Antimicrobial Chemotherapy has a Linear Relationship to the Proportion of Gram-Negative Isolates from Pediatric Burn Wounds

Abstract

Wound infection in burns is a relevant cause of morbidity and mortality in children. We aimed to determine the relationship between antibacterial chemotherapy and Gram-negative burn wound colonization and infection. All children admitted to the pediatric intensive care unit for burn trauma from June 1, 2005 to January 31, 2013 were included. We obtained 141 wound samples, of which 88 (65.7%) showed growth of Gram-positive bacteria. Treatment with antimicrobial chemotherapy was necessary in 23 (31.1%) patients. The proportion of Gram-negative isolates seems to increase linear from 12.5% (95% confidence interval (CI): 4.4%–28.7%) without antibacterial chemotherapy to 36.8% (95% CI: 25.5%–49.6%) with one to 48.9% (95% CI: 35.3%–62.8%) with 2 antimicrobial agents. The Odds ratio for a Gram-negative isolate, in comparison to patients without antibacterial chemotherapy, increased from 4.083 (95% CI: 1.140–15.961) for one administered substance to 6.708 (95% CI: 1.832–26.786) if 2 or more were used.

Conclusion We found that antibacterial chemotherapy seems to facilitate burn wound colonization and results in an increased number of gram-negative isolates from children with burn wounds.

Zusammenfassung

Die Infektion von Brandwunden bei Kindern verzögert nicht nur den Heilungsprozess, sondern erhöht auch signifikant das Risiko von Narbenbildung und Mortalität. Ziel dieser Arbeit war es, den Zusammenhang zwischen antibakterieller Therapie und Besiedlung und Infektion von Brandwunden bei Kindern zu untersuchen. Dafür wurden retrospektiv alle Kinder eingeschlossen, die zwischen Juni 2005 und Januar 2013 aufgrund thermischer Verletzungen auf der pädiatrischen Intensivstation unseres Zentrums behandelt werden mussten. Es wurden 141 Proben genommen, wovon 88 (65,7%) ein Wachstum Gram-positiver Keime zeigten. 23 (31,1%) der Patienten erhielten eine antibakterielle Therapie. Der Anteil Gram-negativer Isolate stieg linear von 12,5% (95% confidence interval (CI): 4,4–28,7%) ohne antibakterielle Therapie, auf 36,8% (95% CI: 25,5–49,6%) bei Behandlung mit einer antibakteriellen Substanz, auf 48,9% (95% CI: 35,3–62,8%) bei Kombinationstherapie aus 2 antibakteriellen Substanzen. Verglichen mit Patienten ohne antibakterielle Therapie, stieg das Odds Ratio für Gram-negative Isolate von 4.083 (95% CI: 1,140–15,961) unter antibakterieller Monotherapie auf 6,708 (95% CI: 1,832–26,786) bei der Verwendung von 2 oder mehr antibakteriellen Substanzen.

Schlussfolgerung Wir konnten herausfinden, dass antibakterielle Therapie die bakterielle Besiedlung von Brandwunden begünstigt und zu einer erhöhten Rate an Gram-negativen Keimen in Wundabstrichen thermisch verletzter Kinder führt.

Key words

burn - child infection - antimicrobial chemotherapy

Schlüsselwörter

Thermische Verletzung - Kind - Infektion - Antibakterielle Therapie

^* * These authors contributed equally.

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