Bloodstream infections by multidrug-resistant bacteria in patients in an intensive care unit for the treatment of burns: a 4-year-experience

Background: Knowledge of the profile of antibiotic resistance in bacteria in a hospital is essential for guiding appropriate patient treatment. This is especially important for the severely ill patients, because treatment must be initiated before the results of cultures can be obtained. In this study, we aimed to analyze the profile of multidrug-resistant bacteria (MR) found in blood cultures from patients admitted to the intensive care unit (ICU) of the Burns Unit of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Methods: We evaluated 178 patients (131 men) admitted to the ICU for the treatment of burns from 2009 to 2011, with a mean age of 29.2 years. Results: Eighty (44.9%) patients indicated positive results in peripheral blood cultures, and there were 66 (82.5%) cases with MR bacteria. Staphylococcus sp. was isolated in 48 cases, of which 33 cases showed resistance to oxacillin. Acinetobacter baumannii was isolated in 11 cases, and 8 of these cases were resistant to imipenem. Pseudomonas sp. was isolated in 19 cases, and 16 of these cases were resistant to imipenem. Enterobacter sp. was isolated in 10 cases, and 2 of these cases were resistant to ciprofloxacin and amikacin. The presence of MR bacteria was not associated with a higher incidence of deaths but was associated with longer hospital stay (52.6 vs. 36.3 days for those with and without MR bacteria, respectively, P = 0.0306). There was no significant association between burned body surface and the presence of MR bacteria. Conclusions: The presence of MR bacteria is an important problem, because of the prevalence and associated morbidity and mortality.