重症烧伤患者医院感染病原学及耐药性分析

Etiological analysis of nosocomial infections in severe burn patients and analysis of drug resistance

目的调查重症烧伤患者医院感染的特点,分析病原菌的分布及药敏特征,关注患者血清中IL-18和IL-23的表达特点,以期为临床观察感染患者的病情及治疗提供帮助。方法收集医院180例重症烧伤患者的临床资料,同时重点关注医院感染的患者,调查感染率、病原菌的特点及药敏特征、感染患者血清中IL-18、IL-23的表达特点,采用SAS6.12进行统计分析,应用χ2检验或t检验。结果共82例患者发生医院感染,感染率为45.56%,创面感染64例、肺部感染10例、泌尿系感染5例、消化系感染3例;患者感染分泌物送检标本共培养出细菌136株,其中革兰阴性菌76株,革兰阳性菌60株;革兰阳性菌中金黄色葡萄球菌和溶血葡萄球菌最多,对万古霉素高度敏感;革兰阴性菌中铜绿假单胞菌和肺炎克雷伯菌最多,对亚胺培南高度敏感,患者感染后血清中IL-18、IL-23的表达明显增高。结论重症烧伤患者感染高发,血清中以IL-18、IL-23为代表的炎性因子变化明显,临床应加强医院感染的管理,对出现感染的患者,要进行分泌物的培养及药敏试验,以期对临床治疗提供帮助。

OBJECTIVE To observe the characteristics of nosocomial infections in the severe burn patients, analyze the distribution and drug susceptibility of pathogens, and pay attention to the expression of IL-18 and IL-23 in serum so as to provide guidance for the clinical treatment of nosocomial infections. METHODS The clinical data of 180 severe burn patients were collected, meanwhile, great attention should be paid to the patients with nosocomial infections, then the incidence of infections, distribution of pathogens, drug susceptibility rate, and expression of serum IL-18 and IL-23 were observed, the statistical analysis was performed with the use of SAS6. 12, and the chi-square test or the t-test was conducted. RESULTS The nosocomial infections occurred in 82 cases with the infection rate of 45.56%, including 64 cases of wound infections, 10 cases of pulmonary infections, 5 cases of urinary tract infections, and 3 cases of gastrointestinal tract infections. Totally 136 strains of pathogens have been isolated from the submitted secretions obtained from the patients with infections, among which there were 76 strains of gram-negative bacteria and 60 strains of gram-positive bacteria; Staphylococcus aureus and Staphylococcus haemolyticus were the predominant species of gram-positive bacteria and were highly susceptible to vancomycin ; Pseudomonas aeruginosa and Klebsiella pneumoniae were the most common species of gram-negative bacteria and were highly susceptible to imipenem. The expression of serum IL-18 or IL-23 was significantly elevated in the patients with infections. CONCLUSION The incidence of nosocomial infections is high in the severe burn patients; the expression of the inflammatory factors such as serum IL-18 and IL-23 changes significantly; it is necessary for the hospital to strengthen the control of nosocomiaI infections and perform the culture of secretions obtained from the patients with infections so as to provide guidance for the clinical treatment.