[Incidence and risk factors for bacteremia on pediatric patients with burns in a specialized care center in Mexico]. / Incidencia y factores de riesgo para bacteriemia en pacientes pediátricos con quemaduras en un Centro de Atención Especializado en México.

BACKGROUND: Bacteremia events are frequent cause of mortality in burn patients and may originate from infected wounds, by bacterial translocation of endogenous microorganisms, from invasive devices or contaminated intravenous solutions. OBJECTIVE: To quantify the incidence of bacteremia in pediatric patients with burns and to identify risk factors. MATERIAL AND METHODS: A prospective cohort study was performed in pediatric patients with burns of Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Bacteremia was diagnosed by blood cultures in patients with clinical manifestations of sepsis. Risk factors were investigated by multivariate analysis with Cox regression. RESULTS: Were included in the cohort 260 patients, median age 3 years. The incidence of bacteremia was 9.6 events per 1,000 days patient. The most frequently isolated bacteria were Enterobacteriaceae (41.9%), Staphylococcus aureus (22.6%) and Pseudomonas aeruginosa (22.6%). Factors associated with bacteremia were: bums ≥ 20% TBSA (HR 11.06; 95% CI 4.8-25.4), deep second degree bums or higher (HR 6.9; 95% CI 2.0-23.3) and have had two or less debridement (HR 26.4; 95% CI 8.0-87.7). CONCLUSIONS: Patients with more extensive and deep burns with fewer debridement are at increased risk of bacteremia.

Incidencia y factores de riesgo para bacteriemia en pacientes pediátricos con quemaduras en un Centro de Atención Especializado en México / Incidence and risk factors for bacteremia on pediatric patients with burns in a specialized care center in Mexico

Background: Bacteremia events are frequent cause of mortality in burn patients and may originate from infected wounds, by bacterial translocation of endogenous microorganisms, from invasive devices or contaminated intravenous solutions. Objective: To quantify the incidence of bacteremia in pediatric patients with burns and to identify risk factors. Material and Methods: A prospective cohort study was performed in pediatric patients with burns of Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Bacteremia was diagnosed by blood cultures in patients with clinical manifestations of sepsis. Risk factors were investigated by multivariate analysis with Cox regression. Results: Were included in the cohort 260 patients, median age 3 years. The incidence of bacteremia was 9.6 events per 1,000 days patient. The most frequently isolated bacteria were Enterobacteriaceae (41.9%), Staphylococcus aureus (22.6%) and Pseudomonas aeruginosa (22.6%). Factors associated with bacteremia were: bums ≥ 20% TBSA (HR 11.06; 95% CI 4.8-25.4), deep second degree bums or higher (HR 6.9; 95% CI 2.0-23.3) and have had two or less debridement (HR 26.4; 95% CI 8.0-87.7). Conclusions: Patients with more extensive and deep burns with fewer debridement are at increased risk of bacteremia.

Introducción: Los eventos de bacteriemia son causa frecuente de mortalidad en pacientes con quemaduras y pueden originarse en heridas infectadas, por translocación bacteriana de microorganismos endógenos, por dispositivos invasores o por soluciones intravenosas contaminadas. Objetivo: Cuantificar la incidencia de bacteriemia en pacientes pediátricos con quemaduras e identificar los factores de riesgo. Material y Métodos: Estudio de cohorte prospectivo, en población pediátrica con quemaduras del Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". En pacientes con manifestaciones clínicas de sepsis se diagnosticó bacteriemia mediante cultivos de sangre. Se indagaron factores de riesgo con análisis multivariado con regresión de Cox. Resultados: Se incluyeron en la cohorte 260 pacientes, mediana de edad 3 años. La incidencia de bacteriemia fue de 9,6 eventos por 1.000 días paciente. Las bacterias más frecuentes aisladas fueron enterobacterias (41,9%), Staphylococcus aureus (22,6%) y Pseudomonas aeruginosa (22,6%). Los factores asociados a bacteriemia fueron: quemaduras ≥ 20% de superficie corporal quemada (HR 11,06; IC 95% 4,8-25,4), quemaduras de segundo grado profundo o mayores (HR 6,9; IC 95% 2,0-23,3) y haber tenido dos o menos desbridamientos (HR 26,4; IC 95% 8,0-87,7). Conclusiones: Pacientes con quemaduras más extensas y profundas, con menor número de desbridamientos presentan mayor riesgo de bacteriemia.