Ronat Jean-Baptiste, Kakol Jabar, Khoury Marwan N, Berthelot Mathilde, Yun Oliver, Brown Vincent, Murphy Richard A
Médecins Sans Frontières/Doctors Without Borders, Paris, France.
Department of Health, Sulaymaniyah, Iraq.
PLoS One. 2014 Aug 11;9(8):e101017. doi: 10.1371/journal.pone.0101017. eCollection 2014.
In low- and middle-income countries, bloodstream infections are an important cause of mortality in patients with burns. Increasingly implicated in burn-associated infections are highly drug-resistant pathogens with limited treatment options. We describe the epidemiology of bloodstream infections in patients with burns in a humanitarian surgery project in Iraq.
We performed a retrospective, descriptive study of blood culture isolates identified between July 2008 and September 2009 among patients with burns in a single hospital in Iraq who developed sepsis.
In 1169 inpatients admitted to the burn unit during the study period, 212 (18%) had suspected sepsis, and 65 (6%) had confirmed bacteremia. Sepsis was considered the primary cause of death in 198 patients (65%; 95% CI 65-70) of the 304 patients that died. The most commonly isolated organisms were Pseudomonas aeruginosa (22 isolates [34%]), Staphylococcus aureus (17 [26%]), Klebsiella pneumoniae (8 [12%]), Staphylococcus epidermidis (7 [11%]), Acinetobacter baumannii (6 [9%]), and Enterobacter cloacae (5 [8%]). A high proportion of Enterobacteriaceae strains produced extended-spectrum beta-lactamase and S. aureus isolates were uniformly methicillin-resistant. For gram-negative bacteria, the most reliably active antibiotics were imipenen and amikacin.
Burn patients with sepsis in Iraq were commonly found to have bloodstream pathogens resistant to most antibiotics available locally. Effective empirical therapy of burn sepsis in this region of Iraq would consist of vancomycin or teicoplanin and a carbapenem-class antibiotic with antipseudomonal activity.
在低收入和中等收入国家，血流感染是烧伤患者死亡的重要原因。与烧伤相关感染的关系日益密切的是治疗选择有限的高度耐药病原体。我们描述了伊拉克一个人道主义外科项目中烧伤患者血流感染的流行病学情况。
我们对2008年7月至2009年9月间在伊拉克一家医院发生脓毒症的烧伤患者中分离出的血培养物进行了回顾性描述性研究。
在研究期间入住烧伤病房的1169名住院患者中，212名（18%）疑似脓毒症，65名（6%）确诊菌血症。在304名死亡患者中，198名（65%；95%CI 65 - 70）患者的脓毒症被认为是主要死亡原因。最常分离出的病原体是铜绿假单胞菌（22株[34%]）、金黄色葡萄球菌（17株[26%]）、肺炎克雷伯菌（8株[12%]）、表皮葡萄球菌（7株[11%]）、鲍曼不动杆菌（6株[9%]）和阴沟肠杆菌（5株[8%]）。高比例的肠杆菌科菌株产生超广谱β-内酰胺酶，金黄色葡萄球菌分离株均对甲氧西林耐药。对于革兰阴性菌，最可靠的活性抗生素是亚胺培南和阿米卡星。
伊拉克烧伤合并脓毒症的患者中，常见对当地可用的大多数抗生素耐药的血流病原体。在伊拉克的这一地区，烧伤脓毒症的有效经验性治疗应包括万古霉素或替考拉宁以及具有抗假单胞菌活性的碳青霉烯类抗生素。
