Wurzer Paul, Cole Megan R, Clayton Robert P, Hundeshagen Gabriel, Nunez Lopez Omar, Cambiaso-Daniel Janos, Winter Raimund, Branski Ludwik K, Hawkins Hal K, Finnerty Celeste C, Herndon David N, Lee Jong O
Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States.
Burns. 2017 Aug;43(5):987-992. doi: 10.1016/j.burns.2017.01.032. Epub 2017 Apr 15.
Burn-related immunosuppression can promote human herpesviridae infections. However, the effect of these infections on morbidity and mortality after pediatric burn injuries is unclear.
We retrospectively analyzed pediatric patients with burns ≥10% of the total body surface area (TBSA) who were admitted between 2010 and 2015. On clinical suspicion of a viral infection, antiviral therapy was initiated. Viral infection was confirmed via Tzanck smear, viral culture, and/or PCR. Study endpoints were mortality, days of antiviral agent administration, type of viral test used, type of viral infection, and length of hospitalization.
Of the 613 patients were analyzed, 28 presented with clinically diagnosed viral infections. The use of Tzanck smears decreased over the past 5 years, whereas PCR and viral cultures have become standard. Patients with viral infections had significantly larger burns (53±15% vs. 38±18%, p<0.001); however, length of stay per TBSA burn was comparable (0.5±0.4 vs. 0.6±0.2, p=0.211). The most commonly detected herpesviridae was herpes simplex virus 1. Two patients died due to sepsis, which was accompanied by HSV infection. The mortality rate among all patients (2.7%) was comparable to that in the infected group (7.1%, p=0.898). Acyclovir was given systemically for 9±8days (N=76) and/or topically for 9±9days for HSV (N=39, combination of both N=33). Ganciclovir was prescribed in three cases for CMV.
Viral infections occur more commonly in patients suffering from larger burns, and HSV infections can contribute to mortality.
烧伤相关的免疫抑制可促进人疱疹病毒科感染。然而，这些感染对小儿烧伤后发病率和死亡率的影响尚不清楚。
我们回顾性分析了2010年至2015年间收治的烧伤面积≥10%总体表面积（TBSA）的儿科患者。临床怀疑有病毒感染时，即开始抗病毒治疗。通过Tzanck涂片、病毒培养和/或PCR确诊病毒感染。研究终点包括死亡率、抗病毒药物给药天数、所用病毒检测类型、病毒感染类型和住院时间。
在分析的613例患者中，28例有临床诊断的病毒感染。在过去5年中，Tzanck涂片的使用减少，而PCR和病毒培养已成为标准方法。病毒感染患者的烧伤面积明显更大（53±15%对38±18%，p<0.001）；然而，每TBSA烧伤的住院时间相当（0.5±0.4对0.6±0.2，p=0.211）。最常检测到的疱疹病毒科病毒是单纯疱疹病毒1型。两名患者因败血症死亡，伴有HSV感染。所有患者的死亡率（2.7%）与感染组（7.1%，p=0.898）相当。阿昔洛韦全身给药9±8天（N=76）和/或局部给药9±9天用于HSV感染（N=39，两者联合使用N=33）。3例CMV感染患者使用了更昔洛韦。
病毒感染在烧伤面积较大的患者中更常见，HSV感染可导致死亡。
