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烧伤患者的微生物感染

Microbial infections in burn patients.

作者信息

Roy Souvik, Mukherjee Preeti, Kundu Sutrisha, Majumder Debashrita, Raychaudhuri Vivek, Choudhury Lopamudra

机构信息

Postgraduate and Research Department of Biotechnology, St. Xavier's College (Autonomous), West Bengal, India.

Department of Microbiology, Sarsuna College (under Calcutta University), West Bengal, India.

出版信息

Acute Crit Care. 2024 May;39(2):214-225. doi: 10.4266/acc.2023.01571. Epub 2024 May 24.

Abstract

Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high risk of developing hospital-acquired infections, with longer patient stays leading to increased chances of acquiring such drug-resistant infections. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are the most common multidrug-resistant (MDR) Gram-negative bacteria identified in burn wound infections (BWIs). BWIs caused by viruses, like Herpes Simplex and Varicella Zoster, and fungi-like Candida spp. appear to occur occasionally. However, the preponderance of infection by opportunistic pathogens is very high in burn patients. Variations in the causative agents of BWIs are due to differences in geographic location and infection control measures. Overall, burn injuries are characterized by elevated serum cytokine levels, systemic immune response, and immunosuppression. Hence, early detection and treatment can accelerate the wound-healing process and reduce the risk of further infections at the site of injury. A multidisciplinary collaboration between burn surgeons and infectious disease specialists is also needed to properly monitor antibiotic resistance in BWI pathogens, help check the super-spread of MDR pathogens, and improve treatment outcomes as a result.

摘要

多重微生物感染是烧伤患者受伤后出现并发症的主要原因。此类入院患者发生医院获得性感染的风险很高,住院时间延长会增加感染此类耐药菌的几率。鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和奇异变形杆菌是在烧伤创面感染(BWI)中鉴定出的最常见的多重耐药(MDR)革兰氏阴性菌。由单纯疱疹和水痘带状疱疹等病毒以及念珠菌属等真菌引起的BWI似乎偶尔发生。然而,烧伤患者中机会性病原体感染的占比非常高。BWI病原体的差异是由于地理位置和感染控制措施的不同。总体而言,烧伤的特征是血清细胞因子水平升高、全身免疫反应和免疫抑制。因此,早期检测和治疗可以加速伤口愈合过程,并降低受伤部位进一步感染的风险。烧伤外科医生和传染病专家之间还需要开展多学科合作,以妥善监测BWI病原体中的抗生素耐药性,有助于遏制MDR病原体的超级传播,并因此改善治疗效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/451c/11167422/b6af4cbae4bd/acc-2023-01571f1.jpg

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