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菲律宾大学-菲律宾总医院阿特烧伤中心这家三级政府医院烧伤创面的细菌学概况

Bacteriologic Profile of Burn Wounds at a Tertiary Government Hospital in the Philippines-UP-PGH ATR Burn Center.

作者信息

Abesamis Gerald Marion M, Cruz Jose Joven V

机构信息

UP-PGH Alfredo T. Ramirez Burn Center, Division of Burns, Department of Surgery, University of the Philippines-Philippine General Hospital, Manila.

出版信息

J Burn Care Res. 2019 Aug 14;40(5):658-668. doi: 10.1093/jbcr/irz060.

Abstract

Wound infection is a major cause of morbidity and mortality among burn patients. Recent changes in the epidemiology of burn wound infections were observed due to the steady rise of drug-resistant bacteria. The objective of this study is to determine the most common burn wound pathogens isolated among patients admitted at the UP-PGH ATR Burn Center, describe their respective susceptibility patterns, and calculate incidence rates of burn wound colonization, local, and invasive infection. Patients admitted at the UP-PGH Burn Center from March 2015 to February 2016 with tissue culture studies were monitored for development of wound infection; patient charts, tissue isolates, and their susceptibility patterns were reviewed. A total of 77 patients were included in the study wherein 36% had no infection, 42% had wound colonization, and 22% developed burn wound infection. Among these patients, 98 specimens were sent for culture studies which revealed Acinetobacter baumannii (25.6%) as the top pathogen isolated, followed by Enterococcus sp. (21.95%), and Pseudomonas sp. (18.29%). Acinetobacter baumannii was also the top isolate among patients with local and invasive infection (86 and 67%, respectively). Multidrug resistance was observed with A. baumannii and Pseudomonas exhibiting resistance towards meropenem, imipenem, cefepime, ciprofloxacin, and piperacillin-tazobactam but remained sensitive to colistin, amikacin, and minocycline. Vancomycin, cotrimoxazole, and ciprofloxacin were active against Gram-positive bacteria. Multidrug-resistant organisms pose a major risk in all burn units. To limit their growth, judicious use of antibiotics, aggressive infection control measures, close surveillance, and frequent antibiograms are needed.

摘要

伤口感染是烧伤患者发病和死亡的主要原因。由于耐药菌的稳步增加,烧伤伤口感染的流行病学最近发生了变化。本研究的目的是确定在菲律宾大学-菲律宾总医院成人及热带病研究所烧伤中心收治的患者中分离出的最常见的烧伤伤口病原体,描述它们各自的药敏模式,并计算烧伤伤口定植、局部和侵袭性感染的发病率。对2015年3月至2016年2月在菲律宾大学-菲律宾总医院烧伤中心住院并进行组织培养研究的患者进行伤口感染发展监测;查阅患者病历、组织分离株及其药敏模式。共有77名患者纳入研究,其中36%无感染,42%有伤口定植,22%发生烧伤伤口感染。在这些患者中,98份标本送检进行培养研究,结果显示鲍曼不动杆菌(25.6%)是分离出的最主要病原体,其次是肠球菌属(21.95%)和假单胞菌属(18.29%)。鲍曼不动杆菌也是局部和侵袭性感染患者中分离出的最主要菌株(分别为86%和67%)。观察到鲍曼不动杆菌和假单胞菌具有多重耐药性,对美罗培南、亚胺培南、头孢吡肟、环丙沙星和哌拉西林-他唑巴坦耐药,但对黏菌素、阿米卡星和米诺环素仍敏感。万古霉素、复方新诺明和环丙沙星对革兰氏阳性菌有活性。多重耐药菌在所有烧伤病房都构成重大风险。为了限制它们的生长,需要明智地使用抗生素、积极的感染控制措施、密切监测和频繁的药敏试验。

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