877 Evaluating First Positive Cultures in Burns: Rethinking Broad-Spectrum Antibiotic Choices
Notice bibliographique
Résumé
Abstract Introduction Nearly all major burn patients experience an infection during their admission. Broad-spectrum antibiotics both alone and in combination may have adverse effects and encourage multi-drug resistance. The purpose of this study is to determine the most appropriate antibiotics for major burn patients on first positive culture (FPC). Methods This was a retrospective study of adult burn patients with >20% TBSA at an ABA verified burn centre from 2018 to 2023. Patients were included if they had at least one positive culture from blood, sputum, urine or wound during their admission or received antibiotics without positive cultures. Standard clinical information was collected along with the first organism cultured and antibiotic used. The primary outcome was the bacterial profile on first positive culture, stratified by sterile (blood and OR culture) and non-sterile (sputum, wound, and urine), and by early (< 5 days) and late (>5 days). The secondary outcome was the empiric antibiotic prescribed on FPC taken. The tertiary outcome was the need for Vancomycin on FPC based on admission MRSA screening results. Descriptive analysis was completed. Results The study population included 144 patients. Median age was 47 (36-59 IQR), 106 were male (74%), median TBSA was 32%, 31 (22%) had inhalation injury and 102 (71%) were mechanically ventilated. One-hundred-nineteen (83%) patients had at least one positive culture: respiratory (58%), wound (27%), blood (8%), and urine (7%). Of all FPCs, most were non-sterile (83%) and early (61%). Most common FPC organisms grown early were MSSA (26%), Haemophilus influenzae (21%), Enterococcus species (9%) and Escherichia coli (7%). Most common FPC organisms grown late were MSSA (17%), Pseudomonas species (12%), Escherichia coli (10%), Enterobacter cloacae complex (8%), and Enterococcus Species (8%). Of all patients included, 141 (98%) were started on antibiotics with the majority prescribed piperacillin/tazobactam (39%), cefazolin (23%), vancomycin (13%) and ceftriaxone (9%). Only 15 (10%) of patients were started on combination therapy. Finally, of the 115 patients screening negative on admission for MRSA, only 4 (3%) had positive MRSA cultures on FPC. Conclusions The results from this study suggest that single agent antibiotics are sufficient for first positive culture. Given the low incidence of Pseudomonas isolated from patients early in admission, ceftriaxone appears to be a reasonable empirical choice of therapy when infection is suspected. There is little need for initiation of Vancomycin on FPC if admission MRSA screen is negative. Applicability of Research to Practice This study helps guide antimicrobial use for the first infection experienced by major burn patients during their admission. Funding for the Study N/A
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,020 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».