Cross-Border Antibiotic Resistance Patterns in Burn Patients

• Published in: Surgical infections Vol. 24; no. 4; p. 327
• Main Authors: Dunbar, Chance, Santorelli, Jarrett E, Marshall, William A, Haines, Laura N, Box, Kevin, Lee, Jeanne G, Strait, Eli, Costantini, Todd W, Smith, Alan M, Doucet, Jay J, Berndtson, Allison E
• Format: Journal Article
• Language: English
• Published: United States 01.05.2023
• Subjects: Adult; Anti-Infective Agents; Drug Resistance, Microbial; Female; Hospitalization; Humans; Length of Stay; Male; Retrospective Studies; United States; United States; global surgery; surgical infections; antibiotic resistance; burns
• ISSN: 1557-8674
• DOI: 10.1089/sur.2022.313

Antimicrobial resistance (AMR) is a growing problem worldwide, with differences in regional resistance patterns partially driven by local variance in antibiotic stewardship. Trauma patients transferring from Mexico have more AMR than those injured in the United States; we hypothesized a similar pattern would be present for burn patients. The registry of an American Burn Association (ABA)-verified burn center was queried for all admissions for burn injury January 2015 through December 2019 with hospital length-of-stay (LOS) longer than seven days. Patients were divided into two groups based upon burn location: United States (USA) or Mexico (MEX). All bacterial infections were analyzed. A total of 73 MEX and 826 USA patients were included. Patients had a similar mean age (40.4 years MEX vs. 42.2 USA) and gender distribution (69.6% male vs. 64.4%). The MEX patients had larger median percent total body surface area burned (%TBSA; 11.1% vs. 4.3%; p ≤ 0.001) and longer hospital LOS (18.0 vs. 13.0 days; p = 0.028). The MEX patients more often had respiratory infections (16.4% vs. 7.4%; p = 0.046), whereas rates of other infections were similar. The MEX patients had higher rates of any resistant organism (47.2% of organisms MEX vs. 28.1% USA; p = 0.013), and were more likely to have resistant infections on univariable analysis; however, on multivariable analysis country of burn was no longer significant. Antimicrobial resistance is more common in burn patients initially burned in Mexico than those burned in the United States, but location was not a predictor of resistance compared to other traditional burn-related factors. Continuing to monitor for AMR regardless of country of burn remains critical.