Search

Infections complicating burns generally transition from Gram-positive to Gram-negatives over the first couple weeks, but this depends on multiple factors. The microbiology of infections complicating crude oil (CO) and hydraulic fracturing (FRAC) burns is unknown.We performed a retrospective study of patients with industrial thermal burns hospitalized2 days with ≥1 day in the ICU between 4/2011-11/2016. Burns were oil-related (ORB; CO or FRAC) or non-oil related (NORB). Epidemiology and microbiology during the first 15 hospital days was compared.149 patients were included, with 11 FRAC and 24 CO. CO burns were more severely burned than those with FRAC and NORB (p0.05). Mortality was 17% and 18% for CO and FRAC burns compared to 3% in NORB (p0.01). More cultures were obtained from ORB than NORB (p0.05). ORB were associated with Stenotrophomonas maltophilia and FRAC associated with Serratia marcescens and Candida glabrata. Patients with FRAC, CO and NORB had a median of 13, 3.5, and 4 days to first positive culture respectively (p=0.03).ORB were associated with more severe burns and unique microbiology. FRAC burns had longer to initial positive culture, potentially suggesting our current methodology is inadequate to diagnose infections associated with FRAC.

Portable pulsed xenon ultraviolet disinfection (PPX-UVD) may reduce healthcare associated infections (HAI). There is limited data to inform use in burn intensive care units (BICU), where multidrug-resistant organisms (MDRO), especially gram negative rods (GNR), commonly cause disease. We evaluated PPX-UVD effects on environmental bioburden and rates of HAI and MDRO acquisition in a BICU. PPX-UVD was used for 3 months after standard cleaning of patient and operating rooms (ORs). Settle and touch plates in patient rooms and ORs were obtained after standard cleaning, pre-and post-PPX-UVD. HAI and MDRO acquisition were evaluated 1year prior to and for 3 month periods before, during, and after PPX-UVD. 110 touch and settle plates (33 pre- and 30 post-PPX-UVD) were obtained after standard cleaning, pre- and post-PPX-UVD. After PPX-UVD, environmental samples with any growth decreased (48% vs 31%, p=0.02), as did mean colony count/sample (2.8 pre- vs 1.6 post-, p=0.03). The 379 colonies largely represented skin commensals, without identified MDRO. Following PPX-UVD, no changes in device-associated infections, overall MDRO, or MDR GNR were seen, though a prolonged interval without healthcare-associated Clostridium difficile infection was observed. PPX-UVD in a BICU reduced overall environmental bioburden, without a statistically significant impact on HAI or MDRO.

Introduction Pulsed-field gel electrophoresis (PFGE) has been used as an adjunct to traditional hospital epidemiology in numerous outbreak investigations, including in burn centers. However, its most effective real-world application remains unclear, with few longitudinal descriptions of use. Setting and methods A 425 bed military tertiary hospital with a 40 bed burn center, from July 2007 to July 2013; retrospective evaluation of hospital infection prevention records was performed and results of PFGE where used in outbreak investigation. Results Twenty-two inquiries for suspected outbreaks were performed. 418 isolates were collected from 168 subjects during this time. 325 (78%) of the isolates originated from the burn intensive care unit. 17 inquiries were for gram-negative bacteria, comprised of 5 for Acinetobacter baumannii-calcoaceticus complex, 4 Klebsiella pneumoniae, 3 Stenotrophomonas maltophilia, 2 Pseudomonas aeruginosa, and 1 of each of the following: Enterobacter cloacae, Raoultella planticola, and Aeromonas hydrophila. The other 5 inquiries were specifically for Staphylococcus aureus. The majority of investigations revealed a combination of clonal and non-clonal isolates, and in no instance did PFGE contribute to targeting of interventions. Conclusion PFGE contributed little to infection prevention interventions, and outbreaks resolved with increased focus on basic practices. Longitudinal studies including greater numbers of outbreaks in different settings are needed to clarify the utility of molecular typing in routine investigations.