Rapid Detection of Staphylococcus Aureus in Burn Patients (PCR-Staph)

• Duration of signs of infection [ Time Frame: 14 days after the administrationof anti-Staphylococcus therapy ] [ Designated as safety issue: No ]
• Duration of antibiotic use [ Time Frame: 14 days after administration of antimicrobial therapy ] [ Designated as safety issue: No ]
• Correlation of PCR result with mortality [ Time Frame: Day 28 of intensive care unit stay ] [ Designated as safety issue: No ]

The purpose of this study is to determine if rapid early detection of the bacteria causing sepsis in burn patients improves patient outcomes.

Burn patients have lost their primary barrier to microorganism invasion and therefore are continually and chronically exposed to pathogens. Ninety-seven percent of patients with >20% total body surface area (TBSA) burns develop septicemia; predominantly involving gram positive cocci including MRSA and methicillin sensitive Staphylococcus aureus. Blood culture (BC) is the traditional detection method for septicemia. However, antibiotics and inadequate sample volumes can impair detection by BC and results can take 3-4 days.

Polymerase chain reaction (PCR) represents a potential adjunct to BC. Pathogens are detected in a growth-independent manner by targeting their genetic make-up. Quantitative determining of pathogen DNA using PCR could aid in determining antimicrobial drug therapy efficacy by providing results on the same testing day as opposed to 3-4 days with BC. PCR may also detect persistent infections during antimicrobial therapy when culture samples are inhibited.

The aims of this study are:(1)to correlate quantitative PCR results with that of the BC; (2) to test the clinical application of PCR results with clinical outcomes of treatment of presumptive diagnosis of staphylococcal sepsis.

• Burns
• Sepsis

• No Intervention: No PCR testing
  Control patients will not have PCR testing. This group will have routine testing and treatment as defined by the standard of care.
• Experimental: PCR testing
  PCR will be used in parallel with routine laboratory tests such as culture. Treatment for PCR results will be based on the standard of care. Treatment of the patient will be dependent on the physician's clinical judgment based on existing clinical information including PCR, microbiology, patient physical presentation, and other laboratory results.
  Intervention: Other: PCR test

Inclusion Criteria:

• 20% or > TBSA burns at hospital admission
• will require BC during hospital stay
• Patient/surrogate able to sign consent

Exclusion Criteria:

• allergic to nafcillin, cefazolin, vancomycin, linezolid, and/or daptomycin
• on antibiotic(s) prior to first BC