战场相关烧伤的感染并发症的流行病学及发生时间
Epidemiology and timing of infectious complications from battlefield-related burn injuries.
作者信息
Geringer Matthew R, Stewart Laveta, Shaikh Faraz, Carson M Leigh, Lu Dan, Cancio Leopoldo C, Gurney Jennifer M, Tribble David R, Kiley John L
机构信息
Infectious Disease Service, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234, United States.
Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817, United States.
出版信息
Burns. 2024 Dec;50(9):107200. doi: 10.1016/j.burns.2024.07.004. Epub 2024 Jul 8.
BACKGROUND
Infections are the most frequent complication and cause of mortality in burn patients. We describe the epidemiology and outcomes of infections among deployed U.S. military personnel with burns.
METHODS
Military personnel who sustained a burn injury in Iraq or Afghanistan (2009-2014) and were admitted to the Burn Center at U.S. Army Institute of Surgical Research at Brooke Army Medical Center were included in the analysis.
RESULTS
The study population included 144 patients who were primarily young (median 24 years) males (99 %) with combat-related burns (62 %) sustained via a blast (57 %), resulting in a median total body surface area burned (TBSA) of 6 % (IQR 3-14 %). Twenty-six (18 %) patients developed infections, with pneumonia being the predominant initial infection (= 16), followed by skin and soft-tissue infections (SSTI, = 6), bloodstream infections (BSI, = 3), and intra-abdominal infections (IAI, = 1). Initial infections were diagnosed at a median of 4 days (IQR 3-5) post-injury for pneumonia, 7 days (IQR 4-12) for SSTIs, 7 days (IQR 6-7) for BSI, and 17 days for IAI. Patients with infections were more severely injured with greater TBSA (median 31 % vs 5 %), more inhalation injury (38 % vs 12 %), and longer time to definitive surgical management (median of 34 days vs 9) compared to those who did not develop infections (p < 0.001). Among patients with inhalation injury, a higher proportion developed pneumonia (42 %) compared to those without inhalation injury (5 %; p < 0.001). Five patients developed an invasive fungal infection. Gram-negative bacilli were most frequently recovered, with 32 % of Gram-negative isolates being multidrug-resistant. Four patients died, of whom all had ≥ 4 infections.
CONCLUSIONS
Military personnel with burn injuries who developed infections were more severely injured with greater TBSA and inhalation injury. Improved understanding of risk factors for burn-related infections in combat casualties is critical for effective management.
背景
感染是烧伤患者最常见的并发症和死亡原因。我们描述了美国现役军人烧伤后感染的流行病学情况及转归。
方法
分析2009年至2014年在伊拉克或阿富汗烧伤并被收治于布鲁克陆军医疗中心美国陆军外科研究所烧伤中心的军人。
结果
研究人群包括144例患者，主要为年轻男性（中位年龄24岁，99%），与战斗相关的烧伤占62%，其中57%由爆炸所致，烧伤总面积（TBSA）中位数为6%（四分位间距3% - 14%）。26例（18%）患者发生感染，其中肺炎是主要的初始感染类型（= 16例），其次是皮肤和软组织感染（SSTI，= 6例）、血流感染（BSI，= 3例）和腹腔内感染（IAI，= 1例）。肺炎初始感染诊断时间中位数为伤后4天（四分位间距3 - 5天），SSTI为7天（四分位间距4 - 12天），BSI为7天（四分位间距6 - 7天），IAI为17天。与未发生感染的患者相比，发生感染的患者烧伤更严重，TBSA更大（中位数31%对5%），吸入性损伤更多（38%对12%），确定性手术治疗时间更长（中位数34天对9天）（p < 0.001）。在有吸入性损伤的患者中，发生肺炎的比例（42%）高于无吸入性损伤的患者（5%；p < 0.001）。5例患者发生侵袭性真菌感染。革兰阴性杆菌最常被分离出，32%的革兰阴性菌分离株对多种药物耐药。4例患者死亡，所有死亡患者均有≥ 4次感染。
结论
发生感染的烧伤军人烧伤更严重，TBSA更大且有吸入性损伤。更好地了解战斗伤员烧伤相关感染的危险因素对于有效治疗至关重要。
Zotero 插件