烧伤患者创面感染的病原菌分布及相关危险因素分析

Analysis of pathogens distribution and risk factors of burn infections in burn patients

目的调查分析烧伤患者创面感染的病原菌分布,探讨烧伤患者创面感染的危险因素,以期为临床有效预防和治疗烧伤患者创面感染提供理论依据。方法选取解放军联勤保障部队第九二六医院2016年1月至2020年12月期间收治的245例烧伤患者,对其创面分泌物病原菌种类及抗菌药物敏感性进行检测,收集其临床相关资料,采用单因素比较法和多因素logistic回归法对引起烧伤创面感染的危险因素进行分析。结果245例烧伤患者中有184例患者发生创面感染,细菌感染率75.10%(184/245),其中多重耐药菌感染占42.93%(79/184)。共检出367株病原菌,其中革兰阳性菌19.62%(72/367),以金黄色葡萄球菌为主,占11.44%(42/367);革兰阴性杆菌株77.11%(283/367),以铜绿假单胞菌和鲍曼不动杆菌为主,分别占20.16%(74/367)和19.89%(73/367);真菌占3.27%(12/367),以曲霉菌为主,占1.91%(7/367)。药敏结果显示导致烧伤患者发生创面感染的病原菌对常见抗菌药物耐药性均较高。单因素分析结果显示,年龄(χ^(2)=8.629,P=0.013)、烧伤面积(χ^(2)=21.504,P=0.002)、烧伤深度(χ^(2)=17.139,P<0.01)、伴有低血容量性休克(χ^(2)=21.112,P=0.000)及住院时长(χ^(2)=21.967,P=0.000)均是导致烧伤创面感染的相关危险因素。多因素Logistic回归分析结果显示,患者年龄<4岁或>69岁(OR=8.414,95%CI:2.971~23.830,P=0.000)、烧伤面积>30%(OR=5.672,95%CI:1.029~31.272,P=0.046)、创面深度达Ⅲ度(OR=4.069,95%CI:1.396~11.858,P=0.010)、住院时间≥15 d(OR=2.593,95%CI:1.091~6.162,P=0.031)是引起烧伤患者创面感染的独立危险因素。结论烧伤患者创面细菌感染率及耐药率高,以革兰阴性菌为主,年龄、烧伤面积、烧伤深度、住院时间是烧伤患者创面感染的高危因素,可针对创面感染危险因素采取针对性措施,降低患者创面感染及医院感染的发生。

Objective To investigate and analyze the distribution of pathogens and to explore the related risk factors of infections in burn patients in order to provide theoretical basis for effective prevention and treatment of wound infections in burn patients.Methods A total of 245 burn patients,admitted to the PLA 926 Hospital from January 2016 to December 2020,were selected.The pathogens and antimicrobial susceptibility of the wound secretions were tested and the clinical data of burn patients were collected.The risk factors of burn wound infection were screened by single factor comparison method and multivariate logistic regression.Results Among the 245 burn patients,184 patients were with bacterial infections,the infection rate was 75.10%(184/245),and 79 patients were multi-drug resistant,accounting for 42.93%(79/184).A total of 367 strains of pathogens were isolated from wound secretions in the 184 patients,among which 72(19.62%,72/367)strains were gram-positive bacteria,mainly Staphylococcus aureus(11.44%,42/367),283(77.11%,283/367)strains were gram-negative bacteria,mainly Pseudomonas aeruginosa(20.16%,74/367)and Acinetobacter baumannii(19.89%,73/367),and 12(3.27%,12/367)strains were fungi,mainly Aspergillus(1.91%,7/367).The results of drug sensitivity tests showed that the pathogens of burn patients were highly resistant to common antibiotics.Monofactor analysis showed that age(χ^(2)=8.629,P=0.013),burn area(χ^(2)=21.504,P=0.002),wound depth(χ^(2)=17.139,P=0.000),hypovolemic shock(χ^(2)=21.112,P=0.000)and length of hospital stay(χ^(2)=21.967,P=0.000)were the related risk factors for wound infections.Multivariate logistic regression analysis showed that ages below 4 years old or over 69 years old(OR=8.414,95%CI:2.971-23.830,P=0.000),burn area>30%(OR=5.672,95%CI:1.029-31.272,P=0.046),Ⅲdegree wound(OR=4.069,95%CI:1.396-11.858,P=0.010),length of hospital stay≥15 days(OR=2.593,95%CI:1.091-6.162,P=0.031)were the independent risk factors of wound infections in burn patients.Conclusions The incidence of wound infection and multi-drug resistance is relatively high in burn patients,and the pathogens are mainly gram-negative bacteria.Age,burn area,burn wound depth and length of hospital stay are the high-risk factors for wound infections,and taking effective preventive measures according to risk factors can reduce the occurrence of wound infections and hospital infections.