Wound infections due to factory gunpowder and pyrotechnic explosions in patients with burn injury: risk factors and antimicrobial resistance.

Abstract

Background: A substantial obstacle in the treatment of burn patients is the management of burn wound infection (BWI). The objective of this investigation was to assess the antimicrobial susceptibility test results and distribution characteristics of microorganisms isolated from the burn wounds of patients affected by the factory gunpowder and pyrotechnic explosions.

Methods: This tertiary burn center conducted a 5-year retrospective observational study of the clinical and laboratory characteristics of pathogenic microorganisms through drug susceptibility tests, species distribution, and timing of wound infections. Two groups of patients were compared: patients with burn wound infection (BWI) versus patients without burn wound infection (Non-BWI).

Results: The study enrolled 313 individuals (median age: 47 years), of whom 286 (91.37%) were male. One hundred twenty‑four (39.6%) developed BWI. Multiple regression analysis showed that inhalation injury, length of stay (LOS), and percentage total body surface area (%TBSA) were independent risk factors for developing BWI. The most frequently isolated bacteria were Acinetobacter baumannii (31.6%) and Klebsiella pneumoniae (10.9%). The median time from admission to first pathogen isolation was 12 days (IQR: 4-25 days) for Gram‑negative bacteria, 20 days (IQR: 10-30 days) for Gram‑positive bacteria, and 35 days (IQR: 18.5-59.5 days) for fungi.

Conclusion: BWI occurred in 39.6% of gunpowder-related burn patients. Independent risk factors were inhalation injury (OR 4.86), larger %TBSA (OR 1.08), and prolonged LOS (OR 1.09). Gram-negative pathogens predominated (74.4%), with A. baumannii (31.6%) showing near-complete resistance. Gram-negative infections emerged earlier (median 12 days) than Gram-positive (20 days) or fungi (35 days). Based on these findings, our burn unit now initiates early surveillance cultures at day 7 post-admission for high-risk patients, prioritizes empiric Gram-negative coverage (specifically anti-Acinetobacter therapy) in the first two weeks, and has implemented enhanced infection control protocols targeting A. baumannii transmission.