Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China.
Department of Burns and Plastic Surgery, The Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu, China.
Clin Microbiol Infect. 2018 Feb;24(2):199.e1-199.e7. doi: 10.1016/j.cmi.2017.06.009. Epub 2017 Jun 19.
To determine the characteristics of bloodstream infections (BSIs) and to evaluate the impact of BSIs on mortality in severe burn patients.
A retrospective observational study was conducted in 20 tertiary hospitals. A total of 185 patients who experienced a massive dust explosion in eastern China were included.
After exclusion, 177 patients were analysed. The median total body surface area (TBSA) burned was 95% (interquartile range 85%-98%). Inhalation injuries occurred in 97.2%. The overall 90-day mortality was 35% (62/177). During the study period, 120 (67.8%) patients developed 253 episodes of BSI with 323 unique causative pathogens. Sixty-six episodes were polymicrobial infections. Catheter-related BSIs (CRBSIs) accounted for 41.5% of the episodes. Acinetobacter baumannii (19.5%), Klebsiella pneumoniae (13.9%) and Candida (12.7%) were the most common organisms. Antimicrobial resistance was found in 63.5% of the isolates, particularly in Gram-negative bacteria. Patients who developed BSIs had a greater illness severity at admission to the intensive care unit, and worse outcomes. After adjusting for demographics, severity of illness and treatment characteristics in a multivariate logistic model, there was a trend toward BSI increasing the risk of 90-day mortality (adjusted OR 3.4; 95% CI 0.9-12.9; p=0.069). In subgroup analyses, CRBSIs (adjusted OR 5.7; 95% CI 1.3-24.9; p=0.021 versus no BSI) and polymicrobial BSIs (adjusted OR 6.1; 95% CI 1.3-28.1; p=0.020 versus no BSI) had greater risk of 90-day mortality.
A strikingly high rate of BSIs was observed in severe burn patients. Gram-negative organisms and fungi were the leading causes. CRBSIs and polymicrobial BSIs were associated with high mortality.
确定血流感染（BSI）的特征，并评估 BSI 对严重烧伤患者死亡率的影响。
在 20 家三级医院进行回顾性观察性研究。共纳入在中国东部经历大规模粉尘爆炸的 185 名患者。
排除后，分析了 177 名患者。总体表烧伤面积中位数为 95%（四分位间距 85%-98%）。吸入性损伤占 97.2%。总体 90 天死亡率为 35%（62/177）。研究期间，120 名（67.8%）患者发生 253 次 BSI，323 次为单一病原体。66 次为混合感染。导管相关 BSI（CRBSI）占 41.5%。最常见的病原体是鲍曼不动杆菌（19.5%）、肺炎克雷伯菌（13.9%）和念珠菌（12.7%）。63.5%的分离株存在抗菌药物耐药性，尤其是革兰氏阴性菌。发生 BSI 的患者在入住重症监护病房时疾病严重程度更高，结局更差。在多变量逻辑模型中，调整人口统计学、疾病严重程度和治疗特征后，BSI 有增加 90 天死亡率的趋势（调整后的 OR 3.4；95%CI 0.9-12.9；p=0.069）。在亚组分析中，CRBSI（调整后的 OR 5.7；95%CI 1.3-24.9；p=0.021 与无 BSI 相比）和混合感染 BSI（调整后的 OR 6.1；95%CI 1.3-28.1；p=0.020 与无 BSI 相比）与 90 天死亡率增加相关。
严重烧伤患者的 BSI 发生率极高。革兰氏阴性菌和真菌是主要病原体。CRBSI 和混合感染 BSI 与高死亡率相关。
