Trottier Vincent, Segura Penelope Gonzalez, Namias Nicholas, King David, Pizano Louis R, Schulman Carl I
Division of Burns, Trauma and Surgical Critical Care, University of Miami, Leonard Miller School of Medicine, Jackson Memorial Hospital, Ryder Trauma Center, Miami, Florida 33136, USA.
J Burn Care Res. 2007 Mar-Apr;28(2):248-54. doi: 10.1097/BCR.0B013E318031A20F.
The objective of this study was to determine the incidence of drug resistance among isolates of Acinetobacter baumannii from our Burn Intensive Care Unit (BICU), the rate of clinical cure, and the mortality rate. We undertook a retrospective review of all cases of infection from the BICU between January 2004 and November 2005. The group consisted of 24 men (80%) and 6 women with a mean age of 43 years (range, 17-76 years, +/-14.5 years). Mean TBSA burned was 43% (range, 9-75%, +/-19%). Mean BICU length of stay was 49 days (range, 5-118 days, +/-30 days). Patients developed their first infection after a mean of 16 days (5-73 days, +/-14 days). The initial site of infection was bronchoalveolar lavage in 21 (70%), blood in 6 (20%), central venous catheter tip in 2 (7%), and urine in 1 (3%). The isolates displayed resistance to imipenem in 87% of cases. No organism displayed resistance to colistin (polymixin E). Patients were treated with colistin in 20 cases (67%), with amikacin in 8 cases (27%), and with imipenem in 2 cases (7%). A total of 10 patients (33%) died, 1 from gastrointestinal bleeding and 9 from active infection, giving an infection related mortality of 30%. In 21 cases (70%), a cure was achieved with a mean duration of treatment of 16 days (range, 4-30 days, +/-7 days). The majority of A. baumannii isolates were multidrug resistant; however, no isolate displayed resistance to colistin. Cure rate was 70% and infection-related mortality reached 30%. More investigation is warranted to improve prevention and to assess new therapeutic agents.
本研究的目的是确定我院烧伤重症监护病房（BICU）分离的鲍曼不动杆菌的耐药发生率、临床治愈率和死亡率。我们对2004年1月至2005年11月间BICU的所有感染病例进行了回顾性研究。该组包括24名男性（80%）和6名女性，平均年龄43岁（范围17 - 76岁，±14.5岁）。平均烧伤总面积为43%（范围9 - 75%，±19%）。在BICU的平均住院时间为49天（范围5 - 118天，±30天）。患者在平均16天（5 - 73天，±14天）后发生首次感染。感染的初始部位为支气管肺泡灌洗21例（70%）、血液6例（20%）、中心静脉导管尖端2例（7%）、尿液1例（3%）。分离株对亚胺培南耐药的占87%。没有菌株对黏菌素（多黏菌素E）耐药。20例患者（67%）接受了黏菌素治疗，8例（27%）接受了阿米卡星治疗，2例（7%）接受了亚胺培南治疗。共有10例患者（33%）死亡，1例死于胃肠道出血，9例死于活动性感染，感染相关死亡率为30%。21例（70%）患者治愈，平均治疗时间为16天（范围4 - 30天，±7天）。大多数鲍曼不动杆菌分离株具有多重耐药性；然而，没有分离株对黏菌素耐药。治愈率为70%，感染相关死亡率达30%。需要进行更多研究以改善预防措施并评估新的治疗药物。
