The burden of infections in burn patients at a tertiary hospital in Tanzania: microbial etiology, drug resistance Patterns, and patient outcomes

• Infection still causes high death and illness rates in burn patients. • Drug-resistant bacteria hinder treatment and extend hospital stays. • Surveillance and stewardship help prevent antibiotic resistance spread. Infections significantly contribute to mortality and morbidity in burn patients, with rising of antibiotic-resistant bacteria further complicates treatment, contributing to poor outcomes. This study determined the burden of infections in burn patients, including microbial etiology, drug resistance patterns, and patient outcomes, at a tertiary hospital in Tanzania. A retrospective cross-sectional study conducted from January 2021 to July 2022 recruited 158 burn patients (median age 3 years, IQR 1–20 years) at Muhimbili National Hospital. Data were obtained from medical records. Descriptive and logistic regression analysis ware performed using Statistical Package for the Social Sciences version 23.0, a p -value of <0.05 at 95% confidence intervals was significant. Of 158 burn patients, 117(74.1%) had infections; predominantly wound infection, 53.0% (n = 62). Wound and bloodstream infections were the predominant co-infections, 25.6% (n = 30), of which similar bacterial species were isolated in 33.3%(n = 10). Pseudomonas aeruginosa, was frequently isolated , found in 37.6%(n = 44) wounds and 50%(n = 2) urine samples. Staphylococcus aureus 33.3%(n = 18) and Coagulase-negative Staphylococci 29.6% (n = 16) w ere frequently isolated from blood. The isolated bacteria were resistant to most antibiotics; the proportion of multidrug-resistant strains was 61.5%(n = 72), 51.9%(n = 28), and 66.7%(n = 2) from wound, blood, and urine samples, respectively. Factors associated with mortality were multi-drug resistance infection (aOR:8.59, 95%CI:2.55–28.96, p = 0.001) and TSBA ≥21% (aOR:10.62, 95%CI:2.22–50.87, p = 0.003). The Majority of burn patients develop infection with multidrug-resistant strains. Mortality was significantly associated with multi-drug resistance and TSBA ≥21%. Therefore, regular surveillance and strengthened stewardship are essential to guide treatment and curb antibiotic resistance.