Methods:

A total of 136 patients admitted at Burn Care Unit during the study period fulfilled inclusion criteria. We collected information related to NI and epidemiological data.

Results:

Most patients were male (63.2%) and non-white (57.4%). Patients’ mean age was 7.64 years. Scalding was the most frequent causal agent (45.6%). The mean body surface area (BSA) was 15.7%. Most of patients (80.9%) had two or more damaged areas. Surgical treatment with grafts was needed in 69 cases (50.7%). Infection was seen in 59 cases (43.4%), and sepsis in 27 (19.8%). Cultures were positive in 22.8%, and Staphylococcus aureus was the most frequent isolated agent (31.2%) found. Antimicrobial drugs were used in 45.6% of patients. The mean length of hospital stay was 22.36 days and mortality rate was 2.5%. According to the statistical analysis there was an association between infection and admission to the Intensive Care Unit (ICU), invasive procedures, grafts, length of hospital stay and BSA.

Conclusion:

Risk factors for infection in burn patients are length of hospital stay, BSA, invasive procedures, admission at ICU and grafts.

Keywords:
Burns; Infection; Child; Adolescent; Risk factors.

	N	%
Gender Male	86	63.2
Female	50	36.8
Race White	41	30.1
Non-white	78	57.4
Black	17	12.5
Age (year) 0 - 1	35	25.7
2 - 5	29	21.3
6 - 10	32	23.5
11 - 19	40	29.5
Age (year)	7.64
Origin Belo Horizonte	30	22.0
Metropolitan Area	40	29.5
Minas Gerais - other cities	66	48.5
Social Class - Monthly Income^ * Information regarding 105 patients. BCU: Burn Care Units.* A (A1; A2)	0
B (B1; B2)	12	11.4
C (C1; C2)	71	67.6
D	18	17.2
E	4	3.8
Comorbities Yes	18	13.2
No	118	86.8
Burn Surface Area (BSA) < 10%	34	25.0
10 - 19%	62	45.6
20 - 39%	36	26.5
> 40%	4	2.9
Mean of BSA	15.7%
Causal Agents Scalding	62	45.6
Fire	60	44.1
Hot solid	5	3.7
Eletrical	8	5.9
Chemical	1	0.7
Infection Yes	59	43.4
No	77	56.6
Mortality Yes	4	2.5
No	132	97.5
Length of Hospital Stay (days)	22.36

	N	%
Total Burn Surface Area Yes	7	5.2
No	129	94.8
Surgical Treatment - Graft Yes	69	50.7
No	67	49.3
Drug Abuse Yes	7	5.1
No	37	27.2
Not applicable (< 10 year)	92	67.7
Local Event Home	100	91.2
Kitchen	51	51
Backyard	31	31
Other	18	18
Other/Unknown	36	8.8
Event Characteristics Accidental	124	91.2
Intentional	12	8.8
Associated Trauma Yes	3	2.2
No	133	97.2
Burn Area Head	6	4.4
Superior members (SM)	7	5.1
Inferior members (IM)	11	8.1
Thorax/Abdomen	2	1.5
2 or more areas	110	80.9
Thorax/Abdomen/Head/SM	31	22.9
Thorax/Abdomen/SM/IM	20	14.7
Thorax/Abdomen/Head/SM/IM	18	13.2
Others	41	30.1
Burn Areas^ * Information regarding 136 patients with one or more burn area - total 318.* Head	71	22.4
Thorax/Abdomen	91	28.6
SM	91	28.6
IM	65	20.4
Infection Yes	59	43.4
No	77	56.6
Systemic Infection - Sepsis Yes	27	19.8
No	109	80.2
Infection^ Information regarding 59 patients.
Systemic	11	18.6
Urinary	1	1.7
Pulmonary	2	3.4
Burn area - skin	31	52.5
Cateter	2	3.4
2 or more associated Antimicrobial drug use	12	20.4
No	74	54.4
Yes - 1 drug	29	21.3
Yes - 2 or more drugs Antimicrobial drug^ ***** There were 62 patients using antimicrobial drug, and 33 using more than one - total 91.*	33	24.3
Cefepime	38	41.8
Vancomicine	21	23.1
Others Positive Culture	32	35.1
Yes	31	22.8
No	37	27.2
Not applicable Isolated Agent^* ****** There were 31 patients with positive cultures, and 12 patients with two or more isolated agentes - total 48. BCU: Burn Care Units.*	68	50
Staphylococcus aureus	15	31.2
Pseudomonas aeruginosa	13	27.1
Acinetobacter baumanni	8	16.7
Others	12	25
Length of antimicrobial drug	12.9

Variables	Infection (n = 59)	No Infection (n = 77)	Total (n = 136) OR (CI 95%) p
Age
< 2 years	16	19	35 (25.74%) 1.13 (0.52 - 2.46) 0.90
> 2 years	43	58	101(74.26%)
Race
White	22	19	41 (30.15%) 1.81 (0.86 - 3.80) 0.16
No-White	37	58	95 (69.85%)
Sex
Male	37	49	86 (63.24%) 0.96 (0.47 - 1.94) 0.95
Female	22	28	50 (36.76%)
Other Hospital
Yes	50	61	111 (81.62%) 1.45 (0.59 - 3.57) 0.55
No	9	16	25 (18.38%)
Procedence
BH and MA	25	45	70 (51.47%) 1.91 (0.96 - 3.80) 0.09
Another cities	34	32	66 (48.53%)
Pre-Hospitalar Treatment
Yes	38	36	74 (54.41%) 1.60 (0.80 - 3.19) 0.24
No	23	39	62 (45.59%)
Comorbidities
Yes	10	8	18 (13.24%) 1.76 (0.65 - 4.78) 0.39
No	49	69	118 (86.76%)
ICU
Yes	15	1	16 (11.76%) 25.91(3.31 - 202.88) < 0.001
No	44	76	177 (88.24%)
Airway Injury
Yes	5	2	7(5.15%) 3.47 (0.65 - 18.57) 0.25
No	54	75	129 (94.85%)
Surgical Treatment - Graft
Yes	40	29	69 (50.74%) 3.48 (1.71 - 7.12) < 0.001
No	19	48	67 (49.26%)
Cateter de Foley
Yes	33	7	40 (29.41%) 12.69 (5 - 32.22) < 0.001
No	26	70	96 (70.59%)
Foley catheter
Yes	11	1	12 (8.82%) 17.41 (2.18 - 139.24) 0.001
No	48	76	124 (91.18%)
Orotracheal Tube
Yes	19	1	20 (14.71%) 36.10 (4.66 - 279.59) < 0.001
No	40	76	116 (85.29%)
Length of Hospital Stay
> 14 dias	50	32	82 (60.29%) 7.81 (3.37 - 18.13) < 0.001
0 - 14 dias	9	45	54 (39.71%)
BSA
> 9%	56	47	103 (75.74%) 11.91 (3.42 - 41.53) < 0.001
0 - 9%	3	30	33 (24.26%)

Variables	Coefficient	Odds Ratio	95% CI	p value
Length of Hospital Stay (days)	0.114	1.121	1.069 - 1.176	< 0.001
BSA %	0.064	1.066	1.021 - 1.113	0.004

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[1] *Corresponding author: Joyce de Sousa Fiorini Lima, Rua Três, 611-101 - Lagoa - Ouro Preto, MG, Brazil Zip Code 35400-000, E-mail: joycefiorini@gmail.com