Victorian Adult Burns Service, Alfred Health, Melbourne, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Antimicrob Resist Infect Control. 2022 Jun 13;11(1):82. doi: 10.1186/s13756-022-01123-w.
Multidrug resistant organisms (MDROs) occur more commonly in burns patients than in other hospital patients and are an increasingly frequent cause of burn-related mortality. We examined the incidence, trends and risk factors for MDRO acquisition in a specialist burns service housed in an open general surgical ward, and general intensive care unit.
We performed a retrospective study of adult patients admitted with an acute burn injury to our specialist statewide tertiary burns service between July 2014 and October 2020. We linked patient demographics, injury, treatment, and outcome details from our prospective burns service registry to microbiology and antimicrobial prescribing data. The outcome of interest was first MDRO detection, stratified into the following groups of interest: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), two groups of Pseudomonas (carbapenem resistant, and piperacillin-tazobactam or cefepime resistant), carbapenem-resistant Acinetobacter species, Stenotrophomonas maltophilia, carbapenem-resistant Enterobacteriaceae (CRE), and extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE). We used a Cox proportional hazards model to evaluate the association between antibiotic exposure and MDRO acquisition.
There were 2,036 acute admissions, of which 230 (11.3%) had at least one MDRO isolated from clinical specimens, most frequently wound swabs. While acquisition rates of individual MDRO groups varied over the study period, acquisition rate of any MDRO was reasonably stable over time. Carbapenem-resistant Pseudomonas was acquired at the highest rate over the study period (3.5/1000 patient days). The 12.8% (29/226) of MDROs isolated within 48 h were predominantly MRSA and Stenotrophomonas. Median (IQR) time from admission to MDRO detection was 10.9 (5.6-20.5) days, ranging from 9.8 (2.7-24.2) for MRSA to 23.6 (15.7-36.0) for carbapenem-resistant P. aeruginosa. Patients with MDROs were older, had more extensive burns, longer length of stay, and were more likely to have operative burn management. We were unable to detect a relationship between antibiotic exposure and emergence of MDROs.
MDROs are a common and consistent presence in our burns unit. The pattern of acquisition suggests various causes, including introduction from the community and nosocomial spread. More regular surveillance of incidence and targeted interventions may decrease their prevalence, and limit the development of invasive infection.
多药耐药菌（MDROs）在烧伤患者中比其他医院患者更为常见，并且是导致烧伤相关死亡率上升的一个越来越常见的原因。我们检查了在一个开放的普通外科病房和普通重症监护病房中，专门的烧伤服务机构中 MDRO 获得的发生率、趋势和危险因素。
我们对 2014 年 7 月至 2020 年 10 月期间在我们的州立三级烧伤服务机构中因急性烧伤而入院的成年患者进行了回顾性研究。我们将患者的人口统计学、损伤、治疗和结果详细信息从我们的前瞻性烧伤服务登记处链接到微生物学和抗菌药物处方数据。感兴趣的结果是首次检测到 MDRO，分为以下感兴趣的组：耐甲氧西林金黄色葡萄球菌（MRSA）、万古霉素耐药肠球菌（VRE）、两组铜绿假单胞菌（耐碳青霉烯类，和哌拉西林他唑巴坦或头孢吡肟耐药）、耐碳青霉烯类不动杆菌属、嗜麦芽窄食单胞菌、耐碳青霉烯类肠杆菌科（CRE）和产超广谱β-内酰胺酶的肠杆菌科（ESBL-PE）。我们使用 Cox 比例风险模型评估抗生素暴露与 MDRO 获得之间的关联。
有 2036 例急性入院，其中 230 例（11.3%）从临床标本中分离出至少一种 MDRO，最常见的是伤口拭子。虽然个别 MDRO 组的获得率在研究期间有所不同，但任何 MDRO 的获得率随时间相对稳定。在研究期间，耐碳青霉烯类铜绿假单胞菌的获得率最高（3.5/1000 患者日）。48 小时内分离出的 MDRO 中，12.8%（29/226）主要为 MRSA 和嗜麦芽窄食单胞菌。从入院到 MDRO 检测的中位（IQR）时间为 10.9（5.6-20.5）天，从 MRSA 的 9.8（2.7-24.2）到耐碳青霉烯类铜绿假单胞菌的 23.6（15.7-36.0）不等。MDRO 患者年龄较大，烧伤面积较大，住院时间较长，更有可能接受手术烧伤治疗。我们未能检测到抗生素暴露与 MDRO 出现之间的关系。
MDRO 在我们的烧伤病房中是一种常见且一致的存在。获得模式表明存在多种原因，包括从社区引入和医院内传播。更定期的发病率监测和有针对性的干预措施可能会降低其流行率，并限制侵袭性感染的发展。
