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Risk factors for the development of early pneumonia in patients with large TBSA burns: a single center study
Dembinski, Doug, MD;
Lax, Elizabeth, MD;
Jiang, Austin, MS
Dale, Elizabeth, MD
University of Cincinnati
2019-02-05
Presenter: Austin Jiang, MS
Affidavit:
This work is the original work of the residents and students listed as authors in this abstract.
Director Name: W. John Kitzmiller, MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction: Patients who suffer large burns (defined as TBSA of burn >30%) represent a subset of patients with increased morbidity. Pneumonia in this subset of patients can develop early during ICU admission and can lead to poor outcomes. Studies have demonstrated that prophylactic antibiotic use can decrease rate of ventilator-associated pneumonia in burn patients. If risk factors for the development of pneumonia could be identified, high-risk patients could be targeted with prophylactic antibiotics in order to improve outcomes.
Methods: A retrospective review of all patients admitted to our burn unit from 2013-2018 was conducted. Patients who suffered TBSA ≥ 30% burns were identified. Inclusion criteria included thermal injury and survival ≥ 48 hours after injury. Demographic, clinical, and microbiological data were collected for analysis.
Results: 23 patients were identified that met inclusion criteria. 73.9% of these patients developed pneumonia within 7 days of their admission. Patients diagnosed with pneumonia were more likely to have required intubation, required escharotomies at time of admission or suffered inhalation injuries. Grade of inhalation injury did not correlate with worse patient outcomes. The most commonly isolated organisms in the first 7 days of ICU admission were MRSA, MSSA, and Enterobacter. 50% of patients had polymicrobial cultures.
Conclusions: Patients who suffer large burns with TBSA ≥ 30% have a high incidence of developing pneumonia. We have identified the need for intubation, need for escharotomies at time of presentation, and presence of inhalation injury (any grade) as risk factors associated with development of pneumonia.
