Burn Unit, Ghent University Hospital, Ghent, Belgium.
Am J Crit Care. 2010 Nov;19(6):e81-7. doi: 10.4037/ajcc2010341.
Bloodstream infections are common in burn patients.
To evaluate the effects of bloodstream infections in patients with severe burn injuries.
A retrospective, pairwise-matched, risk-adjusted cohort study in a 6-bed burn unit was done. "Exposed" patients with microbiological evidence of bloodstream infections (n = 76) were compared with nonexposed patients (n = 103) matched for burn severity (identical Belgian Outcome in Burn Injury score) and length of hospitalization (≥time-to-event in exposed patients). Main outcome measures were length of hospitalization and mortality.
Predominant pathogens were Staphylococcus aureus, enterococci, Pseudomonas aeruginosa, Escherichia coli, coagulase-negative staphylococci, and Candida species. Median patient age was 42 years (interquartile range [IQR], 31-52). Median total burned surface area was 40% (IQR, 25%-50%). Inhalation injury occurred in 54%. Median burn injury score was 4 (IQR, 2-5). Median length of stay before onset of bacteremia was 11 days (IQR, 5.3-19.8). Appropriate antimicrobial therapy was initiated within the first 48 hours in 76%. The exposed group had a higher need for vasopressive/inotropic support (P = .02); need for ventilatory assistance and renal replacement therapy did not differ significantly between groups. Hospital mortality did not differ (P = .30). However, bloodstream infection was associated with longer durations of hospitalization (P < .001) and mechanical ventilation (P < .001).
In this cohort of burn patients, bloodstream infections did not adversely affect survival, but greater durations of ventilator dependency and hospital stay increased costs of care.
血流感染在烧伤患者中很常见。
评估严重烧伤患者血流感染的影响。
在一个 6 床烧伤单元进行了回顾性、配对、风险调整的队列研究。有微生物学证据表明患有血流感染（n=76）的“暴露”患者与烧伤严重程度（相同的比利时烧伤结局评分）和住院时间（暴露患者的时间至事件）相匹配的无暴露患者（n=103）进行比较。主要观察指标是住院时间和死亡率。
主要病原体为金黄色葡萄球菌、肠球菌、铜绿假单胞菌、大肠杆菌、凝固酶阴性葡萄球菌和念珠菌属。患者中位年龄为 42 岁（四分位距[IQR]，31-52）。中位总烧伤面积为 40%（IQR，25%-50%）。吸入性损伤发生率为 54%。烧伤损伤评分中位数为 4（IQR，2-5）。菌血症发生前的中位住院时间为 11 天（IQR，5.3-19.8）。76%的患者在 48 小时内开始接受适当的抗菌治疗。暴露组需要血管加压/正性肌力支持的比例更高（P=.02）；两组间需要呼吸机辅助和肾脏替代治疗的差异无统计学意义。两组间住院死亡率无差异（P=.30）。然而，血流感染与住院时间（P <.001）和机械通气时间（P <.001）延长相关。
在本队列的烧伤患者中，血流感染并未对生存率产生不利影响，但呼吸机依赖和住院时间延长会增加医疗费用。
