Prevalence and Determinants of Multi-Drug Resistance Bacterial Infection Among Burn Patients in a Tertiary Care Center in Nepal

Sujan Maharjan,1 Sweta Shrestha,1 Upasana Acharya,1 Kiran Kishor Nakarmi,2 Sushan Man Shrestha,3 Neeva Maharjan,1 Sunil Shrestha4 1Department of Pharmacy, Kathmandu University, Dhulikhel, Bagmati Province, Nepal; 2Department of Burns, Plastic and Reconstructive Surgery, Nepal Cleft and Burn Center, Kathmandu, Bagmati Province, Nepal; 3Institute of Medicine, Teaching Hospital, Kathmandu, Bagmati Province, Nepal; 4Department of Research and Academics, Kathmandu Cancer Center, Tathali, Nala Road, Bhaktapur, Bagmati Province, NepalCorrespondence: Sweta Shrestha, Department of Pharmacy, Kathmandu University, Kavre, Dhulikhel, Bagmati Province, Nepal, Tel +977 9841470887, Email [email protected]: The emergence of multidrug-resistant organisms (MDROs) in burn patients poses a significant threat to patient outcomes and healthcare systems, especially in resource-limited settings. Burn injuries compromise the skin barrier and often require invasive interventions, increasing the risk of infection and antimicrobial resistance. This study aimed to determine the prevalence of multi-drug resistance (MDR) and identify the associated risk factors.Patient and Methods: A retrospective study was conducted among burn patients admitted to Nepal Cleft and Burn Center, Kathmandu, from January to December 2023. All culture-positive isolates were assessed to determine the prevalence of MDR and distribution of common pathogens. Sociodemographic and clinical data were evaluated using multivariate logistic regression to identify predictors of MDRO infection.Results: Among 535 burn patients, 348 had positive cultures. The prevalence of resistant organisms was 56.82%, comprising MDR (n = 155), Extensively Drug-Resistant (XDR) (n = 147), and Pan-drug Resistant (PDR) (n = 2). The most common Gram-negative isolates were Pseudomonas aeruginosa (29.0%), Klebsiella pneumoniae (18.1%), Citrobacter koseri (17.5%), Acinetobacter baumannii (16.4%), and Escherichia coli (13.8%). Among Gram-positive organisms, Coagulase-negative Staphylococci (15.5%) and MRSA (13.2%) were identified. The use of catheters, nasogastric tubes, and ventilators was significantly higher in MDRO cases. Bloodstream (18.8%), urinary (12.8%), and catheter-related infections (11.2%) were also observed among patients. Intensive Care Unit (ICU) admission [Adjusted Odds Ratio (AOR): 3.047, 95% Confidence Interval (CI): 1.089– 8.528; p = 0.034] and nasogastric tube use [AOR: 11.830, CI: 1.339– 104.489; p = 0.026] were significant predictors of MDRO infection.Conclusion: MDRO infections are highly prevalent (56.82%) in burn patients. ICU stay and use of invasive devices are key risk factors. These findings underscore the importance of antimicrobial stewardship, stringent infection control measures, and routine surveillance for antimicrobial resistance in burn units.Keywords: antibiotic resistance, burn, prevalence, stewardship