Multi-drug resistant Gram negative bacteria in major paediatric burns transferred from overseas hospitals

Dr Fangbo Lin1, Dr Rahul Jayakar1, Mr Paul Baker1

1Middlemore Hospital, Auckland, New Zealand


Background: The presence  of multi-drug resistant Gram negative bacteria (MDRGNB) in burn patients may result in poorer outcomes. Infection or sepsis is difficult to treat and often results in  delayed healing. We suspect that patients transferred from overseas hospitals have a high rate of MDRGNB due to a delay in surgical debridement and use of broad-spectrum antibiotics.

Aim: To review paediatric burn admissions transferred from overseas hospitals, document the incidence of MDRGNB and their outcomes; and identify any risk factors

Methods: We retrospectively analysed all paediatric burns transferred to the New Zealand National Burns Centre (NBC) from an overseas hospital. Primary variables measured were: the presence of MDRGNB, time to first surgery, extent of injury, antibiotic use and outcomes.

Results: 198 paediatric patients were admitted to the NBC with a burn >10% TBSA from 2008 – 2019. 16 were transferred from overseas hospitals with a mean age of 3 years (range: 0 – 11). Tahiti was the most common referral source (75%). Five patients (31%) within this overseas group were cultured with MDRGNB. One patient cultured four different MDRGNB. Mean time to burn debridement was 8.3 days (range: 2 – 16). Scald was the most common mechanism (62%) and the mean TBSA was 38% (range: 12 – 79%). Antibiotic use prior to transfer was not accurately documented. Three patients died during their admission and these were not associated with MDRGNB.

Conclusion: Paediatric burns transferred from overseas hospitals have a high rate of MDRGNB. A delay to primary debridement may play a role developing MDRGNB due to sepsis and use of broad spectrum antibiotics. Overall, the presence of MDRGNB was not associated with adverse outcomes in our population.


A non-training surgical registrar from Auckland working at Middlemore Hospital with interests in Plastics Surgery.

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