Vickers Mark L, Dulhunty Joel M, Ballard Emma, Chapman Paul, Muller Michael, Roberts Jason A, Cotta Menino O
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
ANZ J Surg. 2018 May;88(5):480-485. doi: 10.1111/ans.14144. Epub 2017 Aug 29.
Infection with multidrug-resistant (MDR) Gram-negative organisms leads to poorer outcomes in the critically ill burn patient. The aim of this study was to identify the risk factors for MDR Gram-negative pathogen infection in critically ill burn patients admitted to a major tertiary referral intensive care unit (ICU) in Australia.
A retrospective case-control study of all adult burn patients admitted over a 7-year period was conducted. Twenty-one cases that cultured an MDR Gram-negative organism were matched with 21 controls of similar age, gender, burn size and ICU stay. Multivariable conditional logistic regression was used to individually assess risk factors after adjusting for Acute Burn Severity Index. Adjusted odds ratios (ORs) were reported. P-values < 0.25 were considered as potentially important risk factors.
Factors increasing the risk of MDR Gram-negative infection included superficial partial thickness burn size (OR: 1.08; 95% confidence interval (CI): 1.01-1.16; P-value: 0.034), prior meropenem exposure (OR: 10.39; 95% CI: 0.96-112.00; P-value: 0.054), Gram-negative colonization on admission (OR: 9.23; 95% CI: 0.65-130.15; P-value: 0.10) and escharotomy (OR: 2.66; 95% CI: 0.52-13.65; P-value: 0.24). For cases, mean age was 41 (SD: 13) years, mean total body surface area burned was 47% (SD: 18) and mean days in ICU until MDR specimen collection was 17 (SD: 10) days.
Prior meropenem exposure, Gram-negative colonization on admission, escharotomy and superficial partial thickness burn size may be potentially important factors for increasing the risk of MDR Gram-negative infection in the critically ill burn patient.
多重耐药（MDR）革兰氏阴性菌感染会导致重症烧伤患者的预后更差。本研究的目的是确定入住澳大利亚一家大型三级转诊重症监护病房（ICU）的重症烧伤患者中耐多药革兰氏阴性病原菌感染的危险因素。
对7年内收治的所有成年烧伤患者进行回顾性病例对照研究。21例培养出耐多药革兰氏阴性菌的病例与21例年龄、性别、烧伤面积和ICU住院时间相似的对照进行匹配。在调整急性烧伤严重程度指数后，使用多变量条件逻辑回归单独评估危险因素。报告调整后的比值比（OR）。P值<0.25被视为潜在的重要危险因素。
增加耐多药革兰氏阴性菌感染风险的因素包括浅Ⅱ度烧伤面积（OR：1.08；95%置信区间（CI）：1.01-1.16；P值：0.034）、先前使用美罗培南（OR：10.39；95%CI：0.96-112.00；P值：0.054）、入院时革兰氏阴性菌定植（OR：9.23；95%CI：0.65-130.15；P值：0.10）和焦痂切开术（OR：2.66；95%CI：0.52-13.65；P值：0.24）。病例组的平均年龄为41（标准差：13）岁，平均烧伤总面积为47%（标准差：18），直至采集耐多药标本的ICU平均住院天数为17（标准差：10）天。
先前使用美罗培南、入院时革兰氏阴性菌定植、焦痂切开术和浅Ⅱ度烧伤面积可能是增加重症烧伤患者耐多药革兰氏阴性菌感染风险的潜在重要因素。
