Steinsträsser L, Thies A H, Rabstein S, Steinau H-U
Klinik für Plastische Chirurgie und Schwerbrandverletzte, Berufsgenossenschaftliche Kliniken Bergmannsheil, Ruhr-Universität Bochum, Germany.
Handchir Mikrochir Plast Chir. 2007 Oct;39(5):338-44. doi: 10.1055/s-2007-965694.
The purpose of this study was to identify risk profiles for wound infection of severely burned patients in a retrospective analysis of patients of an intensive care burn unit during 1995 - 2004. The goal of this study was to identify risk factors on wound infection in severely burned patients. Possible influences on mortality were to be discussed. Inclusion criteria of the study population was a minimum age of 18 years and a body surface area burned of at least 40 % during the time period 1995 - 2004. 912 patients were screened and 96 patients were enrolled. Logistic regression was performed to investigate factors influencing wound infection and mortality in the study population. The initially detectable bacteria in the burn wounds were Staphylococcus aureus (21.1 %), Staphylococcus epidermidis (16.2 %) and Enterococcus faecalis (16.2 %). Of all swabs taken the most frequent initial discovered bacteria were Staphylococcus aureus (18.2 %), Staphylococcus epidermidis (12.7 %), Enterococcus faecalis (12.7 %) and Escherichia coli (13.3 %). The majority of positive swabs were the burn wound followed by nose and tracheal secretion. The risk of a wound infection was more likely in the period 2000 - 2004 in comparison to 1995 - 1999 with an Odds Ratio of 0.17 (95 % KI [0.05 - 0.63], p = 0.008). Wound infection was promoted by longer hospitalization on the burn intensive care unit with an Odds Ratio of 2.62 (95 % KI [1.34 - 5.11], p = 0.005) and by bacterial detection in the unburned parts of the body with an Odds Ratio of 5.36 (95 % KI [1.30 - 22.24], p = 0.02). Death was significantly promoted by age (over 50 years) with an Odds Ratio of 11.62 (95 % KI [2.76 - 48.92], p = 0.0008), wound infection with an Odds Ratio of 0.12 (95 % KI [0.03 - 0.52], p = 0.004) and inhalation injury with an Odds Ratio of 5.95 (95 % KI [1.72 - 20.55], p = 0.005). During the study period a rise of wound infections could be notified. Promoting factors were longer hospitalization on the burn intensive care unit and bacterial detection in the unburned parts of the body. Regarding mortality, higher age, wound infection and inhalation injury were prognostic factors.
本研究旨在通过对1995 - 2004年期间一家烧伤重症监护病房患者进行回顾性分析，确定重度烧伤患者伤口感染的风险特征。本研究的目的是识别重度烧伤患者伤口感染的风险因素。还将讨论对死亡率可能产生的影响。研究人群的纳入标准为年龄至少18岁，在1995 - 2004年期间烧伤体表面积至少40%。共筛查了912例患者，96例患者被纳入研究。采用逻辑回归分析研究人群中影响伤口感染和死亡率的因素。烧伤创面最初检测到的细菌为金黄色葡萄球菌（21.1%）、表皮葡萄球菌（16.2%）和粪肠球菌（16.2%）。在所有采集的拭子中，最常最初发现的细菌为金黄色葡萄球菌（18.2%）、表皮葡萄球菌（12.7%）、粪肠球菌（12.7%）和大肠杆菌（13.3%）。大多数阳性拭子来自烧伤创面，其次是鼻腔和气管分泌物。与1995 - 1999年相比，2000 - 2004年期间伤口感染的风险更高，比值比为0.17（95%可信区间[0.05 - 0.63]，p = 0.008）。烧伤重症监护病房住院时间延长会促进伤口感染，比值比为2.62（95%可信区间[1.34 - 5.11]，p = 0.005），身体未烧伤部位检测到细菌也会促进伤口感染，比值比为5.36（95%可信区间[1.30 - 22.24]，p = 0.02）。年龄（50岁以上）会显著促进死亡，比值比为11.62（95%可信区间[2.76 - 48.92]，p = 0.0008），伤口感染的比值比为0.12（95%可信区间[0.03 - 0.52]，p = 0.004），吸入性损伤的比值比为5.95（95%可信区间[1.72 - 20.55]，p = 0.005）。在研究期间，可以注意到伤口感染有所增加。促进因素包括烧伤重症监护病房住院时间延长和身体未烧伤部位检测到细菌。关于死亡率，年龄较大、伤口感染和吸入性损伤是预后因素。
