Contribution of bacterial and viral infections to attributable mortality in patients with severe burns: An autopsy series

Laurie C. D'Avignon, Brian K. Hogan, Clinton K. Murray, Florence L. Loo, Duane R. Hospenthal, Leopoldo C. Cancio, Seung H. Kim, Evan M. Renz, David Barillo, John B. Holcomb, Charles E. Wade, Steven Wolf

Research output: Contribution to journalReview article

87 Citations (Scopus)

Abstract

Bacterial infections are a common cause of mortality in burn patients and viral infections, notably herpes simplex virus (HSV) and cytomegalovirus (CMV) have also been associated with mortality. This study is a retrospective review of all autopsy reports from patients with severe thermal burns treated at the US Army Institute of Research (USAISR) burn unit over 12 years. The review focused on those patients with death attributed to a bacterial or viral cause by autopsy report. Of 3751 admissions, 228 patients died with 97 undergoing autopsy. Death was attributed to bacteria for 27 patients and to virus for 5 patients. Bacterial pathogens associated with mortality included Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus. This association with mortality was independent of % total body surface area burn, % full-thickness burn, inhalation injury, and day of death post-burn. Bloodstream infection was the most common cause of bacteria related death (50%), followed by pneumonia (44%) and wound infection (6%). Time to death following burn was ≤7 days in 30%, ≤14 days in 59% and ≤21 days in 67%. All of the viral infections associated with mortality involved the lower respiratory tract, HSV for 4 and CMV for 1. Four of these 5 patients had evidence of inhalation injury by bronchoscopy, all had facial and neck burns, and 2 had concomitant Staphylococcus pneumonia. Time to death following burn ranged from 14 to 42 days for the 5 patients. Despite advances in care, gram negative bacterial infections and infection with S. aureus remain the most common cause of bacteria related mortality early in the hospital course. Viral infections are also associated with mortality and numbers have remained stable when compared to data from prior years.

Original languageEnglish (US)
Pages (from-to)773-779
Number of pages7
JournalBurns
Volume36
Issue number6
DOIs
StatePublished - Sep 1 2010
Externally publishedYes

Fingerprint

Virus Diseases
Burns
Bacterial Infections
Autopsy
Mortality
Simplexvirus
Bacteria
Cytomegalovirus
Staphylococcus aureus
Pneumonia
Inhalation Burns
Gram-Negative Bacterial Infections
Burn Units
Patient Admission
Body Surface Area
Wounds and Injuries
Klebsiella pneumoniae
Bronchoscopy
Wound Infection
Hospital Mortality

Keywords

  • Autopsy
  • Bacteria
  • Burn
  • Infection
  • Mortality
  • Virus

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Contribution of bacterial and viral infections to attributable mortality in patients with severe burns : An autopsy series. / D'Avignon, Laurie C.; Hogan, Brian K.; Murray, Clinton K.; Loo, Florence L.; Hospenthal, Duane R.; Cancio, Leopoldo C.; Kim, Seung H.; Renz, Evan M.; Barillo, David; Holcomb, John B.; Wade, Charles E.; Wolf, Steven.

In: Burns, Vol. 36, No. 6, 01.09.2010, p. 773-779.

Research output: Contribution to journalReview article

D'Avignon, LC, Hogan, BK, Murray, CK, Loo, FL, Hospenthal, DR, Cancio, LC, Kim, SH, Renz, EM, Barillo, D, Holcomb, JB, Wade, CE & Wolf, S 2010, 'Contribution of bacterial and viral infections to attributable mortality in patients with severe burns: An autopsy series', Burns, vol. 36, no. 6, pp. 773-779. https://doi.org/10.1016/j.burns.2009.11.007
D'Avignon, Laurie C. ; Hogan, Brian K. ; Murray, Clinton K. ; Loo, Florence L. ; Hospenthal, Duane R. ; Cancio, Leopoldo C. ; Kim, Seung H. ; Renz, Evan M. ; Barillo, David ; Holcomb, John B. ; Wade, Charles E. ; Wolf, Steven. / Contribution of bacterial and viral infections to attributable mortality in patients with severe burns : An autopsy series. In: Burns. 2010 ; Vol. 36, No. 6. pp. 773-779.
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