Staphylococcus aureus carriage at admission predicts early-onset pneumonia after burn trauma

Article Article scientifique Article Staphylococcus aureus carriage at admission predicts early-onset pneumonia after burn trauma eng 2017 author Fournier Anne 34813 author Voirol Pierre 829178 author Krahenbuhl Michel 31621 author Bonnemain C-L author Fournier C author Dupuis Lozeron Elise 506035 author Pantet O author Pagani J-L author Revelly J-P author Sadeghipour Farshid 28608 author Eggimann Philippe 135619 author Que Y-A 523-528 10.1007/s10096-016-2828-0 27815777 0934-9723 Early-onset pneumonia (EOP) is frequent after burn trauma, increasing morbidity in the critical resuscitation phase, which may preclude early aggressive management of burn wounds. Currently, however, preemptive treatment is not recommended. The aim of this study was to identify predictive factors for EOP that may justify early empirical antibiotic treatment. Data for all burn patients requiring ≥4 h mechanical ventilation (MV) who were admitted between January 2001 and October 2012 were extracted from the hospital's computerized information system. We reviewed EOP episodes (≤7 days) among patients who underwent endotracheal aspiration (ETA) within 5 days after admission. Univariate and multivariate analyses were performed to identify independent factors associated with EOP. Logistic regression was used to identify factors predicting EOP development. During the study period, 396 burn patients were admitted. ETA was performed within 5 days in 204/290 patients receiving ≥4 h MV. One hundred and eight patients developed EOP; 47 cases were caused by Staphylococcus aureus, 37 by Haemophilus influenzae, and 23 by Streptococcus pneumoniae. Among the 33 patients showing S. aureus positivity on ETA samples, 16 (48.5 %) developed S. aureus EOP. Among the 156 S. aureus non-carriers, 16 (10.2 %) developed EOP. Staphylococcus aureus carriage independently predicted EOP (p < 0.0001). We identified S. aureus carriage as an independent and strong predictor of EOP. As rapid point-of-care testing for S. aureus is readily available, we recommend testing of all patients at admission for burn trauma and the consideration of early preemptive treatment in all positive patients. Further studies are needed to evaluate this new strategy. Adult Burns/complications Carrier State/microbiology Female Humans Male Middle Aged Pneumonia Staphylococcal/epidemiology/microbiology/therapy Respiration Artificial/utilization Retrospective Studies Risk Assessment Staphylococcus aureus/isolation & purification Wounds and Injuries/complications Dewey 613 Dewey 615 31 Section des sciences pharmaceutiques 17 64 Département de santé et médecine communautaires 22A false 88 Epidémiologie clinique 115 European Journal of Clinical Microbiology & Infectious Diseases 36 3 b284b1cc-bced-43be-8c3f-8f1bbf2ee286 Article (Published version) Restricted s10096-016-2828-0.pdf 462771 application/pdf restrictedAccess Faculté des sciences / Section des sciences pharmaceutiques Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires

Title	Published in	Access level	OA Policy	Year	Views	Downloads

Staphylococcus aureus carriage at admission predicts early-onset pneumonia after burn trauma	European Journal of Clinical Microbiology & Infectious Diseases			2017	493	0

Archive ouverte UNIGE

Krahenbuhl, Michel