Sánchez Manuel, Herruzo Rafael, Marbán Alvaro, Araujo Pilar, Asensio Maria J, Leyva Francisco, Casado Cesar, García-de-Lorenzo Abelardo
The Unidad de Quemados Críticos, Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain.
J Burn Care Res. 2012 May-Jun;33(3):386-92. doi: 10.1097/BCR.0b013e318231df95.
The objective of this study is to identify the risk factors related to colonization or infection in an outbreak of multidrug-resistant Klebsiella pneumoniae in a burn patient unit. The authors studied the risk factors associated with colonization or infection using a case-control study design involving patients with multidrug resistant K. pneumoniae (n = 26) and controls (n = 50). They describe the outbreak and provide a retrospective analysis that encompasses patient demographics, microbiological isolation, culture sites, burn features, inhalation injury, biomarkers (lactate and N-terminal probrain natriuretic peptide), general illness severity scores (Acute Physiology and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment), burn-specific severity scores such as the Abbreviated Burn Severity Index (ABSI), length of stay, and mortality. Patients colonized with multidrug-resistant K. pneumoniae were older (55 vs 42 years), presented with larger burns (32 vs 18% of BSA), and more frequently had full-thickness burns (53 vs 22%). They also had higher ABSI, Acute Physiology and Chronic Health Evaluation II, and Sepsis-related Organ Failure Assessment scores, and they required more days of mechanical ventilation and longer stays in the critical burn unit. Multivariate analysis showed that the factors most significantly related to the development of infection or colonization with K. pneumoniae were burns located on head and neck (odds ratio, 4.81) and the ABSI score (odds ratio, 1.66). Control of the outbreak was achieved by enforcing contact precautions and extensive cleaning. An elevated ABSI score and burns located on the head and neck were the risk factors most significantly related to colonization or infection in an outbreak of multidrug-resistant K. pneumoniae in a critical burn patient unit.
本研究的目的是确定烧伤患者病房中耐多药肺炎克雷伯菌暴发时与定植或感染相关的危险因素。作者采用病例对照研究设计，对耐多药肺炎克雷伯菌患者（n = 26）和对照组（n = 50）进行研究，以确定与定植或感染相关的危险因素。他们描述了此次暴发情况，并进行了回顾性分析，内容涵盖患者人口统计学资料、微生物分离情况、培养部位、烧伤特征、吸入性损伤、生物标志物（乳酸和N末端脑钠肽前体）、一般疾病严重程度评分（急性生理与慢性健康状况评分II和脓毒症相关器官功能衰竭评估）、烧伤特异性严重程度评分（如简化烧伤严重程度指数[ABSI]）、住院时间和死亡率。耐多药肺炎克雷伯菌定植患者年龄较大（55岁对42岁），烧伤面积较大（占体表面积的32%对18%），全层烧伤更为常见（53%对22%）。他们的ABSI、急性生理与慢性健康状况评分II和脓毒症相关器官功能衰竭评估评分也更高，需要更多天数的机械通气，在烧伤重症监护病房的住院时间更长。多变量分析显示，与肺炎克雷伯菌感染或定植发生最显著相关的因素是头颈部烧伤（比值比，4.81）和ABSI评分（比值比，1.66）。通过实施接触预防措施和广泛清洁实现了疫情控制。在烧伤重症患者病房耐多药肺炎克雷伯菌暴发时，ABSI评分升高和头颈部烧伤是与定植或感染最显著相关的危险因素。
