Five-year review of infections in a burn intensive care unit: High incidence of Acinetobacter baumannii in a tropical climate

A 5-year review of nosocomial infections, bacteraemia and wound colonization in patients admitted to a burn intensive care unit from June 2001 to May 2006 was carried out. All patients required intubation at some point, and ICU support. Data on bacterial and fungal isolates were entered prospectively into a hospital-wide computerized database. Nosocomial infections (NIs) were defined using standard CDC criteria. Seventy-six patients were admitted during the study period, with 57 qualifying for analysis. Forty-two patients (74%) developed 137 NIs, with 240 NIs/100 admissions. The most common NI was pneumonia (43%), followed by burn wound infection (34%), primary bloodstream infection (20%) and urinary tract infection (3%). The device specific rate of pneumonia was 143 infections per 1000 ventilator days. There were 113 episodes of bacteraemia and 173 episodes of wound colonization without infection. The most common organisms causing nosocomial infections were Acinetobacter sp. (n = 33), followed by methicillin resistant Staphylococcus aureus (MRSA) (n = 24) and Pseudomonas aeruginosa (n = 22). A. baumannii isolates were highly multiresistant, with 82 distinct strains isolated from 47 patients (82% of patients). Data from this and other studies supports the hypothesis that A. baumannii is more common in tropical, warm climes necessitating vigorous infection control measures to optimise patient outcome.