Infections in burned children: epidemiological analysis and risk factors

Abstract

Introduction: Burns are the third cause of accidental deaths among children. Approximately 50-60% of these deaths are the result of an infection.

Objective: To determine infection related risk factors in burned children.

Population and methods: All patients admitted to the Burn Unit of Hospital "Prof. Dr. Juan P. Garrahan" between June 2007 and December 2009 were included. The epidemiology of hospital-acquired infections and the associated outcome measures were determined. Groups of infected and non-infected children were compared using Student's t test or the Mann-Whitney Rank Sum test, as applicable. Dichotomous outcome measures were analyzed with the X2 test using Yates' correction. In order to assess the predictive value of independent outcome measures, the multiple logistic regression model was applied.

Results: In this cohort of 110 children, 128 hospital-acquired infections were recorded in 84 patients. There were 17 deaths (15%); 14 out of these 17 (82%) were related to infection. Infection-related factors included the percentage of burned body surface area; the highest Garces' index; burn depth; antibiotic prophylaxis; the use of topical antibiotics; the presence of a central venous line, an arterial line, a urinary catheter, mechanical ventilation support, escharotomy, and the need of a graft. The multivariate analysis showed a higher risk of infection with the use of central venous lines (RR: 5.15; 95% CI: 1.44-18.46), antibiotic prophylaxis (RR: 5.22; 95% CI: 1.26-21.63), and graft requirement (RR: 3.65; 95% CI: 1.08-12.37).

Conclusions: The presence of lines or catheters, antibiotic prophylaxis, and graft requirement were independent risk factors for infection in burned children.