Multiple-Drug Resistance in Burn Patients: A Retrospective Study on the Impact of Antibiotic Resistance on Survival and Length of Stay.
Multiple-Drug Resistance in Burn Patients: A Retrospective Study on the Impact of Antibiotic Resistance on Survival and Length of Stay.
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DOI：
10.1097/bcr.0000000000000479
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Mosier MJ
中科院分区：
文献类型：
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作者：
van Langeveld I;Gagnon RC;Conrad PF;Gamelli RL;Martin B;Choudhry MA;Mosier MJ
尽管早期治疗有所改善，但烧伤后的存活率仍然受到脓毒症和多器官功能障碍综合征(MODS)的挑战。此外，对感染的敏感性和日益增长的抗生素耐药性使烧伤患者感染多重耐药微生物(MDRO)的风险增加。因此，我们的目标是评估MDRO感染对存活率和住院时间的影响，并检查这些微生物在急性肾损伤、败血症和MODS等并发症的发生中所起的作用。为了研究这一点，我们包括了2012年1月1日至2013年12月31日期间入院的所有烧伤感染患者。患者被分成两组：由多药耐药菌引起的感染患者和由敏感生物引起的感染患者。收集了所有可用培养的数据，以及医疗记录中与人口统计、损伤和治疗相关的变量。MDRO组手术次数(中位数：2比1，P<0.0001)、呼吸机使用天数(21比0天，P<0.0001)、抗生素总天数(21比7天，P<0.0001)、住院天数(39比14天，P<0.0001)与非耐药组比较差异有统计学意义。虽然MDRO感染与患者死亡率无关，但单因素Logistic回归分析显示，20%总胆红素血症(优势比[OR]=4.30，95%可信区间[CI]：1.14-16.29，P=.03)、急性肾损伤(OR=10.93，95%CI：2.74-43.57，P=.001)、脓毒症(OR=19.20，95%CI：3.79-97.27，P<；.001)和MODS(OR=85.49，95%CI：12.97-563.28，P<；0.0001)显著增加患者死亡的几率。这些发现表明，感染多药耐药菌与更多的手术次数、更长的机械通气时间、更多的抗生素日和更长的住院时间有关。
Despite improvements in early treatment, survival following burn injury remains challenged by sepsis and multiple organ dysfunction syndrome (MODS). Additionally, susceptibility to infections and growing antibiotic resistance places burn patients at increased risk for infections with multiple-drug resistant organisms (MDROs). We therefore aimed to evaluate the impact of MDRO infections on survival and hospital length of stay, as well as examine the role of these organisms in the development of complications, such as acute kidney injury, sepsis, and MODS. To study this, we included all burn patients with infections, admitted between January 1, 2012, and December 31, 2013. Patients were divided into two groups: patients with infections caused by MDROs and patients with infections caused by susceptible organisms. Data were collected on all available cultures, as well as demographic, injury, and treatment-related variables from the medical record. The number of operative procedures (median: 2 vs 1, P < .0001), ventilator days (21 vs 0 days, P < .0001), total antibiotic days (21 vs 7days, P < .0001), and length of hospitalization (39 vs 14 days, P < .0001) were significantly different in the MDRO group vs the nonresistant group. While MDRO infection was not associated with patient mortality, univariable logistic regression analyses demonstrated >20% TBSA (odds ratio [OR] = 4.30, 95% confidence interval [CI]: 1.14–16.29, P = .03), acute kidney injury (OR = 10.93, 95% CI: 2.74–43.57, P = .001), sepsis (OR = 19.20, 95% CI: 3.79–97.27, P < .001), and MODS (OR = 85.49, 95% CI: 12.97–563.28, P < .0001) significantly increased the odds of patient mortality. These findings suggest that infections with MDROs are associated with a greater number of surgical procedures, longer duration of mechanical ventilation, more antibiotic days, and longer hospitalization.