A 10-year Retrospective Review of Patient-to-Patient Transmitted Pathogens in Culture-Positive Burn Wounds at a Tertiary Burn Center.

Introduction

Burn wound infection can progress to sepsis and is a significant source of morbidity and mortality. Prevalence of multidrug-resistant organisms are high in burn patients; these organisms can be transmitted between patients leading to poor outcomes.

Objectives

To characterize patient-to-patient transmission of pathogens causing burn wound colonization at a single tertiary hospital burn center in Hamilton, Canada from 2011 to 2020.

Methods

Retrospective chart review of patients admitted to the burn trauma unit at Hamilton General Hospital between 2011 and 2020. Antibiotic susceptibility panels of pathogens cultured from burn patients' wound swab/tissue cultures were compared against pathogens cultured from other burn/nonburn patients with overlapping admission dates. Pathogens were categorized into likely, possible, or unlikely transmission, or normal skin flora on a case-by-case basis.

Results

There were 173 burn patients with positive wound culture and 613 nonburn patients included in the study. Included burn patients had median age 52 years, mostly male (73%) with flame injury (65%), and median total body surface area 18%. There were 18 patients (10%) with likely transmission and 54 patients (31%) with possible transmission. Most frequently implicated pathogens for likely patient-to-patient transmission were methicillin-resistant Staphylococcus aureus (MRSA) (7 patients) and methicillin-resistant coagulase-negative Staphylococci (4 patients). Both burn and nonburn patients were implicated.

Conclusion

The burden of patient-to-patient transmission in culture-positive burn wounds was estimated to be between 10% and 41%. Greater care should be taken to avoid patient-to-patient transmission of pathogens to minimize burn infection morbidity and mortality. Prospective studies should be conducted with genomic sequencing and correlation with clinical outcomes.