Bacteriology of war wounds at the time of injury
Bacteriology of war wounds at the time of injury
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DOI：
10.7205/milmed.171.9.826
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发表时间：
2006-09-01
影响因子：
1.2
通讯作者：
Gourdine, Emmett
中科院分区：
文献类型：
--
作者：
Murray, Clinton K.;Roop, Stuart A.;Gourdine, Emmett
战伤的细菌污染发生在受伤时或治疗过程中。在初始创伤时回收的细菌的表征可能影响用于预防感染的经验性抗菌剂的选择。2004年春，在伊拉克巴格达的第31战斗支援医院就诊的美军伤员，由于急性创伤导致开放性伤口，他们接受了伤口的有氧培养，以鉴定伤口上的细菌。对49名伤员的61处伤口进行了评估。伤口主要位于上肢和下肢，主要是简易爆炸装置或迫击炮造成的。30个伤口（49%）在培养中回收了细菌，鉴定出40种细菌。18名伤员（20处伤口）接受了现场医疗治疗（冲洗和/或抗菌治疗）;其中6人培养出9株细菌。在31名患者的41个伤口中，有24个伤口生长了31种细菌。革兰氏阳性菌（93%），主要是皮肤细菌，是鉴定的主要微生物。仅检测到三种革兰氏阴性菌，其中没有一种被表征为对抗菌剂具有广泛耐药性。回收的唯一耐药菌是两株耐甲氧西林金黄色葡萄球菌（MRSA）。我们对战伤伤后不久的细菌学的评估揭示了低毒力和致病性的革兰氏阳性微生物的优势。伤口中MRSA的存在可能反映了社区获得性MRSA细菌的发病率增加。这些数据表明，使用广谱抗生素对耐药性更强的革兰氏阴性菌，如铜绿假单胞菌和不动杆菌属，在早期伤口处理中是不必要的。
Bacterial contamination of war wounds occurs either at the time of injury or during the course of therapy. Characterization of the bacteria recovered at the time of initial trauma could influence the selection of empiric antimicrobial agents used to prevent infection. In the spring of 2004, U.S. military casualties who presented to the 31st Combat Support Hospital in Baghdad, Iraq, with acute traumatic injuries resulting in open wounds underwent aerobic culture of their wounds to identify the bacteria colonizing the wounds. Forty-nine casualties with 61 separate wounds were evaluated. Wounds were located predominantly in the upper and lower extremities and were primarily from improvised explosive devices or mortars. Thirty wounds (49%) had bacteria recovered on culture, with 40 bacteria identified. Eighteen casualties (20 wounds) had undergone field medical therapy (irrigation and/or antimicrobial treatment); six of these had nine bacterial isolates on culture. Of the 41 wounds from 31 patients who had received no previous therapy, 24 grew 31 bacteria. Gram-positive bacteria (93%), mostly skin-commensal bacteria, were the predominant organisms identified. Only three Gram-negative bacteria were detected, none of which were characterized as broadly resistant to antimicrobial agents. The only resistant bacteria recovered were two isolates of methicillin-resistant Staphylococcus aureus (MRSA). Our assessment of war wound bacterioly soon after injury reveals a predominance of Gram-positive organisms of low virulence and pathogenicity. The presence of MRSA in wounds likely reflects the increasing incidence of community-acquired MRSA bacteria. These data suggest that the use of broad-spectrum antibiotics with efficacy against more resistant, Gram-negative bacteria, such as Pseudomonas aeruginosa and Acinetobacter spp., is unnecessary in early wound management.