Department of Ophthalmology, Cornea and Ocular Surface Clinic, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ministry of Health, Mexico City, Mexico.
Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.
J Burn Care Res. 2022 Jan 5;43(1):43-50. doi: 10.1093/jbcr/irab040.
We aimed to evaluate the characteristics and colonization by pathogenic microorganisms of the ocular surface in patients in a burn center and to determine their association with sedation, mechanical ventilation, and periocular burn. We prospectively evaluated 40 patients during an 8-mo period. Five evaluations where performed, at baseline and weekly on four more occasions or until hospital discharge or death. On each visit, we assessed periocular burn, lid position, Bell's phenomenon, Schirmer's test, presence of chemosis, conjunctival hyperemia, and exposure keratopathy; conjunctival fornix swabs were taken for microbiology culture. Also, we documented the level of sedation, mechanical ventilation status, and systemic and ocular treatment. Absent Bell's phenomenon and chemosis were significantly different at baseline in patients under mechanical ventilation, sedation, and in those with a periocular burn. The cumulative incidence of exposure keratopathy was 22.5% and the cumulative incidence of ocular surface colonization by pathogenic microorganisms was 32.5%. Both outcomes were associated with mechanical ventilation and periocular burn. The most frequent pathogenic microorganisms on the ocular surface were Candida parapsilosis, Acinetobacter baumanii, and Pseudomonas aeuroginosa. We did not observe any case of a persistent epithelial defect, infectious keratitis, corneal perforation or corneal opacity in this cohort. Results from our study may benefit future patients by allowing better risk stratification and treatment strategies for the ocular surface care in burn units.
我们旨在评估烧伤中心患者的眼表特征和致病微生物定植情况，并确定其与镇静、机械通气和眼周烧伤的关系。我们在 8 个月的时间内对 40 名患者进行了前瞻性评估。共进行了 5 次评估，在基线时进行了一次评估，之后在另外 4 次每周评估一次，直至患者出院或死亡。每次就诊时，我们评估眼周烧伤、眼睑位置、贝尔现象、泪液分泌试验、水肿、结膜充血和暴露性角膜炎；采集结膜穹窿拭子进行微生物培养。此外，我们记录了镇静水平、机械通气状态以及全身和眼部治疗情况。在接受机械通气、镇静和眼周烧伤的患者中，基线时贝尔现象和水肿缺失的患者明显不同。暴露性角膜炎的累积发病率为 22.5%，眼表致病性微生物定植的累积发病率为 32.5%。这两种结果都与机械通气和眼周烧伤有关。眼表最常见的致病微生物是近平滑假丝酵母、鲍曼不动杆菌和铜绿假单胞菌。在这组患者中，我们没有观察到任何持续性上皮缺损、感染性角膜炎、角膜穿孔或角膜混浊的病例。我们的研究结果可以通过允许烧伤科更好地对眼表进行风险分层和治疗策略，使未来的患者受益。
