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Risk Factors for Healthcare-Associated Infections in Adult Burn Patients

  • Paula D. Strassle (a1) (a2), Felicia N. Williams (a2) (a3), David J. Weber (a1) (a4), Emily E. Sickbert-Bennett (a1) (a4), Anne M. Lachiewicz (a4), Sonia Napravnik (a1) (a4), Samuel W. Jones (a2) (a3), Bruce A. Cairns (a2) (a3) and David van Duin (a4)...



Burn patients are particularly vulnerable to infection, and an estimated half of all burn deaths are due to infections. This study explored risk factors for healthcare-associated infections (HAIs) in adult burn patients.


Retrospective cohort study.


Tertiary-care burn center.


Adults (≥18 years old) admitted with burn injury for at least 2 days between 2004 and 2013.


HAIs were determined in real-time by infection preventionists using Centers for Disease Control and Prevention criteria. Multivariable Cox proportional hazards regression was used to estimate the direct effect of each risk factor on time to HAI, with inverse probability of censor weights to address potentially informative censoring. Effect measure modification by burn size was also assessed.


Overall, 4,426 patients met inclusion criteria, and 349 (7.9%) patients had at least 1 HAI within 60 days of admission. Compared to <5% total body surface area (TBSA), patients with 5%–10% TBSA were almost 3 times as likely to acquire an HAI (hazard ratio [HR], 2.92; 95% CI, 1.63–5.23); patients with 10%–20% TBSA were >6 times as likely to acquire an HAI (HR, 6.38; 95% CI, 3.64–11.17); and patients with >20% TBSA were >10 times as likely to acquire an HAI (HR, 10.33; 95% CI, 5.74–18.60). Patients with inhalational injury were 1.5 times as likely to acquire an HAI (HR, 1.61; 95% CI, 1.17–2.22). The effect of inhalational injury (P=.09) appeared to be larger among patients with ≤20% TBSA.


Larger burns and inhalational injury were associated with increased incidence of HAIs. Future research should use these risk factors to identify potential interventions.

Infect Control Hosp Epidemiol 2017;38:1441–1448


Corresponding author

Address correspondence to David van Duin, MD, PhD, Division of Infectious Diseases, Department of Medicine, University of North Carolina, 130 Mason Farm Road, Mail code CB #7030, Chapel Hill, NC 27599-7030 (


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Risk Factors for Healthcare-Associated Infections in Adult Burn Patients

  • Paula D. Strassle (a1) (a2), Felicia N. Williams (a2) (a3), David J. Weber (a1) (a4), Emily E. Sickbert-Bennett (a1) (a4), Anne M. Lachiewicz (a4), Sonia Napravnik (a1) (a4), Samuel W. Jones (a2) (a3), Bruce A. Cairns (a2) (a3) and David van Duin (a4)...


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