新德里三级护理中心皮肤科病房脓毒症的临床和细菌学特征及转归。
Clinical and bacteriological profile and outcome of sepsis in dermatology ward in tertiary care center in New Delhi.
机构信息
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi 110 029, India.
出版信息
Indian J Dermatol Venereol Leprol. 2011 Mar-Apr;77(2):141-7. doi: 10.4103/0378-6323.77452.
BACKGROUND
There is paucity of data regarding the clinical and bacteriological profile of sepsis in dermatology in-patients.
AIMS
To study the frequency, etiology, and outcome of sepsis dermatology in-patients.
METHODS
The study was conducted in a 30-bedded dermatology ward of a tertiary care center. Sepsis was defined by presence of ≥2 SIRS (systemic inflammatory response syndrome) criteria along with evidence of infection (clinically obvious/culture proven infection of skin or internal organs). Patients were also assessed for known (common) risk factors of sepsis. In suspected sepsis patients, at least two samples of blood cultures by venepuncture were taken. Pus, skin swab, urine, and sputum samples were also collected for culture as needed with avoidance of contamination.
RESULTS
Among 860 admitted patients studied from November 2004 to July 2006, 103 (12%) fulfilled SIRS criteria. Of these, 63 had nonsepsis causes of SIRS positivity, while 40 (4.65%) had sepsis. Majority of the sepsis patient had vesicobullous diseases (42.5%), erythroderma (25%), toxic epidermal necrolysis (TEN) (22.5%). Severe sepsis developed in 17 (42.5%) patients, while 15 (37.5%) died. Methicillin-resistant Staphylococcus aureus (MRSA) was the commonest organism isolated (99; 25.9%) in all culture specimens followed by Acinetobacter spp. (52; 13.6%), Pseudomonas spp. (40; 10.5%), Methicillin-sensitive S. aureus (MSSA: 33; 8.7%), and Klebsiella spp. (22; 5.8%). Various risk factors affecting mortality and sensitivity patterns for various isolates were also analyzed.
CONCLUSION
Sepsis occurred in 40 (4.65%) inpatients in dermatology ward. The frequency of sepsis was highest in TEN (90%), followed by drug-induced maculopapular rash (20.0%), erythroderma (17.5%), and vesicobullous diseases (8.5%). MRSA, acinetobacter, pseudomonas, MSSA, and Klebsiella were important etiological agents involved in sepsis in dermatology in-patients.
背景
皮肤科住院患者脓毒症的临床和细菌学特征数据匮乏。
目的
研究皮肤科住院患者脓毒症的发生频率、病因和转归。
方法
该研究在一家三级护理中心的 30 张床位皮肤科病房进行。脓毒症的定义为存在≥2 个全身炎症反应综合征（SIRS）标准，伴有感染证据（皮肤或内部器官的临床明显/培养证实的感染）。还评估了患者已知（常见）脓毒症风险因素。疑似脓毒症患者通过静脉穿刺至少采集两份血培养样本。根据需要采集脓液、皮肤拭子、尿液和痰样进行培养，避免污染。
结果
2004 年 11 月至 2006 年 7 月期间，对 860 例入院患者进行了研究，其中 103 例（12%）符合 SIRS 标准。其中，63 例非脓毒症患者的 SIRS 阳性原因，而 40 例（4.65%）为脓毒症。大多数脓毒症患者患有水疱性大疱性疾病（42.5%）、红皮病（25%）、中毒性表皮坏死松解症（TEN）（22.5%）。17 例（42.5%）患者发生严重脓毒症，15 例（37.5%）患者死亡。所有培养标本中最常见的分离菌是耐甲氧西林金黄色葡萄球菌（MRSA）（99 株；25.9%），其次是不动杆菌属（52 株；13.6%）、铜绿假单胞菌（40 株；10.5%）、甲氧西林敏感金黄色葡萄球菌（MSSA：33 株；8.7%）和肺炎克雷伯菌（22 株；5.8%）。还分析了影响死亡率的各种风险因素以及各种分离株的药敏模式。
结论
皮肤科病房住院患者中发生了 40 例（4.65%）脓毒症。TEN 中脓毒症的发生率最高（90%），其次是药物诱导的斑丘疹（20.0%）、红皮病（17.5%）和水疱性大疱性疾病（8.5%）。MRSA、不动杆菌属、铜绿假单胞菌、MSSA 和肺炎克雷伯菌是皮肤科住院患者脓毒症的重要病原体。
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