Coban Yusuf Kenan
Yusuf Kenan Coban, Burn Unit, Department of Plastic Reconstructive and Aesthetic Surgery, Turgut Ozal Medical Centre, Inonu Üniversity Medical Faculty, Malatya 44910, Turkey.
World J Crit Care Med. 2012 Aug 4;1(4):94-101. doi: 10.5492/wjccm.v1.i4.94.
In the last two decades, much progress has been made in the control of burn wound infection and nasocomial infections (NI) in severely burned patients. The continiually changing epidemiology is partially related to greater understanding of and improved techniques for burn patient management as well as effective hospital infection control measures. With the advent of antimicrobial chemotherapeutic agents, infection of the wound site is now not as common as, for example, urinary and blood stream infections. Universal application of early excision of burned tissues has made a substantial improvement in the control of wound-related infections in burns. Additionally, the development of new technologies in wound care have helped to decrease morbidity and mortality in severe burn victims. Many examples can be given of the successful control of wound infection, such as the application of an appropriate antibiotic solution to invasive wound infection sites with simultaneous vacuum-assisted closure, optimal preservation of viable tissues with waterjet debridement systems, edema and exudate controlling dressings impregnated with Ag (Silvercel, Aquacell-Ag). The burned patient is at high risk for NI. Invasive interventions including intravenous and urinary chateterization, and entubation pose a further risk of NIs. The use of newly designed antimicrobial impregnated chateters or silicone devices may help the control of infection in these immunocomprimised patients. Strict infection control practices (physical isolation in a private room, use of gloves and gowns during patient contact) and appropriate empirical antimicrobial therapy guided by laboratory surveillance culture as well as routine microbial burn wound culture are essential to help reduce the incidance of infections due to antibiotic resistant microorganisms.
在过去二十年中，在严重烧伤患者的烧伤创面感染和医院感染（NI）控制方面取得了很大进展。流行病学的不断变化部分与对烧伤患者管理的更深入理解和改进技术以及有效的医院感染控制措施有关。随着抗菌化疗药物的出现，伤口部位的感染现在不像例如泌尿系统和血流感染那样常见。普遍应用早期切除烧伤组织在控制烧伤创面相关感染方面取得了显著改善。此外，伤口护理新技术的发展有助于降低严重烧伤患者的发病率和死亡率。可以列举许多成功控制伤口感染的例子，例如将适当的抗生素溶液应用于侵入性伤口感染部位并同时进行负压封闭引流，用水刀清创系统最佳地保存存活组织，使用含银的水肿和渗出液控制敷料（Silvercel，Aquacell-Ag）。烧伤患者发生医院感染的风险很高。包括静脉内和尿道插管以及气管插管在内的侵入性干预措施进一步增加了医院感染的风险。使用新设计的抗菌浸渍导管或硅胶装置可能有助于控制这些免疫功能低下患者的感染。严格的感染控制措施（在单人病房进行物理隔离，在接触患者时使用手套和隔离衣）以及由实验室监测培养和常规烧伤创面微生物培养指导的适当经验性抗菌治疗对于帮助减少耐抗生素微生物引起的感染发生率至关重要。
