Park Hye-Sung, Pham Chengde, Paul Eldho, Padiglione Alex, Lo Cheng, Cleland Heather
Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia.
Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia.
Burns. 2017 Dec;43(8):1757-1765. doi: 10.1016/j.burns.2017.04.027. Epub 2017 Jun 9.
Early excision of burns reduces the incidence of local and systemic infections caused by colonising microorganisms, and reduces mortality and length of hospital stay. Appropriate antibiotic prophylaxis can reduce the risk of postoperative wound infections and skin graft loss. Antibiotic selection should be based on likely pathogens. However, there are few studies that have investigated the early pathogenic colonisers of acute burn wounds.
To describe pathogenic microorganisms found in acute burns and to make further recommendations on the use of early perioperative prophylactic antibiotics.
All burns patients admitted at the tertiary adult burns centre in Victoria over a 2-year period, who had surface swabs or tissue samples obtained from wounds within 24h of injury were included in this retrospective cohort study. Pathogenic organisms were examined with respect to patient characteristics, burn characteristics, treatment provided and immediate exposure to environmental contaminants.
Nearly one third of burns patients had wounds colonised with pathogenic microorganisms. Gram-negative bacteria were isolated from 52% of these. Staphylococcus aureus was the most common isolate. Pseudomonas and Enterobacter species were the most common gram-negatives. The only independent risk factor associated with early colonisation with gram-negative bacteria was per cent TBSA burn.
Increased colonisation of acute burn wounds with pathogenic gram-negative bacteria was associated with increased size of burn.
早期切除烧伤创面可降低由定植微生物引起的局部和全身感染的发生率，并降低死亡率和缩短住院时间。适当的抗生素预防可降低术后伤口感染和皮肤移植失败的风险。抗生素的选择应基于可能的病原体。然而，很少有研究调查急性烧伤创面早期的致病定植菌。
描述急性烧伤中发现的致病微生物，并对围手术期早期预防性抗生素的使用提出进一步建议。
本回顾性队列研究纳入了维多利亚州三级成人烧伤中心在两年期间收治的所有烧伤患者，这些患者在受伤后24小时内从伤口获取了表面拭子或组织样本。针对患者特征、烧伤特征、所提供的治疗以及立即接触环境污染物的情况对致病微生物进行了检查。
近三分之一的烧伤患者伤口被致病微生物定植。其中52%分离出革兰氏阴性菌。金黄色葡萄球菌是最常见的分离菌。假单胞菌属和肠杆菌属是最常见的革兰氏阴性菌。与革兰氏阴性菌早期定植相关的唯一独立危险因素是烧伤总面积百分比。
急性烧伤创面革兰氏阴性致病细菌定植增加与烧伤面积增大有关。
