Váňa V, Lipový B, Cvanová M, Hanslianová M, Holoubek J
Epidemiol Mikrobiol Imunol. 2025;74(2):97-106. doi: 10.61568/emi/11-6492/20250428/140415.
High voltage electrotrauma is one of the most serious injuries we can encounter in modern medicine, often associated with multiple disabilities and high susceptibility to infectious complications. These patients are admitted to specialized burn centers and require extensive multidisciplinary collaboration. In this study, we aim to uncover the prevalence, types and characteristics of microbial infections that develop in the aftermath of high voltage electrotrauma and to identify risk factors that may contribute to patients' susceptibility to infections.
For the purposes of this publication, data of all 37 patients hospitalized in the intensive care unit of the Department of Burns and Plastic Surgery of the University Hospital in Brno with a diagnosis of high-voltage electrical injury between 2006-2016 were processed. Imprints and swaps from exfoliated areas were repeatedly taken for microbial analysis, together with tracheobronchial aspirate fluid, sputum, or bronchoalveolar lavage, urine and peripheral blood. The obtained data were analysed retrospectively.
Among the 37 patients, the median age was 31.9, with an average hospital stay of 44.3 days and a mortality rate of 8.1%. A total of 28 individuals were dependent on artificial lung ventilation. The incidence of infectious complications varies during the hospitalization period according to the location of sampling cultivation and time spent at the hospital. 97.3% of patients developed infection in at least one body compartment. In 88.8% of cases, it was multipathogenic and in 41.6% a septic condition developed. In our study cohort, G+ dominated over Gstrains. Most common representatives from G+ spectrum were Coagulase negative Staphylococci (97%), Staphylococcus aureus (57%), Enterococcus fecalis et faecium (51%). In Gspectrum, the order was as followed: Klebsiella pneumoniae (46%), Pseudomonas aeruginosa (41%), Escherichia coli (35%) and Acinetobacter baumannii (18.9%). The most common infection observed was burn wound infection (BWI), followed by bloodstream infections (BSI), lower respiratory tract infections (LRTI), and urinary tract infections (UTI), primarily caused by G+ pathogens. Notably, an increased hospital stay duration was associated with a rising prevalence of Gpathogens, particularly K. pneumoniae P. aeruginosa and A. baumannii which exhibited a high degree of antimicrobial resistance.
This study provides a detailed insight into the occurrence and consequences of high-voltage electrical injuries in Moravia over a decade. Factors significantly impacting survival and severity of outcomes included total burn surface area, full-thickness burns, inhalation injury, and the need for tracheostomy. However, the study is limited by its relatively small sample size, long data collection period with potential changes in clinical practice, and single-center design, which may affect the generalizability of the findings. Further multicentric studies are needed to validate these results and refine infection prevention strategies in this patient population.
高压电创伤是现代医学中最严重的损伤之一，常伴有多种残疾且极易发生感染性并发症。这些患者需入住专业烧伤中心，并需要广泛的多学科协作。在本研究中，我们旨在揭示高压电创伤后发生的微生物感染的患病率、类型和特征，并确定可能导致患者易感染的危险因素。
为撰写本论文，我们处理了2006年至2016年间在布尔诺大学医院烧伤与整形外科重症监护病房住院的所有37例诊断为高压电损伤患者的数据。反复采集脱落部位的印记和拭子进行微生物分析，同时采集气管支气管吸出液、痰液、支气管肺泡灌洗液、尿液和外周血。对获得的数据进行回顾性分析。
37例患者中，中位年龄为31.9岁，平均住院时间为44.3天，死亡率为8.1%。共有28人依赖人工肺通气。根据采样培养部位和住院时间，住院期间感染并发症的发生率有所不同。97.3%的患者至少有一个身体部位发生感染。在88.8%的病例中，感染为多病原体感染，41.6%的病例发生了败血症。在我们的研究队列中，革兰氏阳性菌（G+）多于革兰氏阴性菌（G-）。G+菌谱中最常见的代表是凝固酶阴性葡萄球菌（97%）、金黄色葡萄球菌（57%）、粪肠球菌和屎肠球菌（51%）。在G-菌谱中，顺序如下：肺炎克雷伯菌（46%）、铜绿假单胞菌（41%）、大肠杆菌（35%）和鲍曼不动杆菌（18.9%）。观察到的最常见感染是烧伤创面感染（BWI），其次是血流感染（BSI）、下呼吸道感染（LRTI）和尿路感染（UTI），主要由G+病原体引起。值得注意的是，住院时间延长与G-病原体患病率上升相关，尤其是肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌，它们表现出高度的抗菌耐药性。
本研究详细深入地了解了摩拉维亚地区十年来高压电损伤的发生情况及后果。显著影响生存和预后严重程度的因素包括烧伤总面积、全层烧伤、吸入性损伤以及气管切开的必要性。然而，本研究存在局限性，样本量相对较小、数据收集期长且临床实践可能发生变化，以及单中心设计，这可能影响研究结果的普遍性。需要进一步的多中心研究来验证这些结果，并完善该患者群体的感染预防策略。
