Staphylococcus aureus carriage at admission predicts early-onset pneumonia after burn trauma

Background and objectives Early-onset pneumonia (EOP) is frequent after burn trauma, increasing morbidity in the critical resuscitation phase, which may preclude early aggressive management of burn wounds. Currently, however, preemptive treatment is not recommended. The aim of this study was to identify predictive factors for EOP that may justify early empirical antibiotic treatment. Methods Data for all burn patients requiring ≥ 4 h mechanical ventilation (MV) who were admitted to our service between January 2001 and October 2012 were extracted from the hospital's computerized information system. We reviewed EOP episodes (occurring within 7 days after admission) among patients who underwent endotracheal aspiration (ETA) within 5 days after admission. Univariate and multivariate analyses were performed to identify independent factors associated with EOP. Logistic regression was used to identify factors predicting EOP development. Results During the study period, 396 burn patients were admitted. ETA was performed within 5 days in 204/290 patients receiving ≥ 4 h MV. One hundred and eight patients developed EOP and 176 microorganisms were identified. The three most prevalent microorganisms isolated were S. aureus ( n  = 47, 26.7%), Haemophilus influenzae ( n  = 37, 21.0%), and Streptococcus pneumoniae ( n  = 23, 13.1%). All but one ( n  = 46, 97.9%) case of S. aureus EOP were caused by methicillin-sensitive S. aureus . Among the 33 patients showing S. aureus positivity on ETA samples, 16 (48.5%) developed S. aureus EOP. Among the 156, S. aureus non-carriers, 16 (10.2%) developed EOP . S. aureus carriage independently predicted EOP ( P S. aureus carriage as a unique criterion for the initiation of early empirical treatment would have resulted in 17 unnecessary antibiotic treatments in this cohort. Discussion and conclusions We identified S. aureus carriage as an independent and strong predictor of EOP. As rapid point-of-care testing for S. aureus is readily available, we recommend testing of all patients at admission for burn trauma and the consideration of early preemptive treatment in all positive patients. Further studies are needed to evaluate this new strategy.