Highly drug-resistant pathogens implicated in burn-associated bacteremia in an Iraqi burn care unit

Jean Baptiste Ronat, Jabar Kakol, Marwan N. Khoury, Mathilde Berthelot, Oliver Yun, Vincent Brown, Richard A. Murphy

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Objective: In low- and middle-income countries, bloodstream infections are an important cause of mortality in patients with burns. Increasingly implicated in burn-associated infections are highly drug-resistant pathogens with limited treatment options. We describe the epidemiology of bloodstream infections in patients with burns in a humanitarian surgery project in Iraq. Methods: We performed a retrospective, descriptive study of blood culture isolates identified between July 2008 and September 2009 among patients with burns in a single hospital in Iraq who developed sepsis. Results: In 1169 inpatients admitted to the burn unit during the study period, 212 (18%) had suspected sepsis, and 65 (6%) had confirmed bacteremia. Sepsis was considered the primary cause of death in 198 patients (65%; 95% CI 65-70) of the 304 patients that died. The most commonly isolated organisms were Pseudomonas aeruginosa (22 isolates [34%]), Staphylococcus aureus (17 [26%]), Klebsiella pneumoniae (8 [12%]), Staphylococcus epidermidis (7 [11%]), Acinetobacter baumannii (6 [9%]), and Enterobacter cloacae (5 [8%]). A high proportion of Enterobacteriaceae strains produced extendedspectrum beta-lactamase and S. aureus isolates were uniformly methicillin-resistant. For gram-negative bacteria, the most reliably active antibiotics were imipenen and amikacin. Conclusions: Burn patients with sepsis in Iraq were commonly found to have bloodstream pathogens resistant to most antibiotics available locally. Effective empirical therapy of burn sepsis in this region of Iraq would consist of vancomycin or teicoplanin and a carbapenem-class antibiotic with antipseudomonal activity.

Original languageEnglish (US)
Article numbere101017
JournalPLoS One
Volume9
Issue number8
DOIs
StatePublished - Aug 11 2014

Fingerprint

Burn Units
bacteremia
Pathogens
Bacteremia
Burns
Iraq
sepsis (infection)
Sepsis
Anti-Bacterial Agents
drugs
pathogens
Pharmaceutical Preparations
Teicoplanin
Epidemiology
Carbapenems
Methicillin
blood flow
Amikacin
Vancomycin
beta-Lactamases

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Ronat, J. B., Kakol, J., Khoury, M. N., Berthelot, M., Yun, O., Brown, V., & Murphy, R. A. (2014). Highly drug-resistant pathogens implicated in burn-associated bacteremia in an Iraqi burn care unit. PLoS One, 9(8), [e101017]. https://doi.org/10.1371/journal.pone.0101017

Highly drug-resistant pathogens implicated in burn-associated bacteremia in an Iraqi burn care unit. / Ronat, Jean Baptiste; Kakol, Jabar; Khoury, Marwan N.; Berthelot, Mathilde; Yun, Oliver; Brown, Vincent; Murphy, Richard A.

In: PLoS One, Vol. 9, No. 8, e101017, 11.08.2014.

Research output: Contribution to journalArticle

Ronat, JB, Kakol, J, Khoury, MN, Berthelot, M, Yun, O, Brown, V & Murphy, RA 2014, 'Highly drug-resistant pathogens implicated in burn-associated bacteremia in an Iraqi burn care unit', PLoS One, vol. 9, no. 8, e101017. https://doi.org/10.1371/journal.pone.0101017
Ronat, Jean Baptiste ; Kakol, Jabar ; Khoury, Marwan N. ; Berthelot, Mathilde ; Yun, Oliver ; Brown, Vincent ; Murphy, Richard A. / Highly drug-resistant pathogens implicated in burn-associated bacteremia in an Iraqi burn care unit. In: PLoS One. 2014 ; Vol. 9, No. 8.
@article{1ae0ceb8c5884de1a45eb4cd580dc8e5,
title = "Highly drug-resistant pathogens implicated in burn-associated bacteremia in an Iraqi burn care unit",
abstract = "Objective: In low- and middle-income countries, bloodstream infections are an important cause of mortality in patients with burns. Increasingly implicated in burn-associated infections are highly drug-resistant pathogens with limited treatment options. We describe the epidemiology of bloodstream infections in patients with burns in a humanitarian surgery project in Iraq. Methods: We performed a retrospective, descriptive study of blood culture isolates identified between July 2008 and September 2009 among patients with burns in a single hospital in Iraq who developed sepsis. Results: In 1169 inpatients admitted to the burn unit during the study period, 212 (18{\%}) had suspected sepsis, and 65 (6{\%}) had confirmed bacteremia. Sepsis was considered the primary cause of death in 198 patients (65{\%}; 95{\%} CI 65-70) of the 304 patients that died. The most commonly isolated organisms were Pseudomonas aeruginosa (22 isolates [34{\%}]), Staphylococcus aureus (17 [26{\%}]), Klebsiella pneumoniae (8 [12{\%}]), Staphylococcus epidermidis (7 [11{\%}]), Acinetobacter baumannii (6 [9{\%}]), and Enterobacter cloacae (5 [8{\%}]). A high proportion of Enterobacteriaceae strains produced extendedspectrum beta-lactamase and S. aureus isolates were uniformly methicillin-resistant. For gram-negative bacteria, the most reliably active antibiotics were imipenen and amikacin. Conclusions: Burn patients with sepsis in Iraq were commonly found to have bloodstream pathogens resistant to most antibiotics available locally. Effective empirical therapy of burn sepsis in this region of Iraq would consist of vancomycin or teicoplanin and a carbapenem-class antibiotic with antipseudomonal activity.",
author = "Ronat, {Jean Baptiste} and Jabar Kakol and Khoury, {Marwan N.} and Mathilde Berthelot and Oliver Yun and Vincent Brown and Murphy, {Richard A.}",
year = "2014",
month = "8",
day = "11",
doi = "10.1371/journal.pone.0101017",
language = "English (US)",
volume = "9",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "8",

}

TY - JOUR

T1 - Highly drug-resistant pathogens implicated in burn-associated bacteremia in an Iraqi burn care unit

AU - Ronat, Jean Baptiste

AU - Kakol, Jabar

AU - Khoury, Marwan N.

AU - Berthelot, Mathilde

AU - Yun, Oliver

AU - Brown, Vincent

AU - Murphy, Richard A.

PY - 2014/8/11

Y1 - 2014/8/11

N2 - Objective: In low- and middle-income countries, bloodstream infections are an important cause of mortality in patients with burns. Increasingly implicated in burn-associated infections are highly drug-resistant pathogens with limited treatment options. We describe the epidemiology of bloodstream infections in patients with burns in a humanitarian surgery project in Iraq. Methods: We performed a retrospective, descriptive study of blood culture isolates identified between July 2008 and September 2009 among patients with burns in a single hospital in Iraq who developed sepsis. Results: In 1169 inpatients admitted to the burn unit during the study period, 212 (18%) had suspected sepsis, and 65 (6%) had confirmed bacteremia. Sepsis was considered the primary cause of death in 198 patients (65%; 95% CI 65-70) of the 304 patients that died. The most commonly isolated organisms were Pseudomonas aeruginosa (22 isolates [34%]), Staphylococcus aureus (17 [26%]), Klebsiella pneumoniae (8 [12%]), Staphylococcus epidermidis (7 [11%]), Acinetobacter baumannii (6 [9%]), and Enterobacter cloacae (5 [8%]). A high proportion of Enterobacteriaceae strains produced extendedspectrum beta-lactamase and S. aureus isolates were uniformly methicillin-resistant. For gram-negative bacteria, the most reliably active antibiotics were imipenen and amikacin. Conclusions: Burn patients with sepsis in Iraq were commonly found to have bloodstream pathogens resistant to most antibiotics available locally. Effective empirical therapy of burn sepsis in this region of Iraq would consist of vancomycin or teicoplanin and a carbapenem-class antibiotic with antipseudomonal activity.

AB - Objective: In low- and middle-income countries, bloodstream infections are an important cause of mortality in patients with burns. Increasingly implicated in burn-associated infections are highly drug-resistant pathogens with limited treatment options. We describe the epidemiology of bloodstream infections in patients with burns in a humanitarian surgery project in Iraq. Methods: We performed a retrospective, descriptive study of blood culture isolates identified between July 2008 and September 2009 among patients with burns in a single hospital in Iraq who developed sepsis. Results: In 1169 inpatients admitted to the burn unit during the study period, 212 (18%) had suspected sepsis, and 65 (6%) had confirmed bacteremia. Sepsis was considered the primary cause of death in 198 patients (65%; 95% CI 65-70) of the 304 patients that died. The most commonly isolated organisms were Pseudomonas aeruginosa (22 isolates [34%]), Staphylococcus aureus (17 [26%]), Klebsiella pneumoniae (8 [12%]), Staphylococcus epidermidis (7 [11%]), Acinetobacter baumannii (6 [9%]), and Enterobacter cloacae (5 [8%]). A high proportion of Enterobacteriaceae strains produced extendedspectrum beta-lactamase and S. aureus isolates were uniformly methicillin-resistant. For gram-negative bacteria, the most reliably active antibiotics were imipenen and amikacin. Conclusions: Burn patients with sepsis in Iraq were commonly found to have bloodstream pathogens resistant to most antibiotics available locally. Effective empirical therapy of burn sepsis in this region of Iraq would consist of vancomycin or teicoplanin and a carbapenem-class antibiotic with antipseudomonal activity.

UR - http://www.scopus.com/inward/record.url?scp=84905833839&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84905833839&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0101017

DO - 10.1371/journal.pone.0101017

M3 - Article

C2 - 25111170

AN - SCOPUS:84905833839

VL - 9

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 8

M1 - e101017

ER -