Glik Justyna, Kawecki Marek, Gaździk Tadeusz, Nowak Mariusz
Centre for Burns Treatment in Siemianowice Śląskie.
Pol Przegl Chir. 2012 Jan;84(1):6-16. doi: 10.2478/v10035-012-0002-7.
Despite development of combustiology, infections continue to be the most important cause of death among patients with burns. Sepsis is the most severe clinical presentation of infection in patients after thermal injuries who require immediate treatment. Early diagnosis and proper treatment of sepsis are important in the clinical management that is often hampered for multiple reasons, e.g. impaired patient immunity, problems with microorganisms with multi-antibacterial drug resistance. The aim of the study was to assess effect of type of a microorganism isolated from blood and wound on results of treatment of sepsis in patients with burns.
Effect of type of microorganisms isolated from blood and wound on the result of treatment of sepsis was studied in 338 patients hospitalized immediately after an injury in Centre for Burn Treatment in Siemianowice Śląskie in years 2003 - 2004 (at the age of 18 - 96 years, 66 women and 272 men). Clinical symptoms of generalized infection were found in all study subjects. The study group was divided into two subgroups: cured patients and patients who died of sepsis. The following parameters were assessed in both subgroups: type of microorganism isolated from blood, type of microorganism isolated from wound as well as occurrence of the same and different infections of blood and burn wound.
positive blood cultures were found in 165 patients (48.8%), 106 (64.2%) were cured, 59 (35.8%) died. The most commonly isolated microorganisms in cured patients were Gram(+) Staphylococcus epidermidis MRSE (19.81%) and Staphylococcus aureus MRSA (18.87%). Gram(-) intestinal rods were least commonly isolated from this group. The most commonly isolated microorganisms from blood of patients who were to die, included non-fermenting Gram(-) rods Acinetobacter baumannii (35.59%) and Pseudomonas aeruginosa (22.03%). Mixed bacterial flora was found in the blood of 22.03% patients. Among patients who were to die, the same microorganisms were found in the blood and in the wound in 32.2% of patients, while this rate was 17.92 in cured patients. The most commonly found bacteria in the blood and burn wound in the cured patients included Staphylococcus aureus MRSA (31.58%) and Staphylococcus aureus (21.05%). In the group of patients who were to die, the most common bacteria isolated simultaneously from the blood and burn wound included Acinetobacter baumannii (47.37%) and Pseudomonas aeruginosa (36.84%).
尽管烧伤学有所发展，但感染仍是烧伤患者最重要的死亡原因。脓毒症是热损伤患者感染最严重的临床表现，需要立即治疗。脓毒症的早期诊断和恰当治疗在临床管理中很重要，但常常因多种原因受到阻碍，例如患者免疫力受损、微生物多重耐药问题。本研究的目的是评估从血液和伤口分离出的微生物类型对烧伤患者脓毒症治疗结果的影响。
2003年至2004年在希米亚诺维采 Śląskie 烧伤治疗中心对338例受伤后立即住院的患者（年龄18 - 96岁，66名女性和272名男性）进行了研究，观察从血液和伤口分离出的微生物类型对脓毒症治疗结果的影响。所有研究对象均有全身感染的临床症状。研究组分为两个亚组：治愈患者和死于脓毒症的患者。在两个亚组中评估了以下参数：从血液中分离出的微生物类型、从伤口分离出的微生物类型以及血液和烧伤伤口相同和不同感染的发生情况。
165例患者（48.8%）血培养呈阳性，106例（64.2%）治愈，59例（35.8%）死亡。治愈患者中最常分离出的微生物是革兰氏阳性表皮葡萄球菌MRSE（19.81%）和金黄色葡萄球菌MRSA（18.87%）。该组中革兰氏阴性肠道杆菌分离最少。即将死亡患者血液中最常分离出的微生物包括非发酵革兰氏阴性杆菌鲍曼不动杆菌（35.59%）和铜绿假单胞菌（22.03%）。22.03%的患者血液中发现混合菌群。在即将死亡的患者中，32.2%的患者血液和伤口中发现相同微生物，而治愈患者的这一比例为17.92%。治愈患者血液和烧伤伤口中最常见的细菌包括金黄色葡萄球菌MRSA（31.58%）和金黄色葡萄球菌（21.05%）。在即将死亡的患者组中，同时从血液和烧伤伤口分离出的最常见细菌包括鲍曼不动杆菌（47.37%）和铜绿假单胞菌（36.84%）。
