Infection in Patients With Burn Injury: Sources, Pathogens, Sensitivity, and Role of Empirical Antibiotics Therapy

Abstract

BACKGROUND: Infection in the patient with burn injury is a leading cause of morbidity and mortality worldwide. Clinicians in low- and middle-income countries are often left with no option other than to commence empirical antibiotics. OBJECTIVE: To determine the magnitude of infection in patients with burn injury, the sources of these infections, the prevalent microorganisms and their sensitivity pattern, and the sensitivity of the microorganisms to empirical therapy. MATERIALS AND METHODS: This prospective observational study was conducted in a regional burn center in western Nigeria between October 2010 and March 2020. RESULTS: A total of 364 patients were included in the study, with males constituting 58.5% (213) of the patients and females 41.5% (151) of the patients. The median patient age was 22 years. Flame was the most common cause of burn injury (61.5% [n = 224]). The median total body surface area burn was 22%. The majority of the patients had a clinical diagnosis of infection (85.4% [n = 311]), with the burn wound (60.8%), respiratory tract (22.2%), and urinary tract (6.1%) constituting the clinical sources of the infection. The most prevalent causes of burn wound infection were Klebsiella pneumoniae (K pneumoniae) (30.2%), Staphylococcus aureus (S aureus) (24.3%), and Pseudomonas aeruginosa (P aeruginosa) (21.0%). All cultured bacteria with the exception of Citrobacter freundii were sensitive to amikacin, with K pneumoniae and S aureus being the most sensitive to it, and P. aeruginosa being more sensitive to ceftazidime. The most commonly prescribed empirical antibiotics were amikacin (20.3%) and levofloxacin (19.8%). The cultured organisms in burn injury patients with wound infection showed high sensitivity and specificity to empirical antibiotics therapy. CONCLUSION: The results of this study indicate that the source of infection determines the most likely organism and its sensitivity profile.