Burn-associated bloodstream infections in pediatric burn patients: Time distribution of etiologic agents

- Gram-positive organisms accounted for 66.4% of the causative pathogens for bloodstream infections (BSIs).
- Gram-negative organisms and candida infections were less commonly seen in pediatric burn patients.
- The median duration of BSI caused by gram-positive bacteria was 5 days and was significantly shorter than BSIs caused by other organisms.
- Empirical antibiotics in burn patients with good gram-positive coverage are indicated for infections in the first week after burn.

BackgroundInfections are the leading cause of morbidity and mortality in patients with burns in burn units. Bloodstream infections (BSIs) in patients with burns may result from burn wound infection, use of invasive devices such as central venous catheters, and translocation of the gastrointestinal flora.ObjectiveIn this study, we investigated the distribution and antimicrobial drug resistance of causative pathogens in children with burns and the durational changes of microorganisms in the distribution of BSIs in children.MethodsThis study was conducted at the Pediatric Burn Unit (PBU) of Dr. Behçet Uz Children Research and Training Hospital during the period of November 2008-April 2015. The study subjects were all the patients admitted to the PBU, in whom microorganisms were isolated at least from one of the cultures, including blood and catheter cultures.ResultsGram-positive bacteria were the most common causative agents of BSI in patients with burns (66.4%), followed by gram-negative bacteria (22.1%) and fungi (11.5%). The median duration of development of BSIs caused by gram-positive bacteria from the time of burn was 5 days (ranging from 2 to 54 days of burn), which was significantly shorter than that of BSIs caused by gram-negative bacteria (12 days) and fungal pathogens (13 days).ConclusionThe etiologic agents of BSIs in children may differ from those in adults. Gram-negative drug-resistant bacteria such as multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii were important agents of BSI in patients with burns, especially in the long term; however, gram-positive bacteria should also be considered while deciding the antimicrobial therapy, especially in the early periods of burn.