The impact of nosocomially-acquired resistant Pseudomonas aeruginosa infection in a burn unit
The impact of nosocomially-acquired resistant Pseudomonas aeruginosa infection in a burn unit
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DOI：
10.1097/01.ta.0000240175.18189.af
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发表时间：
2007-07-01
影响因子：
--
通讯作者：
Tredget, Edward E.
中科院分区：
文献类型：
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作者：
Armour, Alexis D.;Shankowsky, Heather A.;Tredget, Edward E.
背景医院获得性铜绿假单胞菌仍然是烧伤患者感染和脓毒性死亡的严重原因。本研究旨在量化烧伤人群中医院传播的耐药铜绿假单胞菌的影响。使用TRACS烧伤数据库，确定了48例对庆大霉素耐药的铜绿假单胞菌患者（假单胞菌组）。39例患者在年龄、总体表面积、入院年份和是否存在吸入性损伤方面与无耐药铜绿假单胞菌培养物的对照组（对照组）病例匹配。研究死亡率和各种发病率终点，以及抗生素费用。假单胞菌组的死亡率（33%）明显高于对照组（8%，p < 0.001）。假单胞菌组的住院时间延长（73.4 +/- 11.6 vs. 58.3 +/- 8.3天）。通气天数（23.9 +/- 5.4 vs. 10.8 +/- 2.4，p < 0.05），手术次数（5.2 ± 0.6 vs. 3.4 ± 0.4，p < 0.05），以及血液制品使用量（压积细胞51.1 +/- 8.0对21.1 +/- 3.4，p < 0.01;血小板11.9 +/- 3.0对1.4 +/- 0.7，p < 0.01）在假单胞菌组中均显著较高。抗生素的费用也明显较高（$2，658.52 +/- $647.93 vs. $829.22 +/- $152.82，p < 0.01）.结论：烧伤患者中氨基糖苷类抗生素耐药铜绿假单胞菌的医院定植或感染，或两者均与显著较高的发病率、死亡率和护理费用相关。与对照组患者相比，增加资源消耗并不能防止显著更高的死亡率。因此，预防、鉴定和根除医院内假单胞菌污染对于具有成本效益的、成功的烧伤护理至关重要。
Background. Nosocomially-acquired Pseudomonas aeruginosa remains a serious cause of infection and septic mortality in burn patients. This study was conducted to quantify the impact of nosocomially-transmitted resistant P. aeruginosa in a burn population.Methods. Using a TRACS burn database, 48 patients with P. aeruginosa resistant to gentamicin were identified (Pseudomonas group). Thirty-nine were case-matched to controls without resistant P. aeruginosa cultures (control group) for age, total body surface area, admission year, and presence of inhalation injury. Mortality and various morbidity endpoints were examined, as well as antibiotic costs.Results. There was a significantly higher mortality rate in the Pseudomonas group (33% vs. 8%,p < 0.001) compared with in the control group. Length of stay was increased in the Pseudomonas group (73.4 +/- 11.6 vs. 58.3 +/- 8.3 days). Ventilatory days (23.9 +/- 5.4 vs. 10.8 +/- 2.4, p < 0.05), number of surgical procedures (5.2 +/- 0.6 vs. 3.4 0.4, p < 0.05), and amount of blood products used (packed cells 51.1 +/- 8.0 vs. 21.1 +/- 3.4, p < 0.01; platelets 11.9 +/- 3.0 vs. 1.4 +/- 0.7, p < 0.01) were all significantly higher in the Pseudonionas group. Cost of antibiotics was also significantly higher ($2,658.52 +/- $647.93 vs. $829.22 +/- $152.82, p < 0.01).Conclusions: Nosocomial colonization or infection, or both, of burn patients with aminoglycoside-resistant P. aeruginosa is associated with significantly higher morbidity, mortality, and cost of care. Increased resource consumption did not prevent significantly higher mortality rates when compared with that of control patients. Thus, prevention, identification, and eradication of nosocomial Pseudomonas contamination are critical for cost-effective, successful burn care.