Identifying risk factors for transitioning from colonisation to infection in burn patients: a retrospective study at the Ghent university hopsital burns centre

Borges Noah, Rapol Soetkin, 2023
Despite a decrease in the incidence of burn injuries and burn-related fatalities in high income countries, the World Health Organisation (WHO) states that burn injuries remain a widespread problem. Burn wound fatalities account for 180.000 deaths yearly: it being the fourth most lethal traumatic injury (1,2,3). Additionally, the majority of the estimated 11 million annual burn injuries occurs particularly in low- or middle-income countries. In these regions, prevention measures and treatment options are considerably more limited (1). Infection is a significant factor to the morbidity and mortality of burn patients. Notably, when compared to other intensive care unit (ICU) populations, burn patients exhibit the highest incidence of infectious complications. This situation offers a unique opportunity to improve the treatment of burn patients (4, 5). The introduction of early excision and skin grafting in the 1970’s led to a decrease in nosocomial infection-related mortality in high income countries (2). Notwithstanding these improvements, burn site infections are still associated with important morbidity and mortality. Several factors are associated with a higher susceptibility to infections in these patients such as loss of the skin barrier, a dysregulated immune response, increased hospital stay and numerous therapeutic and diagnostic interventions (4, 6). Given the difficulty in distinguishing between burn wound colonisation and infection, antibiotics are frequently administered in cases where infection cannot be ruled out, leading to potential overuse where infection is not confirmed. If colonisation advances to systemic infection, mortality rates can reach as high as 75%. The majority of these deaths can be attributed to nosocomial infections such as pneumonia, sepsis, urinary tract infections, and acute burn wound infections (BWI). On top of this, there is facilitated horizontal transmission between burn patients, making burn care units infection hotspots for prolonged outbreaks and further spreading of potentially multi-drug resistant (MDR) infections to different hospital departments. In conclusion, there has been a growing amount of interest in the prevention of both burn site and other nosocomial infections that could lead to sepsis, septic shock, and ultimately death (4, 7, 8, 9). The primary impediment in addressing the prevention of burn wound infections lies in the inherent challenge of distinguishing between colonisation and infection in patients. This dissertation is dedicated to the investigation of identifying risk factors for burn infections in burn patients, with the aim of clarifying risk factors that increase susceptibility to burn wound infections. Conducted as a retrospective study, we analysed patients admitted from January 2013 to January 2023 in our Burn Centre unit. This study seeks to identify the risk factors through statistical analyses. Although several risk factors for infection have been established in various other burn centres, determining risk factors at the burn centre of Ghent University Hospital is essential as infections and their causative pathogens may be different according to the region of the burn centre (6). By conducting a comprehensive investigation into these determinants, this study hopes to potentially reduce the morbidity and mortality associated with burn wound infections. The findings of this research will contribute to the enhancement of burn wound care protocols and the use of antibiotics, improving the overall management of burn wound patients and ultimately reducing the impact of infections.

Promotor Stan Monstrey
Opleiding Geneeskunde
Kernwoorden Burn Wound Infection Risk factor