Hospital-acquired sepsis in burn patients: epidemiology, bacterial profiles, and risk factors in a tertiary burn center in Iran

Abstract

Sepsis is a significant cause of morbidity and mortality in burn patients due to compromised skin integrity and immune dysfunction. Despite advancements in burn care, hospital-acquired infections continue to be a significant challenge, particularly in low-resource settings. This cross-sectional observational study was conducted over a 12-month period at Mousavi Hospital, a tertiary referral burn center in Zanjan, Iran. All patients admitted with burn injuries who remained hospitalized for more than 72 hours were evaluated for hospital-acquired sepsis. Sepsis was diagnosed based on the combination of clinical signs and relevant laboratory and imaging findings. Demographic, clinical, and microbiological data were collected from medical records. Multivariate logistic regression was used to identify independent risk factors. Among 453 burn patients, 176 (38.8%) developed hospital-acquired sepsis. Sepsis was significantly associated with advanced age (p = 0.007), rural residence (p < 0.001), lower educational level (p = 0.004), higher burn severity (p < 0.001), and prolonged hospitalization (p < 0.001). The most commonly isolated microorganism was Pseudomonas aeruginosa (32.1%), followed by Citrobacter spp. (22.6%) and Staphylococcus aureus (15.1%). Multivariate logistic regression identified burn percentage (OR = 1.184, p = 0.001), length of hospital stay (OR = 1.585, p < 0.001), and lower educational level (OR = 0.501, p = 0.005) as independent predictors of sepsis. Hospital-acquired sepsis remains highly prevalent in burn patients. The key independent predictors were Total Body Surface Area (TBSA), duration of hospitalization, and education level. Regular microbial surveillance, timely diagnosis using burn-specific criteria, and targeted infection control measures are essential to reducing sepsis-related complications in this vulnerable population.