Li Zhaoyinqian, Xie Jingling, Yang Jiaxin, Liu Siyi, Ding Zixuan, Hao Jingchen, Ding Yinhuan, Zeng Zhangrui, Liu Jinbo
Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China.
Infect Drug Resist. 2021 Nov 12;14:4727-4738. doi: 10.2147/IDR.S338627. eCollection 2021.
This study aimed to determine the clinical manifestations, antimicrobial resistance, molecular characteristics, and risk factors for ESKAPE pathogens infection in burn patients.
A retrospective study of 187 burn patients infected with ESKAPE pathogens was conducted at the Department of Plastic and Burn Surgery of the Affiliated Hospital of Southwest Medical University (Luzhou, China) from October 2018 to June 2021. All strains were identified using a MicroScan WalkAway 96 Plus System, and antimicrobial susceptibilities were determined using the VITEK system or the disk diffusion method. The antimicrobial resistance genes of multi-drug resistant ESKAPE (MDR-ESKAPE) were detected by polymerase chain reaction (PCR). The multivariable logistic regression analysis was used to estimate the risk factors for ESKAPE infection and MDR-ESKAPE infection.
A total of 255 strains were isolated in various types of clinical specimens from 187 burn patients, of which 47.5% were ESKAPE pathogens (121/255). Among these, MDR-ESKAPE pathogens accounted for 55% (67/121). Additionally, , , , and were the most prevalent genes detected in , and spp., respectively. The independent risk factors for ESKAPE infection were total body surface area (TBSA) >30-50% (odds ratio [OR] = 10.428; 95% confidence interval [CI], 2.047 to 53.108), TBSA >50% (OR = 15.534; 95% CI, 1.489 to 162.021), and parenteral nutrition (OR = 3.597; 95% CI, 1.098 to 11.787). No independent risk factors were found for MDR-ESKAPE infection.
Clinical staff should be alert to the risk of nosocomial infection with ESKAPE pathogens in burn patients receiving parenteral nutrition and under TBSA >30%. Full attention should also be paid to the ESKAPE resistance, strict adherence to infection control protocols for the rational use of antimicrobial agents, and enhanced clinical standardization of antimicrobial agents management.
本研究旨在确定烧伤患者中ESKAPE病原体感染的临床表现、抗菌药物耐药性、分子特征及危险因素。
对2018年10月至2021年6月在西南医科大学附属医院（中国泸州）整形烧伤外科收治的187例感染ESKAPE病原体的烧伤患者进行回顾性研究。所有菌株均采用MicroScan WalkAway 96 Plus系统进行鉴定，抗菌药物敏感性采用VITEK系统或纸片扩散法测定。采用聚合酶链反应（PCR）检测多重耐药ESKAPE（MDR-ESKAPE）的抗菌药物耐药基因。采用多变量逻辑回归分析评估ESKAPE感染和MDR-ESKAPE感染的危险因素。
从187例烧伤患者的各类临床标本中共分离出255株菌株，其中47.5%为ESKAPE病原体（121/255）。其中，MDR-ESKAPE病原体占55%（67/121）。此外， 、 、 和 分别是在 、 和 菌中检测到的最常见基因。ESKAPE感染的独立危险因素为总体表面积（TBSA）>30%-50%（比值比[OR]=10.428；95%置信区间[CI]，2.047至53.108）、TBSA>50%（OR=15.534；95%CI，1.489至162.021）和肠外营养（OR=3.597；95%CI，1.098至11.787）。未发现MDR-ESKAPE感染的独立危险因素。
临床工作人员应警惕接受肠外营养且TBSA>30%的烧伤患者发生ESKAPE病原体医院感染的风险。还应充分关注ESKAPE耐药性，严格遵守抗菌药物合理使用的感染控制方案，并加强抗菌药物管理的临床规范化。
