Homelessness, not Area Deprivation Index, is an Independent Risk Factor for Resistant Infections in Burn Patients

Author(s):
Stephen Stopenski; Louis Perkins; Jarrett Santorelli; Laura Haines; Jeanne Lee; Eli Strait; Todd Costantini; Jay Doucet; Allison Berndtson

Background:

The region along the California-Mexico border is characterized by a high incidence of burn cases, featuring a diverse population with varying socioeconomic statuses. Patients with burn injuries are especially prone to healthcare-associated infections (HAI), however, the influence of socioeconomic status on infections following burn injury remains poorly understood. The objective of this study was to evaluate the association between socioeconomic disadvantage and risk of infection among burn patients.

Hypothesis:

We hypothesized that greater socioeconomic disadvantage, as measured by Area Deprivation Index (ADI), would be associated with higher risk of infection following a burn injury.

Methods:

The burn registry of an American Burn Association-verified burn center was queried for all admissions between 2015 to 2019. Patients admitted for less than seven days or with a home address outside California were excluded. Collected data included demographics, burn characteristics, and culture results. Patient home addresses were geocoded, and correlated ADI scores were classified into quintiles. Homeless patients were classified as a separate category. Groups were then compared using univariate and multivariate analysis. The primary outcome was any infection (wound, urine, respiratory, or blood). Resistant infections were analyzed as a secondary outcome.

Results:

788 patients were included for analysis. The cohort was 64% male, 44% white, with a median age of 45 (IQR 25-58) and median total body surface area burn (%TBSA) of 4% (IQR 2-9%). The median ADI state decile was 6 (IQR 5-8); 5% (n=36) of patients were homeless. 17% (n=131) of patients had an infection during their admission, while 6% (n=50) had an infection with a resistant organism. Risk factors for having a hospital associated infection included age (p=0.018), %TBSA burned (p<0.001), smoking (p<0.028), and alcohol intoxication (p=0.003). Homelessness was an independent risk factor for resistant infection (OR = 3.37, CI 1.05-9.31, p=0.027, Figure 1). ADI quintile was not associated with either overall or resistant infections.

Conclusions:

Homeless patients are at increased risk of developing an infection with a resistant organism when admitted with a burn.