Bacteriological cultures on admission of the burn patient: To do or not to do, that's the question
Bacteriological cultures on admission of the burn patient: To do or not to do, that's the question
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DOI：
10.1016/j.burns.2015.08.006
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发表时间：
2016-03-01
期刊：
影响因子：
2.7
通讯作者：
Boxma, H.
中科院分区：
文献类型：
--
作者：
Dokter, J.;Brusselaers, N.;Boxma, H.
简介：在许多烧伤中心，入院时从鼻子、喉咙、会阴和烧伤创面采集常规细菌学拭子，以检查是否存在微生物，这些微生物需要采取特殊措施进行隔离或初步治疗。例如，根据荷兰“搜索并销毁”的政策，感染多重耐药细菌的患者必须严格隔离，而感染了贝塔溶血性化脓性链球菌的患者必须接受抗生素治疗，以防止一期闭合失败或皮肤移植物丢失。在这方面，入院时培养的细菌在后来的感染并发症中的作用被调查。这项研究的目的是评估系统的初步细菌学监测，基于广泛的荷兰数据收集。材料和方法：共有3271名患者初步住院鹿特丹烧伤中心1987年1月至2010年8月期间，包括完整的细菌学拭子从鼻子，喉咙，会和烧伤创面。在这项研究中，微生物监测的目的是在任何监测培养中识别耐药微生物，如耐甲氧西林金黄色葡萄球菌(MRSA)、多重耐药不动杆菌和多重耐药假单胞菌，以及Lancefield Aβ-溶血性链球菌(HSA)。在没有生长或典型的低水平细菌在鼻子、喉咙和会定植且一种微生物没有过度生长的情况下，培养物被标记为“正常菌群或不可疑”。此外，195名(6.0%)后来成为败血症的患者的血培养与入院时的培养相比较，以确定当前微生物的作用。结果：入院时近61%的伤口培养结果为“无可疑”。入院时培养出MRSA的比例为0.4%(14/3271)，其中12例(85.7%)被遣返。总体而言，9.3%(12/129)的遣返患者感染了MRSA。多重耐药不动杆菌和假单胞菌分别占0.3%(11/3271和10/3271)。129例患者中有18例(14%)在烧伤中心入院后24小时内的细菌培养中检出一种或多种耐药菌。入院时，3.6%(117/3271)的患者发现化脓性链球菌，主要发生在10岁以下的儿童(81/1065=7.6%)。结论：影响创面愈合和引起主要感染的耐药细菌或微生物仅在少数烧伤患者入院时的细菌学标本中发现。然而，隔离和治疗方面的后果是非常重要的，这证明了入院时进行系统细菌学监测的合理性。在国外医院住院数天并被遣返的患者在入院时在我们烧伤中心表现出更多的定植。已确定的微生物不仅是(多重)耐药细菌，这表明医院环境可能很快成为污染源。这些患者应该特别注意耐药细菌。在较小的儿童中观察到HSA污染的频率更高。入院时存在的细菌似乎在预测以后的脓毒症中不起主要作用。(C)2015年爱思唯尔有限公司和ISBI。版权所有。
Introduction: In many burn centers, routine bacteriological swabs are taken from the nose, throat, perineum, and the burn wound on admission, to check for the presence of microorganisms that require specific measures in terms of isolation or initial treatment. According to the Dutch policy of "search and destroy," for example, patients infected by multiresistant bacteria have to be strictly isolated, and patients colonized with beta-hemolytic Streptococcus pyogenes must receive antibiotic therapy to prevent failed primary closure or loss of skin grafts. In this respect, the role of bacteria cultured on admission in later infectious complications is investigated. The aim of this study is to assess systematic initial bacteriological surveillance, based on an extensive Dutch data collection.Materials and methods: A total of 3271 patients primarily admitted to the Rotterdam Burn Centre between January 1987 and August 2010 with complete bacteriological swabs from nose, throat, perineum, and the burn wounds were included. For this study, microbiological surveillance was aimed at identifying resistant microorganisms such as methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Acinetobacter, and multiresistant Pseudomonas, as well as Lancefield A beta-hemolytic streptococci (HSA), in any surveillance culture.The cultures were labeled as "normal flora or non-suspicious" in the case of no growth or a typical low level of bacterial colonization in the nose, throat, and perineum and no overgrowth of one type of microorganism.Further, the blood cultures of 195 patients (6.0%) who became septic in a later phase were compared with cultures taken on admission to identify the role of the initially present microorganisms. Statistical analysis was performed using SPSS 20.0.Results: Almost 61% of the wound cultures are "non-suspicious" on admission. MRSA was cultured in 0.4% (14/3271) on admission; 12 out of these 14 patients (85.7%) were repatriated. Overall, 9.3% (12/129) of the repatriated patients were colonized with MRSA. Multiresistant Acinetobacter or Pseudomonas was detected in 0.3% (11/3271 and 10/3271, respectively). In total, 18 of the 129 repatriated patients (14%) had one or more resistant bacteria in cultures taken within the first 24 h after admission in our burn center.On admission, S. pyogenes was found in 3.6% of patients (117/3271), predominantly in children up to 10 years of age (81/1065 = 7.6%).Conclusions: Resistant bacteria or microorganisms that impede wound healing and cause major infections are found only in few bacteriological specimens obtained on admission of patients with burn wounds. However, the consequences in terms of isolation and therapy are of great importance, justifying the rationale of a systematic bacteriological surveillance on admission.Patients who have been hospitalized for several days in a hospital abroad and are repatriated show more colonization at admission in our burn center. The microorganisms identified are not only (multi) resistant bacteria, showing that a hospital environment can quickly become a source of contamination. These patients should receive special attention for resistant bacteria. HSA contamination is observed more frequently in younger children. Bacteria present at admission do not seem to play a predominant role in predicting later sepsis. (C) 2015 Elsevier Ltd and ISBI. All rights reserved.