A Decade of Reduced Gram-Negative Infections and Mortality Associated With Improved Isolation of Burned Patients.

Infection is a major cause of morbidity and mortality in hospitalized burned patients. We have previously estimated the added risk for mortality due to infection in a population of more than 5500 admissions for burns and demonstrated that bacteremia was associated with a 21% increase of mortality above that predicted by logistic regression analysis of injury severity and age. When the bacteremic population was subdivided by pathogen, gram-negative opportunists were found to be the principal cause of the observed increase in mortality. Mortality in the group of patients with gram- negative bacterernia (GNB) was more than 50% greater than that predicted for patients without bacterernia. The clinical significance of gram - negative pathogens in burned patients became obvious after the introduction of newer generations of penicillin and arninoglycosides in the early 1960s. Pseudomonas domonas aerginosa and members of the Enterobacteriaceae family became predominant and, during the subsequent 20 years, caused several endemics .4.5 Distinguishing features of these endernics were multiple antimicrobial resistance and consistent biotypes within causative strains.