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A rapid emergence of multidrug resistance pathogens in mass burn casualty patients: Longitudinal surveillance from serial blood and pus cultures

Year: 2026

Type: article

Abstract: Background Severe burn injuries are commonly complicated by high rates of infection and antimicrobial resistance (AMR). Longitudinal data mapping microbial dynamics in burn patients, particularly following mass casualty events, are limited. The study aimed to analyzing the microbial trends and AMR patterns derived from weekly paired blood and wound specimens collected from survivors of the Morogoro disaster. Methodology A retrospective longitudinal observation study was conducted on 13 critically ill burn patients from the 2019 disaster of a fuel tanker exploded in Morogoro, Tanzania. Weekly paired blood and deep wound swabs were collected, yielding 90 specimens over 12 weeks. Isolated bacteria were identified and tested for antibiotic susceptibility. Results A total of 62 pathogenic isolates were recovered. A clear temporal shift was observed: initial dominance by multidrug-resistant (MDR) gram-negative pathogens ( Acinetobacter baumannii , Pseudomonas aeruginosa ) in Weeks 1–2, followed by a transition to gram-positive bacteria (Weeks 3–5), and finally a resolution phase (Weeks 6–12) characterized by sterile cultures. Resistance escalated rapidly; in A. baumannii , resistance to third-generation cephalosporins rose to 71.4% by Week 2. Concordance between blood and wound isolates confirmed the burn wound as the source of invasive infection. Mortality was 76.9%, with all fatalities attributed to sepsis. Conclusion Serial surveillance reveals a predictable microbial succession and alarming acceleration of AMR in severely burned patients, directly linking wound colonization to lethal sepsis. These findings underscore the urgent need for protocolized serial culture-guided antibiotic stewardship and reinforced infection control in burn management.

Source: Burns Open

DOI: 10.1016/j.burnso.2026.100513