Prevalence and resistance of Pseudomonas aeruginosa in severely burned patients: a 10-year retrospective study.
Prevalence and resistance of Pseudomonas aeruginosa in severely burned patients: a 10-year retrospective study.
复制标题
严重烧伤患者中铜绿假单胞菌的患病率和耐药性：一项 10 年回顾性研究。
作者：
B. Lipovy;H. Říhová;M. Hanslianová;N. Gregorová;I. Suchánek;P. Brychta
背景
革兰氏阴性菌引起的感染并发症是目前严重烧伤患者死亡的主要原因。铜绿假单胞菌是世界范围内烧伤中心最令人恐惧的医院感染病原体，死亡率最高。
材料和方法
该研究涉及2000年至2009年期间在布尔诺大学医院烧伤和重建外科重症监护室住院的成年患者。这些患者因热损伤住院。我们评估了烧伤面积的范围、年龄、入院时和出院时或解剖时的损伤深度（组织学）以及在重症监护室的住院时间。通过完成定期拭子，我们不仅监测和评估了烧伤区域的微生物状况，还监测和评估了下呼吸系统、泌尿道和血流中的微生物状况。
结果
该研究涉及2000年至2009年期间在布尔诺大学医院烧伤和重建外科重症监护室因烧伤创伤住院的640名成人。患者烧伤面积的平均程度为36.2% TBSA（2-97% TBSA），平均年龄为36.7%（18-92岁），在重症监护室的平均住院时间为27.1天（1-151天）。我们在这些患者中共分离出2，958株铜绿假单胞菌（包括在同一患者中重复分离的假单胞菌菌株）。其中最常见的是从烧伤部位（1 301株）、下呼吸道（651株）和泌尿道（592株）分离出的铜绿假单胞菌。在监测期间，从我们的患者中分离出的菌株数量增加（2000年146株，2009年521株）。此外，我们注意到对除多粘菌素外的所有可用抗生素的耐药性增加。所有监测年份的铜绿假单胞菌菌株对粘菌素保持100%敏感。在常规使用的抗生素中，美罗培南显示出最大的耐药性增加（2000年，这包括总共18%的耐药铜绿假单胞菌菌株，2009年为58%的菌株）。头孢他啶显示出类似的结果（2000年12%，2009年39%的耐药菌株）。阿米卡星对假单胞菌感染表现出相对较好的效果; 2009年，我们登记了34%的铜绿假单胞菌对该氨基糖苷类抗生素的耐药菌株。2000年铜绿假单胞菌多重耐药株13株（占8.9%），2009年为171株（占32.82%）。
结论
在我们的研究中，我们指出了铜绿假单胞菌菌株的流行率和耐药性都呈上升趋势。这限制了我们选择合适的抗生素治疗。这就是为什么感染并发症在严重烧伤患者的发病率和死亡率中起着如此重要的作用。
BACKGROUND
Infection complications caused by gram-negative bacteria nowadays constitute the dominant mortality cause in severely burned patients. Pseudomonas aeruginosa is the most feared nosocomial pathogen among burn centers worldwide, with the highest mortality.
MATERIAL AND METHODS
The study involved adult patients hospitalized at the Intensive Care Unit at the Department of Burns and Reconstructive Surgery, University Hospital Brno, between the years 2000 and 2009. These patients were hospitalized for thermal injuries. Retrospectively we have evaluated the extent of the burned areas, ages, depth of injury at admission and at discharge or in dissection (histology) and length of hospitalization on the Intensive Care Unit. By completing regular swabs we monitored and evaluated the microbiological situation not only at the burned areas but also in the lower respiratory system, in the urinary tract and in the blood stream.
RESULTS
The study involved a total of 640 adults hospitalized at the Intensive Care Unit at the Department of Burns and Reconstructive Surgery, University Hospital Brno, for burn trauma between the years 2000 and 2009. The average extent of the burned area in patients was 36.2% TBSA (2-97% TBSA), average age was 36.7% years (18-92 years), average length of hospitalization at the Intensive Care Unit was 27.1 days (1-151 days). We isolated a total of 2,958 strains of Pseudomonas aeruginosa (including repeated isolation of pseudomonas strains in the same patients) in these patients. The most frequently found of these was Pseudomonas aeruginosa isolated from the burned area (1,301 strains), from the lower respiratory system (651) and from the urinary tract (592 strains). During the monitored period the number of strains isolated in our patients increased (146 strains in 2000, 521 strains in 2009). Furthermore, we noticed increased resistance to all available antibiotics except Polymyxins. All of the Pseudomonas aeruginosa strains in the monitored years maintained 100% sensitivity to Colistin. Of the routinely used antibiotics Meropenem showed the greatest increase of resistance (in 2000 this comprised a total of 18% of the resistant Pseudomonas aeruginosa strains, and in 2009 58% of the strains). Ceftazidime shows similar results (in 2000 12%, in 2009 39% of resistant strains). Amikacin displayed a relatively good effect against pseudomonas infections; in 2009 we registered total of 34% of the resistant strains of Pseudomonas aeruginosa to this aminoglycoside. In 2000 there were 13 multiresistant strains (i.e. 8.9%) of Pseudomonas aeruginosa, in 2009 the figure was 171 strains (i.e. 32.82%).
CONCLUSION
In our study we point to the increasing trend not only in the prevalence but also in the resistance of Pseudomonas aeruginosa strains. This limits our choices for suitable antibiotic therapy. This is why infection complications play such a significant role in morbidity and mortality in severely burned patients.