Lipový B, Rihová H, Hanslianová M, Gregorová N, Suchánek I, Brychta P
Department of Burns and Reconstructive Surgery, University Hospital Brno, Czech Republic.
Acta Chir Plast. 2010;52(2-4):39-43.
Infection complications caused by gram-negative bacteria nowadays constitute the dominant mortality cause in severely burned patients. Pseudomonas aeruginosa is the most feared nosocomial pathogen among burn centers worldwide, with the highest mortality.
The study involved adult patients hospitalized at the Intensive Care Unit at the Department of Burns and Reconstructive Surgery, University Hospital Brno, between the years 2000 and 2009. These patients were hospitalized for thermal injuries. Retrospectively we have evaluated the extent of the burned areas, ages, depth of injury at admission and at discharge or in dissection (histology) and length of hospitalization on the Intensive Care Unit. By completing regular swabs we monitored and evaluated the microbiological situation not only at the burned areas but also in the lower respiratory system, in the urinary tract and in the blood stream.
The study involved a total of 640 adults hospitalized at the Intensive Care Unit at the Department of Burns and Reconstructive Surgery, University Hospital Brno, for burn trauma between the years 2000 and 2009. The average extent of the burned area in patients was 36.2% TBSA (2-97% TBSA), average age was 36.7% years (18-92 years), average length of hospitalization at the Intensive Care Unit was 27.1 days (1-151 days). We isolated a total of 2,958 strains of Pseudomonas aeruginosa (including repeated isolation of pseudomonas strains in the same patients) in these patients. The most frequently found of these was Pseudomonas aeruginosa isolated from the burned area (1,301 strains), from the lower respiratory system (651) and from the urinary tract (592 strains). During the monitored period the number of strains isolated in our patients increased (146 strains in 2000, 521 strains in 2009). Furthermore, we noticed increased resistance to all available antibiotics except Polymyxins. All of the Pseudomonas aeruginosa strains in the monitored years maintained 100% sensitivity to Colistin. Of the routinely used antibiotics Meropenem showed the greatest increase of resistance (in 2000 this comprised a total of 18% of the resistant Pseudomonas aeruginosa strains, and in 2009 58% of the strains). Ceftazidime shows similar results (in 2000 12%, in 2009 39% of resistant strains). Amikacin displayed a relatively good effect against pseudomonas infections; in 2009 we registered total of 34% of the resistant strains of Pseudomonas aeruginosa to this aminoglycoside. In 2000 there were 13 multiresistant strains (i.e. 8.9%) of Pseudomonas aeruginosa, in 2009 the figure was 171 strains (i.e. 32.82%).
In our study we point to the increasing trend not only in the prevalence but also in the resistance of Pseudomonas aeruginosa strains. This limits our choices for suitable antibiotic therapy. This is why infection complications play such a significant role in morbidity and mortality in severely burned patients.
目前，革兰氏阴性菌引起的感染并发症是重度烧伤患者的主要死亡原因。铜绿假单胞菌是全球烧伤中心最令人恐惧的医院病原体，死亡率最高。
该研究纳入了2000年至2009年间在布尔诺大学医院烧伤与重建外科重症监护病房住院的成年患者。这些患者因热烧伤住院。我们回顾性评估了烧伤面积、年龄、入院时和出院时或解剖（组织学）时的损伤深度以及在重症监护病房的住院时间。通过定期采集拭子，我们不仅监测和评估了烧伤部位的微生物状况，还监测和评估了下呼吸道、泌尿系统和血流中的微生物状况。
该研究共纳入了2000年至2009年间在布尔诺大学医院烧伤与重建外科重症监护病房因烧伤创伤住院的640名成年患者。患者的平均烧伤面积为36.2% 体表面积（2%-97% 体表面积），平均年龄为36.7岁（18-92岁），在重症监护病房的平均住院时间为27.1天（1-151天）。我们在这些患者中共分离出2958株铜绿假单胞菌（包括同一患者中铜绿假单胞菌菌株的重复分离）。其中最常见的是从烧伤部位分离出的铜绿假单胞菌（1301株）、从下呼吸道分离出的（651株）和从泌尿系统分离出的（592株）。在监测期间，我们患者中分离出的菌株数量有所增加（2000年为146株，2009年为521株）。此外，我们注意到除多粘菌素外，对所有可用抗生素的耐药性均有所增加。在监测年份中，所有铜绿假单胞菌菌株对黏菌素的敏感性均保持100%。在常用抗生素中，美罗培南的耐药性增加最为显著（2000年，耐药铜绿假单胞菌菌株中该抗生素耐药的占18%，2009年为58%）。头孢他啶也有类似结果（2000年为12%，2009年为39%的耐药菌株）。阿米卡星对铜绿假单胞菌感染显示出相对较好的效果；2009年，我们记录到对这种氨基糖苷类耐药的铜绿假单胞菌菌株占34%。2000年有13株多重耐药铜绿假单胞菌菌株（即8.9%），2009年这一数字为171株（即32.82%）。
在我们的研究中，我们指出不仅铜绿假单胞菌菌株的患病率呈上升趋势，其耐药性也呈上升趋势。这限制了我们选择合适抗生素治疗的范围。这就是为什么感染并发症在重度烧伤患者的发病率和死亡率中起着如此重要作用的原因。
