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CLINICAL CHARACTERISTICS AND RISK FACTORS OF MORTALITY AMONG SEVERE BURN PATIENTS WITH ISOLATES OF VANCOMYCIN-RESISTANT ENTEROCOCCI

Department of Internal Medicine, Hallym University College of Medicine, Seoul, South Korea

PURPOSE: Vancomycin-resistant enterococci (VRE) are multi-drug resistant organisms that have emerged as important nosocomial pathogens in recent years. VRE emergence has been blamed mainly on the increased and inappropriate use of antibiotics, in particular, the cephalosporins and the glycopeptide, vancomycin. Burn patients are highly vulnerable to acquiring VRE infection. This study was focused on the clinical characteristics and risk factors of mortality among severe burn patients with VRE isolation during recent 4 years.

METHODS: 104 cases (M:F=69:35) that had VRE isolation from January 1, 2000 to December, 2003, were reviewed. We analyzed clinical characteristics and the risk factors that contribute to death by using univariate and multivariate analyses, retrospectively.

RESULTS: Mean percent total body surface area (%TBSA) of survivors (n=80) and non-survivors (n=24) were 41.64±20.68% and 58.08±22.64% (p=0.003). Total 144 strains of VRE were isolated from 104 patients. Most of VRE colonization or infection were caused by Enterococcus faecium (82.6%) and E. casseliflavus (14.6%). There were no significant difference in VRE species distribution between survivors and non-survivors (p> 0.05). The risk factors for mortality were %TBSA burn, APACHE II scores, mechanical ventilation, nasogastric tube, previous use of cefepime and ticarcillin/clavulanate, rectal VRE colonization and initial VRE bacteremia in univariate analysis. However, independent risk factor of death were APACHE II score, mechanical ventilation and initial VRE bacteremia in multivariate analyses.

CONCLUSION: Severe burn patients with VRE isolation should be reassessed carefully, especially in those who had high APACHE II scores at ICU admission, mechanical ventilation and initial VRE bacteremia.

CLINICAL IMPLICATIONS: More strict infection control and efforts to eradicate VRE may be needed among severe burn patients with VRE isolation.

DISCLOSURE: Heung Woo, None.