Management of multidrug-resistant bacterial infections in burn patients: Challenges and strategies for optimal care

Abstract

AIM: To evaluate the prevalence and resistance of multidrug-resistant pathogens (MDR) in patients in the Burn Intensive Care Unit (UFA). BACKGROUND: MDR bacterial infections pose significant challenges in the management of burs, as the associated risk of infection is exacerbated by factors such as the hypermetabolic response, systemic inflammation, immune dysfunction, and the disruption of the skin barrier, leading to increased morbidity and mortality among burn patients. METHODS: A study was conducted from 01.06.2023, to 30.06.2024, involving 59 patients hospitalized in the UFA of the County Emergency Clinical Hospital in Timișoara. Bacterial identification was performed using MALDI-TOF Bruker and VITEK® 2 systems. Antibiotic susceptibility testing was conducted following EUCAST 2023 standards, ensuring accurate assessment of resistance profiles. RESULTS: A total of 363 biological samples were collected for analysis, of which 296 (81.54%) were resistant. The study revealed 231 (73.82%) MDR bacterial strains among the resistant samples. Most samples were wound secretions (n= 93, 40.26%) and blood cultures (n= 82, 35.50%). Key pathogens identified included Acinetobacter baumannii (n= 80, 34.63%), Klebsiella pneumoniae (n= 44, 19.05%), Coagulase-negative Staphylococci (n= 23, 9.96%), all were methicillin-resistant, Staphylococcus aureus (n= 21, 9.09%), of which 16 (76.19%) were methicillin-resistant. Other resistance patterns included extensive drug resistance (n= 77, 33.33%), extended beta-lactam producers (n= 71, 30.74%) and carbapenemase producers (n= 124, 53.68%). CONCLUSIONS: The management of MDR infections in burn patients is essential for improving clinical outcomes and reducing associated mortality by implementing rigorous screening protocols, interdisciplinary collaboration, enhanced antibiotic stewardship and continuous monitoring of bacterial colonization