Eldad A, Icekson M, Zur T, Slosser D, Maly A, Arielli D, Burvin R, Ad-El D, Neuman A
Department of Plastic Surgery and Burn Unit, Hadassah University Hospital, Ein Kerem Jerusalem, Israel.
J Burn Care Rehabil. 2003 May-Jun;24(3):154-7. doi: 10.1097/01.BCR.0000069440.78932.70.
A 3-year-old girl with 52% TBSA scalds, mostly partial thickness, was treated topically with 5% mafenide acetate solution and 1% silver sulfadiazine cream. All blood cultures and wound swabs were negative for the first 5 days. On day 6 gram-negative bacteria and yeast forms were isolated from her wounds. High fever and leukocytosis were present and the child was treated with intravenous ampicillin and gentamicin according to sensitivity bacteriogram. The bacteria were identified as Pseudomonas aeruginosa and the yeast was Candida tropicalis. On day 7, Escherichia coli was identified in blood cultures and intravenous cefixime was added. Amphotericin B was added on day 9 when blood cultures grew Candida tropicalis and Burkholderia cepacia. On day 13 dark pigmentation foci developed on some areas of partial-thickness burns in the back, resembling invasive wound infection. White blood cell count was 14,300 cells/mm3, and her body temperature reached 39.7 degrees C. Cultures from the pigmented areas were negative, and biopsies revealed deposits of silver. Most of the areas healed uneventfully, and only about 8% TBSA needed grafting, including some of the pigmented areas. No residual pigmentation remained on discharge.
一名3岁女童，烧伤面积达体表面积的52%，大部分为浅度烧伤，采用5%醋酸磺胺米隆溶液和1%磺胺嘧啶银乳膏进行局部治疗。最初5天，所有血培养和伤口拭子检查均为阴性。第6天，从她的伤口分离出革兰氏阴性菌和酵母样菌。患儿出现高热和白细胞增多，根据药敏试验结果，采用静脉注射氨苄西林和庆大霉素进行治疗。细菌鉴定为铜绿假单胞菌，酵母为热带念珠菌。第7天，血培养中鉴定出大肠杆菌，遂加用静脉注射头孢克肟。第9天，血培养生长出热带念珠菌和洋葱伯克霍尔德菌，加用两性霉素B。第13天，背部浅度烧伤的一些部位出现色素沉着灶，类似侵袭性伤口感染。白细胞计数为14,300个/mm³，体温达到39.7℃。色素沉着部位的培养结果为阴性，活检显示有银沉积。大部分区域愈合顺利，仅约8%的体表面积需要植皮，包括一些色素沉着部位。出院时无残留色素沉着。
