Tsai Wen-Ping, Chen Chung-Lin, Ko Wen-Chien, Pan Shin-Chen
Division of Plastic Surgery, Department of Surgery, School of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 704, Taiwan.
Burns. 2006 Mar;32(2):155-8. doi: 10.1016/j.burns.2005.08.016. Epub 2006 Jan 31.
Stenotrophomonas maltophilia has been increasingly reported as a nosocomial opportunistic pathogen in debilitated patients, including burn patients. There is, however, only one published report in English that discusses S. maltophilia bacteremia in burns. We performed a retrospective chart review and statistical analysis of the incidence, the duration of hospital stays before a diagnosis of bacteremia, antimicrobial susceptibility, prognosis, and mortality risk factors in burn patients. From January 1996 to December 2004, 14 episodes of S. maltophilia bacteremia in 13 of 666 patients admitted to the burn center at our hospital were identified. The patients, nine males and four females, ranged in age from 1 to 76 years (mean: 42.9+/-24.4 years). Eleven injuries were from flame burns and two were from scald burns. The mean total burned surface area (TBSA) was 47+/-30.2% and mean prognostic burn index (PBI) was 81.7+/-31.3. The average annual incidence was 2.3 episodes per 1000 admissions, and no outbreak cluster was noticed. The mean hospital stay before bacteremia was 19.8+/-11.9 days. Most isolates were susceptible to ticarcillin-clavulanate (87.5%) and moxalactam (85.7%). The overall mortality was 30.7% (4/13) and correlated significantly with TBSA (P<0.01) and PBI (P<0.05). The incidence of S. maltophilia bacteremia was higher in hospitalized burn patients than in hospitalized non-burn patients. Different antimicrobial susceptibility patterns may exist, especially in different geographic regions. Awareness of the possibility of infection by this opportunistic pathogen and commencement of adequate antibiotics treatment, especially after 3 weeks of intensive care, should be incorporated into the strategy of treatment in major burn patients.
嗜麦芽窄食单胞菌越来越多地被报道为包括烧伤患者在内的虚弱患者的医院机会性病原体。然而，仅有一篇英文发表报告讨论了烧伤患者中的嗜麦芽窄食单胞菌血症。我们对烧伤患者中嗜麦芽窄食单胞菌血症的发病率、菌血症诊断前的住院时间、抗菌药物敏感性、预后及死亡危险因素进行了回顾性病历审查和统计分析。1996年1月至2004年12月，在我院烧伤中心收治的666例患者中，有13例发生了14次嗜麦芽窄食单胞菌血症。患者中男性9例，女性4例，年龄1至76岁（平均：42.9±24.4岁）。11例为火焰烧伤，2例为烫伤。平均总烧伤面积（TBSA）为47±30.2%，平均预后烧伤指数（PBI）为81.7±31.3。年平均发病率为每1000例入院患者2.3次，未发现暴发聚集现象。菌血症发生前的平均住院时间为19.8±11.9天。大多数分离株对替卡西林-克拉维酸（87.5%）和拉氧头孢（85.7%）敏感。总死亡率为30.7%（4/13），与TBSA（P<0.01）和PBI（P<0.05）显著相关。住院烧伤患者中嗜麦芽窄食单胞菌血症的发病率高于住院非烧伤患者。可能存在不同的抗菌药物敏感性模式，尤其是在不同地理区域。在主要烧伤患者的治疗策略中，应纳入对这种机会性病原体感染可能性的认识以及开始适当的抗生素治疗，尤其是在重症监护3周后。
