严重烧伤合并真菌感染五例

Five patients with severe burns complicated by fungal infection

2016年6—11月,笔者单位收治5例特重度烧伤患者,入院早期经验性应用广谱抗生素抗细菌感染和氟康唑抗真菌感染。伤后7~21d,5例患者均发生真菌感染,根据真菌培养结果选用卡泊芬净、伏立康唑或两性霉素B脂质体,并对感染创面行多次清创及换药处理,待创面感染控制后,多次行自体皮移植术。经5~11d积极的抗真菌感染治疗及创面处理后,2例患者病情趋于稳定,创面分泌物多次培养未见真菌,入院后52~54d创面愈合出院;3例患者因烧伤程度重和/或年龄偏大,真菌感染由四肢创面迅速扩大至躯干,后续发展成烧伤脓毒症导致多脏器功能衰竭而死亡。

From June to November 2016, 5 patients with severe burns were admitted to our unit. Broad-spectrum antibiotic and fluconazole were used on patients as earlier empirical anti-infection therapy of bacteria and fungi. Seven to twenty-one days after injury, 5 patients developed fungal infection. Antifungal agents of caspofungin, voriconazole, and amphotericin B liposomewere were used according to the results of fungal culture, and the infected wounds were also treated with repeated debridement and dressing change. Multiple autologous skin grafts were performed after infection control of wounds. With the above antifungal infection treatment for 5 to 11 days, 2 patients′ condition tended to be stable, and no fungus was found in wound secretion after cultured for many times. The patients were discharged with wounds healed after 52 to 54 days′ hospital stay. Due to severe burns degree and or elder age, fungal infection aggravated and expanded to the trunk in the other 3 patients, then developed into burn sepsis, resulting in patients died of multiple organ failure secondary to sepsis.