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中华损伤与修复杂志(电子版) ›› 2021, Vol. 16 ›› Issue (05) : 406 -410. doi: 10.3877/cma.j.issn.1673-9450.2021.05.006

论著

特重度烧伤合并吸入性损伤患者血流感染的临床特征及其主要风险因素分析
马珍珠1, 窦懿2, 张寅2, 张勤2, 吴蓓雯3,†()   
  1. 1. 200025　上海交通大学护理学院
    2. 200025　上海交通大学医学院附属瑞金医院灼伤整形科
    3. 200025　上海交通大学医学院附属瑞金医院护理部
  • 收稿日期:2021-07-22 出版日期:2021-10-01
  • 通信作者: 吴蓓雯

Analysis of clinical characteristics and main risk factors of bloodstream infection in patients with severe burn combined with inhalation injury

Zhenzhu Ma1, Yi Dou2, Yin Zhang2, Qin Zhang2, Beiwen Wu3,†()   

  1. 1. School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China
    2. Department of Burns and Plastic Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    3. Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2021-07-22 Published:2021-10-01
  • Corresponding author: Beiwen Wu
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马珍珠, 窦懿, 张寅, 张勤, 吴蓓雯. 特重度烧伤合并吸入性损伤患者血流感染的临床特征及其主要风险因素分析[J]. 中华损伤与修复杂志(电子版), 2021, 16(05): 406-410.

Zhenzhu Ma, Yi Dou, Yin Zhang, Qin Zhang, Beiwen Wu. Analysis of clinical characteristics and main risk factors of bloodstream infection in patients with severe burn combined with inhalation injury[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2021, 16(05): 406-410.

目的

通过研究特重度烧伤合并吸入性损伤患者临床特征和风险因素，为未来构建特重度烧伤合并吸入性损伤患者血流感染风险模型提供依据。

方法

回顾性分析上海交通大学医学院附属瑞金医院灼伤整形科2010年1月1日至2019年12月31日收治的符合入选标准的185例患者的病历资料。分析其基本特征、烧伤情况、转运情况、血流感染的特点、治疗及结局。根据其是否发生血流感染将患者分为感染组62例(33.51%)和未感染组123例(66.49%)，分析该类患者血流感染的临床特征及发生血流感染的危险因素，并行单因素分析和Logistic回归分析。

结果

185例特重度烧伤合并吸入性损伤患者中有62例发生血流感染。检出阳性率从高到低的前3位细菌分别是肺炎克雷伯菌(36.25%)，铜绿假单胞菌(28.75%)，鲍曼不动杆菌(13.75%)。感染组烧伤总面积、Ⅲ度烧伤面积均显著高于非感染组，差异均有统计学意义(Z＝4.361、4.652，P<0.05);感染组ICU住院时间、住院时间显著长于非感染组，差异均有统计学意义(Z＝4.297、2.769，P< 0.05)。感染组和非感染组男女构成比差异有统计学意义(χ2＝4.237，P <0.05)。感染组和非感染组接受机械通气的患者构成比差异有统计学意义(χ2＝13.788, P< 0.05)。最终Logistic回归结果显示ICU住院时间为独立危险因素(OR＝1.035，95%CI＝1.014~1.057，P<0.05)。

结论

特重度烧伤合并吸入性损伤患者具有血流感染高风险，其中肺炎克雷伯杆菌、铜绿假单胞菌、鲍曼不动杆菌等革兰氏阴性菌为主要致病菌，ICU住院时间为特重度烧伤合并吸入性损伤患者发生血流感染的独立危险因素。

关键词: 烧伤, 损伤，吸入性, 危险因素, 血流感染
Objective

To investigate the clinical characteristics and risk factors of bloodstream infection and to provide basis for constructing the risk model of bloodstream infection in patients with severe burn combined with inhalation injury in the future.

Methods

Clinical data of 185 patients who met the inclusion criteria in Department of Burns and Plastic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 1, 2010 to December 31, 2019 were retrospectively analyzed. Demographic characteristics, burn condition, transfer condition, characteristics of bloodstream infection and prognosis, treatment and outcome were analyzed. The patients were divided into infected group (n=62, 33.51%) and uninfected group (n=123, 66.49%) according to whether or not they had bloodstream infection. The characteristics of bloodstream infection and the risk factors of bloodstream infection in these patients were analyzed through Mann-Whitney U test、χ2 test and Logistic regression analysis.

Results

Sixty-two of the 185 patients with severe burn combined with inhalation injury had bloodstream infection. The top three bacteria with positive rate from high to low were Klebsiella pneumoniae (36.25%), Pseudomonas aeruginosa (28.75%) and Acinetobacter baumannii (13.75%). Compared with non-infection group, the total burn area, full-thickness burn area, ICU length of stay and length of hospital stay of infection group were obviously higher than the non-infection group, the differences were statistically significant(Z= 4.361, 4.652, 4.297, 2.769; P< 0.05). The constituent ratio of male and receiving mechanical ventilation were higher in infection group, the differences were statistically significant(χ2=4.237, 13.788; P< 0.05). Further logistic regression analysis showed that ICU length of stay was the independent risk factor for the severe burn patients combined with inhalation injury (odds ratio=1.035, 95% confidence interval=1.014-1.057, P< 0.05).

Conclusion

The incidence of bloodstream infection was high in patients with severe burn combined with inhalation injury, and the main pathogens was Gram-negative bacteria, especially Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii. The ICU length of stay was an independent risk factor for bloodstream infection in patients with severe burn combined with inhalation injury.

Key words: Burns, Burns, inhalation, Risk factors, Bloodstream infection
表1 细菌分布情况
细菌种类 检出菌次数 百分比(%)
肺炎克雷伯杆菌 29 36.25
铜绿假单胞菌 23 28.75
鲍曼不动杆菌 11 13.75
金黄色葡萄球菌 8 10.00
肠球菌属 8 10.00
奇异变形杆菌 1 1.25
合计 80 100
表2 革兰氏阴性菌的抗生素药物敏感试验结果[次(%)]
抗生素 肺炎克雷伯杆菌(n＝29) 铜绿假单胞菌(n＝23) 鲍曼不动杆菌(n＝11)
亚胺培南 5(17.24) 0 0
美罗培南 5(17.24) 0 0
帕尼培南 5(17.24) 0 0
复方新诺明 5(17.24) 0 0
头孢他啶 2(6.90) 15(65.22) 0
头孢哌酮/舒巴坦钠 1(3.45) 0 0
哌拉西林/他唑巴坦 3(10.34) 0 0
丁胺卡那霉素 4(13.79) 0 2(18.18)
替加环素 13(44.83) 0 1(9.09)
头孢吡肟 5(17.24) 0 0
头孢替坦 1(3.45) 0 0
氨曲南 2(6.90) 2(8.70) 0
庆大霉素 3(10.34) 0 0
妥布霉素 3(10.34) 0 0
环丙沙星 2(6.90) 9(39.13) 0
左氧氟沙星 2(6.90) 0 0
磷霉素 2(6.90) 0 0
表3 感染组与非感染组特重度烧伤合并吸入性损伤患者资料比较
组别 例数 年龄[岁，M(IQR)] 性别 BMI[kg/m2, M(IQR)] 烧伤至入院时间[h, M(IQR)] 烧伤总面积[%TBSA, M(IQR)]
男 女
感染组 62 40.00(20.00) 56 6 23.15(5.36) 4.00(5.00) 83.00(26.00)
非感染组 123 45.00(21.00) 96 27 23.24(4.47) 4.00(4.00) 67.0(25.00)
χ2值     4.237      
Z值   1.702     0.321 0.346 4.361
P值   0.089 0.040 0.748 0.729 0
组别 例数 Ⅲ度烧伤面积[%TBSA，M(IQR)] 基础疾病 住院时间[d, M(IQR)] ICU住院时间[d, M(IQR)] 机械通气
有 无 是 否
感染组 62 50.50(30.00) 12 50 55.00(53.00) 41.50(45.00) 47 15
非感染组 123 33.00(38.00) 33 90 38.00(36.00) 26.00(25.00) 58 65
χ2值     1.251     13.788
Z值   4.652     2.769 4.297    
P值   0 0.263 0.006 0 0
表4 185例重度烧伤合并吸入性损伤患者发生血流感染影响因素的Logistic回归分析
影响因素 风险比 95%CI P值
性别 0.393 0.137~1.124 0.081
烧伤总体表面积 1.032 1.000~1.066 0.051
Ⅲ度烧伤面积 1.011 0.994~1.028 0.214
住院时间 0.992 0.977~1.007 0.275
接受机械通气 0.850 0.363~1.992 0.709
ICU住院时间 1.035 1.014~1.057 0.001
[1]
Girardot T, Rimmelé T, Venet F, et al. Apoptosis-induced lymphopenia in sepsis and other severe injuries [J]. Apoptosis, 2017, 22(2): 295-305.
[2]
Egozi D, Hussein K, Filson S, et al. Bloodstream infection as a predictor for mortality in severe burn patients: an 11-year study [J]. Epidemiol Infect, 2014, 142(10): 2172-2179.
[3]
Dudoignon E, Alanio A, Anstey J, et al. Outcome and potentially modifiable risk factors for candidemia in critically ill burns patients: A matched cohort study [J]. Mycoses, 2019, 62(3): 237-246.
[4]
Renau Escrig AI, Salavert M, Vivó C, et al. Candidemia in major burns patients [J]. Mycoses, 2016, 59(6): 391-398.
[5]
Jones SW, Williams FN, Cairns BA, et al. Inhalation Injury: Pathophysiology, Diagnosis, and Treatment [J]. Clin Plast Surg, 2017, 44(3): 505-511.
[6]
Foncerrada G, Culnan DM, Capek KD, et al. Inhalation Injury in the Burned Patient [J]. Ann Plast Surg, 2018, 80(3 Suppl 2): S98-S105.
[7]
Tang CQ, Li JQ, Shou BM, et al. Epidemiology and outcomes of bloodstream infections in 177 severe burn patients from an industrial disaster: a multicentre retrospective study [J]. Clin Microbiol Infect, 2018, 24(2): 199e1- e7.
[8]
Bahemia IA, Muganza A, Moore R, et al. Microbiology and antibiotic resistance in severe burns patients: A 5 year review in an adult burns unit [J]. Burns, 2015, 41(7): 1536-1542.
[9]
Tan Chor Lip H, Tan JH, Thomas M, et al. Survival analysis and mortality predictors of hospitalized severe burn victims in a Malaysian burns intensive care unit [J]. Burns Trauma, 2019, 7: 3.
[10]
沈自燕，林少清，杜兴冉，等. 医院获得性肺炎克雷伯菌血流感染临床特征及预后影响因素[J/CD]. 中华实验和临床感染病杂志(电子版), 2020, 14(3): 198-205.
[11]
Smolle C, Cambiaso-Daniel J, Forbes AA, et al. Recent trends in burn epidemiology worldwide: A systematic review [J]. Burns, 2017, 43(2): 249-257.
[12]
Monteiro D, Silva I, Egipto P, et al. Inhalation injury in a burn unit: a retrospective review of prognostic factors [J]. Ann Burns Fire Disasters, 2017, 30(2): 121-125.
[13]
Witt CE, Stewart BT, Rivara FP, et al. Inpatient and post-discharge outcomes following inhalation injury among critically injured burn patients [J]. J Burn Care Res, 2021: irab029.
[14]
Sutton T, Lenk I, Conrad P, et al. Severity of Inhalation Injury is Predictive of Alterations in Gas Exchange and Worsened Clinical Outcomes [J]. J Burn Care Res, 2017, 38(6): 390-395.
[15]
Arifi H, Ahmeti H, Zatriqi V, et al. Epidemiology of burn injuries in Kosovo: a 10-year review [J]. Ann Burns Fire Disasters, 2017, 30(3): 163-166.
[16]
Li H, Yao Z, Tan J, et al. Epidemiology and outcome analysis of 6325 burn patients: a five-year retrospective study in a major burn center in Southwest China [J]. Sci Rep, 2017, 7: 46066.
[17]
Perween N, Prakash SK, Siddiqui O. Multi Drug Resistant Klebsiella Isolates in Burn Patients: A Comparative Study [J]. J Clin Diagn Res, 2015，9(9): DC14-6.
[18]
Emami A, Bazargani A, Mohammadi AA, et al. Detection of blaPER-1 & blaOxa10 among imipenem resistant isolates of Pseudomonas aeruginosa isolated from burn patients hospitalized in Shiraz Burn Hospital [J]. Iran J Microbiol, 2015, 7(1): 7-11.
[19]
Fochtmann-Frana A, Freystätter C, Vorstandlechner V, et al. Incidence of risk factors for bloodstream infections in patients with major burns receiving intensive care: A retrospective single-center cohort study [J]. Burns, 2018, 44(4): 784-792.
[20]
窦懿，张勤. 烧伤病房抗菌药物使用及细菌耐药性的单中心分析[J]. 中华医学杂志，2020, 100(18): 1401-1408.
[21]
Emami A, Pirbonyeh N, Keshavarzi A, et al. Three Year Study of Infection Profile and Antimicrobial Resistance Pattern from Burn Patients in Southwest Iran [J]. Infect Drug Resist, 2020, 13: 1499-1506.
[22]
Dvorak JE, Ladhani HA, Claridge JA. Review of Sepsis in Burn Patients in 2020 [J]. Surg Infect (Larchmt), 2021, 22(1): 37-43.
[23]
Zhou J, Tan J, Gong Y, et al. Candidemia in major burn patients and its possible risk factors: A 6-year period retrospective study at a burn ICU [J]. Burns, 2019, 45(5): 1164-1171.
[24]
Fochtmann A, Forstner C, Hagmann M, et al. Predisposing factors for candidemia in patients with major burns [J]. Burns, 2015, 41(2): 326-332.
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