C54-25 Epidemiology and Predictors of Nosocomial Infection in Burn Intensive Care Unit Patients at a Quaternary Care Hospital in Colombia

Abstract Rationale Burn patients in the intensive care unit (ICU) are highly vulnerable to nosocomial infections due to extensive skin barrier loss, invasive procedures, and immune dysregulation. These infections significantly increase morbidity, mortality, and healthcare costs. This study aimed to determine the incidence of ICU-acquired infections in adult burn patients and identify independent risk factors associated with their development. Methods We performed a single-center, retrospective, analytical case-control study of adults (18 years) admitted to a specialized burn ICU between January 2023 and December 2024. Cases were defined as patients who developed infections based on clinical and/or microbiological criteria; controls were contemporaneous burn ICU patients without infection. Demographics, comorbidities, burn characteristics, and clinical interventions were extracted from electronic records. Incidence rates were calculated, and group comparisons were performed using χ² or Fisher’s exact tests for categorical variables and Wilcoxon or Student’s t tests for continuous variables. Multivariable penalized logistic regression was used to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results Among 361 patients analyzed, 40 developed ICU-acquired infections, corresponding to an incidence of 11.1% (≈11 infections per 1,000 ICU-days). Microbiological isolates were available in 24 cases, most commonly Pseudomonas aeruginosa (21%) and Enterococcus faecalis (13%). Infected patients had greater total body surface area (TBSA) burned (median 15% vs 6%; p0.001), more inhalation injuries (18% vs 2.5%; p0.001), and longer hospital stays (median 29 vs 5 days; p0.001). Diabetes mellitus was more frequent among infected patients (15% vs 4.4%; p=0.015). The infection group required more invasive procedures, including mechanical ventilation (43% vs 6.9%), tracheostomy (40% vs 4.7%), central venous catheterization (60% vs 17%), and urinary catheterization (60% vs 18%) (all p0.001). ICU mortality was markedly higher among infected patients (13% vs 0.6%; p0.001).In multivariable analysis (adjusted R²=0.34; AUC=0.88), three factors remained independently associated with infection: pre-existing diabetes mellitus (OR 5.4, 95% CI 0.96-29.4; p=0.049), need for blood transfusion (OR 8.3, 95% CI 2.3-33.7; p=0.002), and tracheostomy (OR 7.8, 95% CI 1.4-44.9; p=0.018). Conclusions Approximately one in nine burn ICU patients developed an ICU-acquired infection, which was associated with a 20-fold increase in mortality. The need for transfusion and tracheostomy—markers of clinical severity—were the strongest predictors. Enhanced infection surveillance, aseptic technique, glycemic optimization, and restrictive transfusion strategies may mitigate infection-related morbidity and mortality in this high-risk population. This abstract is funded by: None