Development and validation of a screening tool for early identification of bloodstream infection in acute burn injury patients

Carbapenem-resistant Gram-negative bacteria (CR-GNB) in ICUs: resistance genes, therapeutics, and prevention - a comprehensive review

Intensive care units (ICUs) are specialized environments dedicated to the management of critically ill patients, who are particularly susceptible to drug-resistant bacteria. Among these, carbapenem-resistant Gram-negative bacteria (CR-GNB) pose a significant threat endangering the lives of ICU patients. Carbapenemase production is a key resistance mechanism in CR-GNB, with the transfer of resistance genes contributing to the extensive emergence of antimicrobial resistance (AMR). CR-GNB infections are widespread in ICUs, highlighting an urgent need for prevention and control measures to reduce mortality rates associated with CR-GNB transmission or infection. This review provides an overview of key aspects surrounding CR-GNB within ICUs. We examine the mechanisms of bacterial drug resistance, the resistance genes that frequently occur with CR-GNB infections in ICU, and the therapeutic options against carbapenemase genotypes. Additionally, we highlight crucial preventive measures to impede the transmission and spread of CR-GNB within ICUs, along with reviewing the advances made in the field of clinical predictive modeling research, which hold excellent potential for practical application.

Characteristics of bloodstream infection and initial antibiotic use in critically ill burn patients and their impact on patient prognosis

To investigate the bacterial epidemiology of blood cultures taken during the treatment of critically ill burn patients, the use of antibiotics at admission and before the observation of positive blood cultures, and their effect on prognosis. A retrospective study method was used. From January 1, 2010, to December 31, 2019, burn patients who met the inclusion criteria and were treated at the Burn Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, were enrolled in the study. Data were collected from the patients' electronic medical records. General patient information, including length of hospital stay, length of intensive care unit (ICU) stay, in-hospital mortality, the bacteria epidemiological characteristics of blood cultures, and the use of antibiotics within 24 h after admission and before a positive blood culture was observed, was collected. Independent sample t tests and χ² tests were used to compare the effects of a positive blood culture and the use of appropriate antibiotics within 24 h after admission and before the observation of a positive blood culture on prognosis. (1) The three most frequently detected bacteria in the blood cultures were Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii, and the amount of K. pneumoniae detected increased gradually. (2) Compared with the group of patients who were negative for bloodstream infection , the positive bloodstream infection group had a larger total body burn surface area (TBSA) (t = - 5.097, P = 0.000) and third-degree burn area (t = - 5.133, P = 0.000), a significantly longer length of hospital stay (t = 3.003, P = 0.003) and the length of ICU stay (t = 4.258, P = 0.000), and a significantly higher rate of in-hospital mortality (χ² = 8.485, P = 0.004). When K. pneumoniae was detected, the length of hospital stay (t = 2.148, P = 0.035) and the length of ICU stay (t = 2.880, P = 0.005) were significantly prolonged. (3) The two antibiotics that were most frequently used in patients with acute burns within 24 h after admission were lincomycin (90 cases, 29.32%) and carbapenems (79 cases, 25.73%). Comparing the clinical characteristics of the lincomycin group and the carbapenem group, the TBSA (t = - 3.34, P = 0.001) and the third-degree burn area (t = - 6.08, P = 0.000) of the patients in the carbapenem group were larger, and the length of hospital stay (t = - 2.136, P = 0.035) and length of ICU stay (t = - 5.18, P = 0.000) were longer, but the difference in in-hospital mortality was not statistically significant (χ² = 1.983, P = 0.159). (4) Comparing the group with appropriate initial antibiotic use within 24 h of admission to the inappropriate use group, the TBSA (t = - 0.605, P = 0.547), the third-degree burn area (t = 0.348, P = 0.729), the length of hospital stay (t = - 0.767, P = 0.445), the length of ICU stay (t = - 0.220, P = 0.827) and in-hospital mortality (χ² = 1.271, P = 0.260) were not significantly different. (5) Comparing the group with appropriate antibiotic use before a positive blood culture was observed to the group with inappropriate antibiotic use, the TBSA (t = - 0.418, P = 0.677), the third-degree burn area (t = 0.266, P = 0.791), the length of hospital stay, the length of ICU stay (t = 0.995, P = 0.322) and in-hospital mortality (χ² = 1.274, P = 0.259) were not significantly different. We found that patients with a positive blood culture had a larger burn area and a worse prognosis; that the greater the amount of K. pneumoniae in the bloodstream of burn patients was, the longer the hospital and ICU stays were; that whether appropriate antibiotics were administered to acute critical burn patients 24 h after admission had no effect on the prognosis; and that whether appropriate antibiotics were administered before a positive blood culture was observed had no effect on prognosis.

The 2021 American Burn Association State and Future of Burn Science Working Group, Shupp JW, Holmes JH, Moffatt LT, Phelan HA, Sousse L, Romanowski KS, Jeschke M, Kowalske KJ, Badger K, Allely R, Cartotto R, Burmeister DM, Kubasiak JC, Wolf SE, Wallace KF, Gillenwater J, Schneider DM, Hultman CS, Wiechman SA, Bailey JK, Powell HM, Travis TE, Supp DM, Carney BC, Johnson LS, Johnson LS, Chung KK, Chung KK, Kahn SA, Gibson ALF, Christy RJ, Carter JE, Carson JS, Palmieri TL, Kopari NM, Blome-Eberwein SA, Hickerson WL, Parry I, Cancio JM, Suman O, Schulman CI, Lamendella R, Hill DM, Wibbenmeyer LA, Nygaard RM, Wagner AL, Carter ADW, Greenhalgh DG, Lawless MB, Carlson DL, Harrington DT. Proceedings of the 2021 American Burn Association State and Future of Burn Science Meeting

Periodically, the American Burn Association (ABA) has convened a State of the Science meeting on various topics representing multiple disciplines within burn care and research. In 2021 at the request of the ABA President, meeting development was guided by the ABA's Burn Science Advisory Panel (BSAP) and a subgroup of meeting chairs. The goal of the meeting was to produce both an evaluation of the current literature and ongoing studies, and to produce a research agenda and/or define subject matter-relevant next steps to advance the field(s). Members of the BSAP defined the topics to be addressed and subsequently solicited for nominations of expert speakers and topic leaders from the ABA's Research Committee. Current background literature for each topic was compiled by the meeting chairs and the library then enhanced by the invited topic and breakout discussion leaders. The meeting was held in New Orleans, LA on November 2nd and 3rd and was formatted to allow for 12 different topics, each with two subtopics, to be addressed. Topic leaders provided a brief overview of each topic to approximately 100 attendees, followed by expert-lead breakout sessions for each topic that allowed for focused discussion among subject matter experts and interested participants. The breakout and topic group leaders worked with the participants to determine research needs and associated next steps including white papers, reviews and in some cases collaborative grant proposals. Here, summaries from each topic area will be presented to highlight the main foci of discussion and associated conclusions.