Wardhana A, Djan R, Halim Z
Burn Unit, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
Plastic and Reconstructive Surgery Division, Department of Surgery, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
Ann Burns Fire Disasters. 2017 Jun 30;30(2):107-115.
Infection is a major cause of mortality and morbidity among burn patients. An effective measure to reduce infection is routine monitoring of bacterial infection and antimicrobial susceptibility patterns at the burn unit. This will help to create a burn centre-specific empirical antibiotic therapy protocol. A retrospective, descriptive study was conducted at the Cipto Mangunkusumo Hospital (RSCM) Burn Unit between September-November 2016. Data regarding bacterial culture isolates, antimicrobial susceptibility spectrum, and the number of burn patients diagnosed with sepsis were collected. There were 36 patients with positive bacterial cultures, with the isolates changing continuously between Klebsiella pneumonia (17%), Pseudomonas Aeruginosa (12%) and Acinetobacter baumannii (11%). High resistance was found for 10 antimicrobials, particularly cephalosporins. The three bacteria were only sensitive to carbapenem, aminoglycosides and tigecycline. Fourteen patients were diagnosed with sepsis (38.9%), 10 died. Two major sepsis-causing bacteria were P. aeruginosa (33.3%) and K. pneumoniae (28.9%). Bacterial isolates in our setting changed every month. Almost all bacterial isolates are multi-drug resistant, highly resistant to the empirical therapy given (ceftriaxone), leading to outbreaks of sepsis and increased mortality rates. Carbapenem (imipenem, meropenem and doripenem) and aminoglycosides (amikacin) combination was the selected empirical therapy.
感染是烧伤患者死亡和发病的主要原因。减少感染的一项有效措施是在烧伤病房对细菌感染和抗菌药物敏感性模式进行常规监测。这将有助于制定针对烧伤中心的经验性抗生素治疗方案。2016年9月至11月期间，在西托·曼古库苏莫医院（RSCM）烧伤病房开展了一项回顾性描述性研究。收集了有关细菌培养分离株、抗菌药物敏感性谱以及诊断为败血症的烧伤患者数量的数据。有36例患者细菌培养呈阳性，分离株在肺炎克雷伯菌（17%）、铜绿假单胞菌（12%）和鲍曼不动杆菌（11%）之间不断变化。发现10种抗菌药物存在高耐药性，尤其是头孢菌素。这三种细菌仅对碳青霉烯类、氨基糖苷类和替加环素敏感。14例患者被诊断为败血症（38.9%），10例死亡。两种主要的败血症致病菌是铜绿假单胞菌（33.3%）和肺炎克雷伯菌（28.9%）。我们研究中的细菌分离株每月都有变化。几乎所有细菌分离株都具有多重耐药性，对经验性治疗药物（头孢曲松）高度耐药，导致败血症暴发和死亡率上升。碳青霉烯类（亚胺培南、美罗培南和多利培南）和氨基糖苷类（阿米卡星）联合用药是选定的经验性治疗方案。
