乌干达感染烧伤患者的微生物学发现和临床结果

IF 1 Q4 CRITICAL CARE MEDICINE European burn journal Pub Date : 2023-02-07 DOI:10.3390/ebj4010007
Johannes Weinreich, Christina Namatovu, S. Nsibirwa, L. Mbabazi, H. Kajumbula, Nadine Dietze, Christoph Lübbert, Hawah Nabajja, J. Musaazi, Charles Kabugo, A. von Braun
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摘要

院内伤口感染是烧伤患者最可怕的并发症。然而,在资源匮乏的环境中,获得必要的微生物诊断是困难的。这项前瞻性观察队列研究旨在描述乌干达最大的烧伤和整形外科专科收治的伤口感染患者的细菌病原体、耐药性概况和临床结果。采集血液和伤口拭子培养进行细菌种类鉴定和抗生素敏感性试验。在2020年10月至2022年4月期间,共纳入140例患者(女性:n = 62, 44.3%),中位年龄为26岁(IQR 7-35),其中大多数(n = 101, 72.2%)为烧伤创面(72.3%为2b级,14.9%为3级)。革兰氏阴性肠杆菌、假单胞菌和不动杆菌最常从创面拭子中分离出来,几乎所有分离株都具有多重耐药,治疗方案非常有限。虽然21名(15%)研究参与者的临床结果是有利的,但大多数参与者都有残疾(轻度:n = 41,29.3%,中度:n = 52,37%,重度:n = 14(10%))。12名(8.6%)研究参与者死亡,主要死于革兰氏阴性败血症。我们的研究结果强调,迫切需要常规获得微生物诊断,以改善患者护理和当地对抗菌素耐药性的监测工作。
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Microbiological Findings and Clinical Outcomes in Ugandan Patients with Infected Burn Wounds
Nosocomial wound infections are a dreaded complication in patients with burns. However, access to the necessary microbiological diagnostics is impaired in low-resource settings. This prospective observational cohort study aimed to describe the bacterial pathogens, resistance profiles and clinical outcomes of patients with wound infections admitted to the largest specialized unit for burns and plastic surgery in Uganda. Blood and wound swab cultures were taken for bacterial species identification and antibiotic susceptibility testing. A total of 140 patients (female: n = 62, 44.3%) with a median age of 26 (IQR 7–35) years were included between October 2020 and April 2022, of which the majority (n = 101, 72.2%) had burn wounds (72.3% Grade 2b, 14.9% Grade 3). Gram-negative Enterobacterales, Pseudomonas spp. and Acinetobacter spp. were most commonly isolated from wound swabs and nearly all isolates were multidrug resistant with very limited treatment options. While the clinical outcome was favorable in 21 (15%) study participants, the majority were left with disabilities (minor: n = 41, 29.3%, moderate: n = 52, 37%, major: n = 14 (10%)). Twelve (8.6%) study participants died, mostly of Gram-negative sepsis. Our findings highlight the urgent need for routine access to microbiological diagnostics to improve patient care and local surveillance efforts on antimicrobial resistance.
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