Epidemiology and Outcomes of Bloodstream Infections in Patients in a Burns Intensive Care Unit: An 8-Year Retrospective Study

By
Héloïse Petit
Christian de Tymowski
Emmanuel Dudoignon
Mathilde Liberge
Jean-Luc Donay
Maite Chaussard
Maxime Coutrot
Alexandru Cupaciu
Lucie Guillemet
Benjamin Deniau
Alexandre Pharaboz
Mourad Benyamina
Blandine Denis
Guillaume Mellon
Matthieu Lafaurie
Alexandre Alanio
François Dépret
Béatrice Berçot
François Caméléna
March 12, 2025
0 min

Open Forum Infectious Diseases

Overview

This retrospective study of 1402 burn patients admitted to a French burns ICU over eight years found bloodstream infections (BSIs) occurred in 21% of patients and were associated with older age, higher burn severity, and increased complications. Gram-positive bacteria predominated early, while multidrug-resistant Pseudomonas aeruginosa became more common after two weeks, highlighting evolving pathogen profiles.

Background

Burns intensive care units (BICUs) have improved survival in burn patients, but infections and sepsis remain leading causes of mortality, accounting for approximately 65% of deaths. Bloodstream infections significantly increase mortality risk, especially when caused by multidrug-resistant (MDR) bacteria. Burn patients are at high risk for MDR infections due to prolonged hospitalization, invasive devices, and prior antibiotic exposure. Understanding local epidemiology is critical for guiding empirical antimicrobial therapy and infection control.

Data Highlights

Parameter	Value
Total patients admitted	1402
Patients with BSI	303 (21%)
Median total body surface area burned	10%
Common comorbidities	Smoking, hypertension
Early BSI predominant pathogens (first week)	Gram-positive bacteria (Staphylococcus aureus)
Late BSI predominant pathogens (>15 days)	Gram-negative bacteria, especially MDR Pseudomonas aeruginosa
Trends over study period	Decrease in Acinetobacter baumannii; increase in MDR P. aeruginosa after 2015

Key Findings

BSI occurred in 21% of burn patients admitted to the BICU.
Patients with BSI were older, had higher severity scores, larger burn areas, and more complications than those without BSI.
Gram-positive bacteria, mainly Staphylococcus aureus, dominated early bloodstream infections within the first week.
Gram-negative pathogens, particularly multidrug-resistant Pseudomonas aeruginosa, became more prevalent after 15 days of hospitalization.
Over the 8-year period, Acinetobacter baumannii infections decreased significantly, while MDR Pseudomonas aeruginosa infections increased after 2015.
Surveillance cultures and multidisciplinary antibiotic stewardship were integral to managing infections and guiding therapy.

Clinical Implications

Clinicians should be aware of the temporal shift in causative pathogens of bloodstream infections in burn patients, with early infections typically caused by gram-positive bacteria and later infections by MDR gram-negative bacteria such as Pseudomonas aeruginosa. Empirical antimicrobial therapy should be guided by local epidemiology and adjusted based on surveillance cultures and susceptibility data. Infection prevention and antimicrobial stewardship programs are essential to reduce MDR pathogen emergence and improve patient outcomes.

Conclusion

Bloodstream infections remain a significant complication in burn patients, with evolving pathogen profiles over time that impact management strategies. Continuous surveillance and tailored antimicrobial approaches are crucial to optimize outcomes in this vulnerable population.

References

Saint-Louis University Hospital BICU Study 2012-2020 -- Analysis of Bloodstream Infection Epidemiology and Patient Outcomes in a Burns Intensive Care Unit