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Article(id=1240950902610260704, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240950898113966774, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202310175, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1697040000000, receivedDateStr=2023-10-12, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773795350934, onlineDateStr=2026-03-18, pubDate=1712678400000, pubDateStr=2024-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773795350934, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773795350934, creator=13701087609, updateTime=1773795350934, updator=13701087609, issue=Issue{id=1240950898113966774, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='7', pageStart='1153', pageEnd='1344', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773795349862, creator=13701087609, updateTime=1773795519367, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240951609136567133, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240950898113966774, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240951609136567134, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240950898113966774, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1295, endPage=1301, ext={EN=ArticleExt(id=1240950902987748074, articleId=1240950902610260704, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The epidemiological characteristics and etiological analysis of infection in 2 434 hospitalized burn patients, columnId=1228016572065837304, journalTitle=Modern Preventive Medicine, columnName=Experimental Technology and Applications, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the epidemiological characteristics and pathogen distribution of burn patients at the hospital.

Methods

The medical records of 2 434 burn patients who met the inclusion criteria in the First Affiliated Hospital of Anhui Medical University from 2019 to 2022 were analyzed, including sex, age, injury factors, burn site, burn severity, and seasonal distribution of burns, as well as the type of pathogen of infection, the source of tissue/body fluid and its drug resistance. The species of pathogens were identified by Matter-assisted Laser Desorption Time-of-flight Mass Spectrometry (VITEK-MS), and the drug sensitivity of the top three pathogens was determined by VITEK2 Compact. SPSS27.0 and WHONET5.6 statistical software were used to analyze the data.

Results

A total of 2 434 burn patients were enrolled in this study, with a male-to-female ratio of 2.2915. The average age was 29.8 ±25.95 years old. Adults and the elderly were most likely to have burns in summer, while children were more likely to suffer from burns in spring. Hot water scald was the main cause of disease. A total of 952 strains of pathogenic bacteria were collected, all of which were isolated for the first time. The top five pathogens were Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Klebsiella pneumoniae, and Enterobacter cloacae. The number of pathogens isolated from wound secretions was the largest, accounting for 83.93% (799/952). The resistance rate of Pseudomonas aeruginosa to the first and second generation cephalosporins was 100%, but the resistance rate to aztreonam, tobramycin,and piperacillin decreased. The resistance rates of Acinetobacter baumannii to polymyxin B, minocycline, and tigecyclines were all 0, and the resistance rates to other antibiotics were all ≥ 50.0%. The resistance rate to penicillin and Staphylococcus aureus was more than 90%, but it was completely sensitive to vancomycin, linezolid, tigecyclines, and ampicillin/sulbactam.

Conclusion

Based on the age range division, there are significant differences in gender, cause of injury, prehospital treatment, burn severity, and burn site. Scald is the main cause of injury, limbs are the most prone to burn, and cases occur in summer most commonly. The main pathogen of burn infection is Pseudomonas aeruginosa, which mainly comes from wound secretions.

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目的

研究院内烧伤患者的流行病特征和感染的病原菌分布特征。

方法

分析2019—2022年安徽医科大学第一附属医院所收治的符合入选标准的2 434例住院烧伤患者病历资料，包括患者性别、年龄、致伤因素、烧伤部位、烧伤严重程度、烧伤季节分布，以及感染的病原菌类型、组织/体液来源和其耐药情况。采用基质辅助激光解吸飞行时间质谱(matter-assisted laser desorption time-of-flight mass spectrometry，VITEK-MS)鉴定病原菌种类，并用VITEK 2 Compact测定排在前三位病原菌的药物敏感度。采用SPSS 27.0和WHONET 5.6统计软件对数据进行分析。

结果

本研究共纳入2 434例烧伤患者，男女比例为2.29:1，平均年龄（29.8±25.95）岁。成人和老人夏季最易发生烧伤，儿童多见于春季。热水烫伤是主要致病原因。共收集952株感染病原菌，且均为非重复首次分离株，前五位的病原菌依次为铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌和阴沟肠杆菌。从创面分泌物中分离出的病原菌数量最多，占83.93%(799/952)。铜绿假单胞菌对一、二代头孢耐药率为100%，但对氨曲南、妥布霉素、哌拉西林等耐药率有下降趋势。鲍曼不动杆菌对多黏菌素B、米诺环素和替加环素耐药率均为0，对其它试验的抗生素耐药率均≥50.0%。对青霉素，金黄色葡萄球菌的耐药率超出90.0%，但对万古霉素、利奈唑胺、替加环素和氨苄西林/舒巴坦完全敏感。

结论

基于年龄段划分，患者在性别、受伤原因、院前是否处理、烧伤严重程度和烧伤部位这些方面存在明显差异。烫伤是主要的受伤原因，四肢是最容易烧伤部位，病患在夏季最为常见。烧伤患者感染的主要病原菌是铜绿假单胞菌，主要来源于创面分泌物。

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王中新，E-mail:
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丁守甫（1991—），男，主管技师，研究方向；烧伤患者的预防，预后及耐药监测

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丁守甫（1991—），男，主管技师，研究方向；烧伤患者的预防，预后及耐药监测

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丁守甫（1991—），男，主管技师，研究方向；烧伤患者的预防，预后及耐药监测

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Access Microbiol, 2021, 3(10): 273., articleTitle=Photodynamic antimicrobial chemotherapy coupled with the use of the photosensitizers methylene blue and temoporfin as a potential novel treatment for Staphylococcus aureus in burn infections, refAbstract=null), Reference(id=1240972176745099280, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, doi=null, pmid=null, pmcid=null, year=2020, volume=17, issue=12, pageStart=1655, pageEnd=1658, url=null, language=null, rfNumber=[14], rfOrder=17, authorNames=付晓蕊, 康蓓佩, 徐修礼, journalName=检验医学与临床, refType=null, unstructuredReference=付晓蕊，康蓓佩，徐修礼，等.烧伤科患者分离金黄色葡萄球菌耐药性和耐药基因分析[J].检验医学与临床，2020，17（12）：1655-1658., articleTitle=烧伤科患者分离金黄色葡萄球菌耐药性和耐药基因分析, refAbstract=null), Reference(id=1240972176933842967, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, doi=null, pmid=null, pmcid=null, year=2020, volume=17, issue=12, pageStart=1655, pageEnd=1658, url=null, language=null, rfNumber=[14], rfOrder=18, authorNames=Fu XR, Kang BP, Xu XL, journalName=Laboratory Medicine and Clinic, refType=null, unstructuredReference=Fu XR, Kang BP, Xu XL, et al. Drug resistance and resistance gene analysis of Staphylococcus aureus isolated from patients in the department of burns[J]. Laboratory Medicine and Clinic, 2020, 17(12): 1655-1658., articleTitle=Drug resistance and resistance gene analysis of Staphylococcus aureus isolated from patients in the department of burns, refAbstract=null), Reference(id=1240972177021923355, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, doi=null, pmid=null, pmcid=null, year=2010, volume=14, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[15], rfOrder=19, authorNames=Brusselaers N, Monstrey S, Vogelaers D, journalName=Crit Care, refType=null, unstructuredReference=Brusselaers N, Monstrey S, Vogelaers D, et al. Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality[J]. Crit Care, 2010, 14: R188., articleTitle=Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1240972164615172522, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, xref=null, ext=[AuthorCompanyExt(id=1240972164640338351, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, companyId=1240972164615172522, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, China), AuthorCompanyExt(id=1240972164644532656, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, companyId=1240972164615172522, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=安徽医科大学第一附属医院，安徽 合肥 230000)])], figs=[ArticleFig(id=1240972168796893878, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=EN, label=Figure 1, caption=Injury season distribution of hospitalized burn patients in 3 age groups, figureFileSmall=APVxwc3pn/7+QjqrAreBsw==, figureFileBig=q2xgvidpjOcwrPgE4CLrGQ==, tableContent=null), ArticleFig(id=1240972168893362879, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=CN, label=图1, caption=三个年龄段烧伤住院患者受伤季节分布, figureFileSmall=APVxwc3pn/7+QjqrAreBsw==, figureFileBig=q2xgvidpjOcwrPgE4CLrGQ==, tableContent=null), ArticleFig(id=1240972169061135053, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=EN, label=Figure 2, caption=Distribution of injury factors among hospitalized burn patients in 3 age groups, figureFileSmall=xraIY42dCGMeZlfz478iqQ==, figureFileBig=PrAJyUMFepGIH+JorT3Gkg==, tableContent=null), ArticleFig(id=1240972169254073054, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=CN, label=图2, caption=三个年龄段烧伤住院患者致伤因素分布, figureFileSmall=xraIY42dCGMeZlfz478iqQ==, figureFileBig=PrAJyUMFepGIH+JorT3Gkg==, tableContent=null), ArticleFig(id=1240972169388290798, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=EN, label=Figure 3, caption=Distribution of prehospital treatment of hospitalized patients with different burn causes, figureFileSmall=X3exnHGWfAapbXDMZ7HYlg==, figureFileBig=Yb6V+ZHdxOkDWW8tUjBfsA==, tableContent=null), ArticleFig(id=1240972170860491507, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=CN, label=图3, caption=不同致伤因素住院患者院前处理分布, figureFileSmall=X3exnHGWfAapbXDMZ7HYlg==, figureFileBig=Yb6V+ZHdxOkDWW8tUjBfsA==, tableContent=null), ArticleFig(id=1240972171070206719, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=EN, label=Figure 4, caption=Distribution of burn factors in patients with different burn severity, figureFileSmall=O5MZ3GLAf0u3WKdAY2b5jg==, figureFileBig=Ndb1qG2Ct2guVX92GNDN7w==, tableContent=null), ArticleFig(id=1240972171204424462, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=CN, label=图4, caption=不同烧伤严重程度患者烧伤因素的分布, figureFileSmall=O5MZ3GLAf0u3WKdAY2b5jg==, figureFileBig=Ndb1qG2Ct2guVX92GNDN7w==, tableContent=null), ArticleFig(id=1240972171351225116, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=EN, label=Figure 5, caption=Distribution of injured sites in hospitalized burn patients of 3 age groups, figureFileSmall=iAGzNY8ZIaWtcpqUQWIuzg==, figureFileBig=jhC7xmRt8pwLqSuVugHyhA==, tableContent=null), ArticleFig(id=1240972171456082725, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=CN, label=图5, caption=三个年龄段烧伤住院患者受伤部位分布, figureFileSmall=iAGzNY8ZIaWtcpqUQWIuzg==, figureFileBig=jhC7xmRt8pwLqSuVugHyhA==, tableContent=null), ArticleFig(id=1240972171661603635, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=EN, label=Table 1, caption=

Epidemiological characteristics of hospitalized burn patients ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
烧伤情况例数（n=2 434）年龄组（岁）P值
≤14（n=973）15～59（n=1 130）≥60（n=331）
性别<0.001
男性1 512(62.12)588(60.43)753(66.63)171(51.66)
女性922(37.88)385(39.57)377(33.37)160(48.34)
受伤季节>0.05
春季621(25.51)287(29.50)259(22.90)75(22.66)
夏季821(33.73)283(29.09)404(35.75)134(40.48)
秋季383(15.74)143(14.70)193(17.08)47(14.20）
冬季609(25.02)260(26.71)274(24.27)75(22.66)
致伤因素<0.001
热水烫伤1 326(54.48)863(88.70)344(30.44)119(35.95)
火焰烧伤860(35.33)90(9.25)578(51.15)192(58.00)
电击烧伤205(8.40)18(1.85)174(15.40)13(3.93)
化学烧伤43(1.79)2(0.20)34(3.01)7(2.12)
烧伤后处理<0.001
院前处理365(15.00)200(20.55)143(12.65)22(6.65)
院前未处理2 069(85.00)773(79.45)987(87.35)309(93.35)
烧伤严重程度<0.001
轻度293(12.04)74(7.60)176(15.58)43(12.99)
中度1 634(67.13)699(71.84)717(63.45)218(65.86)
重度287(11.79)135(13.87)114(19.09)38(11.48)
特重度220(9.04)65(6.69)123(1.88)32(9.67)
烧伤部位
头面颈1 029356545128
躯干1 080527434119
四肢2 0516991 042310
其他1864411230
), ArticleFig(id=1240972171787432764, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=CN, label=表1, caption=

烧伤住院患者的流行病学特征［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
烧伤情况例数（n=2 434）年龄组（岁）P值
≤14（n=973）15～59（n=1 130）≥60（n=331）
性别<0.001
男性1 512(62.12)588(60.43)753(66.63)171(51.66)
女性922(37.88)385(39.57)377(33.37)160(48.34)
受伤季节>0.05
春季621(25.51)287(29.50)259(22.90)75(22.66)
夏季821(33.73)283(29.09)404(35.75)134(40.48)
秋季383(15.74)143(14.70)193(17.08)47(14.20）
冬季609(25.02)260(26.71)274(24.27)75(22.66)
致伤因素<0.001
热水烫伤1 326(54.48)863(88.70)344(30.44)119(35.95)
火焰烧伤860(35.33)90(9.25)578(51.15)192(58.00)
电击烧伤205(8.40)18(1.85)174(15.40)13(3.93)
化学烧伤43(1.79)2(0.20)34(3.01)7(2.12)
烧伤后处理<0.001
院前处理365(15.00)200(20.55)143(12.65)22(6.65)
院前未处理2 069(85.00)773(79.45)987(87.35)309(93.35)
烧伤严重程度<0.001
轻度293(12.04)74(7.60)176(15.58)43(12.99)
中度1 634(67.13)699(71.84)717(63.45)218(65.86)
重度287(11.79)135(13.87)114(19.09)38(11.48)
特重度220(9.04)65(6.69)123(1.88)32(9.67)
烧伤部位
头面颈1 029356545128
躯干1 080527434119
四肢2 0516991 042310
其他1864411230
), ArticleFig(id=1240972171892290373, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=EN, label=Table 2, caption=

Distribution of pathogens detected in hospitalized burn patients from 2019 to 2022 (strains)

, figureFileSmall=null, figureFileBig=null, tableContent=
年份（年）菌株数铜绿鲍曼肺克金葡阴沟大肠粪肠溶葡嗜麦芽其他
201934598725047221991198
20201843928174115184976
20212064256213418146834
20222175433283820218843
合计952233189116160757227362321
), ArticleFig(id=1240972172030702415, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=CN, label=表2, caption=

2019—2022年住院治疗的烧伤患者病原菌的分布情况（株）

, figureFileSmall=null, figureFileBig=null, tableContent=
年份（年）菌株数铜绿鲍曼肺克金葡阴沟大肠粪肠溶葡嗜麦芽其他
201934598725047221991198
20201843928174115184976
20212064256213418146834
20222175433283820218843
合计952233189116160757227362321
), ArticleFig(id=1240972172181697370, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=EN, label=Table 3, caption=

Detection of pathogenic bacteria in different parts of hospitalized burn patients from 2019 to 2022 (strains)

, figureFileSmall=null, figureFileBig=null, tableContent=
年份
（年）		菌株数创面分泌物组织咽拭子导管尿痰导尿管脓液血骨髓脑脊液
201933626914123512116400
20202382089623233200
202120817912500352110
202217014310312460001
合计9527994526610212511711
), ArticleFig(id=1240972172332692325, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=CN, label=表3, caption=

2019—2022年住院治疗的烧伤患者不同部位病原菌的检出情况（株）

, figureFileSmall=null, figureFileBig=null, tableContent=
年份
（年）		菌株数创面分泌物组织咽拭子导管尿痰导尿管脓液血骨髓脑脊液
201933626914123512116400
20202382089623233200
202120817912500352110
202217014310312460001
合计9527994526610212511711
), ArticleFig(id=1240972172450132847, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=EN, label=Table 4, caption=

Source distribution of strains in tissues or body fluids of burn patients (strains)

, figureFileSmall=null, figureFileBig=null, tableContent=
菌名菌株数创面分泌物组织咽拭子导管尿痰导尿管血骨髓脑脊液脓液
铜绿假单胞菌23320611432510001
鲍曼不动杆菌1891633701652002
金黄色葡萄球菌16013210301243113
肺炎克雷伯116984502330001
阴沟肠杆菌75633310130001
大肠埃希菌72529102060002
溶血葡萄球菌36320100021000
粪肠球菌27213010010001
嗜麦芽窄食单胞菌23190101200000
其他21132111201000
合计9527994526610212571111
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菌株在烧伤患者组织或体液的来源分布情况（株）

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菌名菌株数创面分泌物组织咽拭子导管尿痰导尿管血骨髓脑脊液脓液
铜绿假单胞菌23320611432510001
鲍曼不动杆菌1891633701652002
金黄色葡萄球菌16013210301243113
肺炎克雷伯116984502330001
阴沟肠杆菌75633310130001
大肠埃希菌72529102060002
溶血葡萄球菌36320100021000
粪肠球菌27213010010001
嗜麦芽窄食单胞菌23190101200000
其他21132111201000
合计9527994526610212571111
), ArticleFig(id=1240972172680819584, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=EN, label=Table 5, caption=

The resistance rate (%) of pathogens to commonly used antibiotics in burn patients from 2019 to 2022

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抗菌药物铜绿假单胞菌耐药率鲍曼不动杆菌耐药率金黄色葡萄球菌耐药率
2019年2020年2021年2022年2019年2020年2021年2022年2019年2020年2021年2022年
(n=98）(n=39)(n=42)(n=54)（n=72)(n=28)(n=56)(n=33）(n=47)(n=41)(n=34)(n=38)
哌拉西林54.411.59.70.087.780.096.786.0————
CSL59.87.121.419.421.560.091.888.0
TZP48.27.720.90.0————
头孢他啶21.723.120.915.890.785.795.8100.0
头孢吡肟31.52.616.30.067.567.995.8100.0
氨曲南55.028.120.09.1————
亚胺培南30.87.711.631.685.776.095.790.0
美罗培南28.00.014.70.075.972.796.0100.0
阿米卡星9.12.614.00.037.171.493.8100.0————
庆大霉素65.017.914.625.990.985.795.8100.070.65147.20.0
妥布霉素60.815.414.00.089.685.794.1100.0————
环丙沙星67.87.714.00.090.985.794.9100.074.556.947.231.6
LEV66.47.714.00.080.885.785.583.372.55647.216.7
厄他培南0.00.00.00.0————0.00.00.0—
SAM————88.385.794.1100———
头孢唑啉100.0100.0100.0100.0
头孢曲松90.985.795.890.1
头孢噻肟88.385.096.8100
米诺环素7.00.00.00————
替加环素0.00.00.000.00.00.00.0
PB0.00.00.00————
复方新诺明85.785.791.5100.0————
青霉素G————98.096.198.195.5
苯唑西林94.989.7100.050.0
利福平68.651.041.517.9
莫西沙星72.054.943.446.2
克林霉素13.011.89.442.3
红霉素84.370.669.844.4
四环素74.564.045.30.0
QDA3.92.00.00.0
利奈唑胺0.00.00.00.0
万古霉素————————0.00.00.00.0
), ArticleFig(id=1240972172781482889, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240950902610260704, language=CN, label=表5, caption=

2019—2022年住院烧伤患者检出病原菌对常用抗菌药物的耐药率（%）

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抗菌药物铜绿假单胞菌耐药率鲍曼不动杆菌耐药率金黄色葡萄球菌耐药率
2019年2020年2021年2022年2019年2020年2021年2022年2019年2020年2021年2022年
(n=98）(n=39)(n=42)(n=54)（n=72)(n=28)(n=56)(n=33）(n=47)(n=41)(n=34)(n=38)
哌拉西林54.411.59.70.087.780.096.786.0————
CSL59.87.121.419.421.560.091.888.0
TZP48.27.720.90.0————
头孢他啶21.723.120.915.890.785.795.8100.0
头孢吡肟31.52.616.30.067.567.995.8100.0
氨曲南55.028.120.09.1————
亚胺培南30.87.711.631.685.776.095.790.0
美罗培南28.00.014.70.075.972.796.0100.0
阿米卡星9.12.614.00.037.171.493.8100.0————
庆大霉素65.017.914.625.990.985.795.8100.070.65147.20.0
妥布霉素60.815.414.00.089.685.794.1100.0————
环丙沙星67.87.714.00.090.985.794.9100.074.556.947.231.6
LEV66.47.714.00.080.885.785.583.372.55647.216.7
厄他培南0.00.00.00.0————0.00.00.0—
SAM————88.385.794.1100———
头孢唑啉100.0100.0100.0100.0
头孢曲松90.985.795.890.1
头孢噻肟88.385.096.8100
米诺环素7.00.00.00————
替加环素0.00.00.000.00.00.00.0
PB0.00.00.00————
复方新诺明85.785.791.5100.0————
青霉素G————98.096.198.195.5
苯唑西林94.989.7100.050.0
利福平68.651.041.517.9
莫西沙星72.054.943.446.2
克林霉素13.011.89.442.3
红霉素84.370.669.844.4
四环素74.564.045.30.0
QDA3.92.00.00.0
利奈唑胺0.00.00.00.0
万古霉素————————0.00.00.00.0
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2 434例住院烧伤患者的流行病学特征及其感染的病原学分析
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丁守甫 , 李聪 , 潘亚萍 , 王中新
现代预防医学 | 实验技术及其应用 2024,51(7): 1295-1301
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现代预防医学 | 实验技术及其应用 2024, 51(7): 1295-1301
2 434例住院烧伤患者的流行病学特征及其感染的病原学分析
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丁守甫, 李聪, 潘亚萍, 王中新
作者信息
  • 安徽医科大学第一附属医院，安徽 合肥 230000

    • 丁守甫（1991—），男，主管技师，研究方向；烧伤患者的预防，预后及耐药监测

通讯作者:

王中新，E-mail:
The epidemiological characteristics and etiological analysis of infection in 2 434 hospitalized burn patients
Shou-fu DING, Cong LI, Ya-ping PAN, Zhong-xin WANG
Affiliations
  • The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, China
出版时间: 2024-04-10 doi: 10.20043/j.cnki.MPM.202310175
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摘要
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目的

研究院内烧伤患者的流行病特征和感染的病原菌分布特征。

方法

分析2019—2022年安徽医科大学第一附属医院所收治的符合入选标准的2 434例住院烧伤患者病历资料，包括患者性别、年龄、致伤因素、烧伤部位、烧伤严重程度、烧伤季节分布，以及感染的病原菌类型、组织/体液来源和其耐药情况。采用基质辅助激光解吸飞行时间质谱(matter-assisted laser desorption time-of-flight mass spectrometry，VITEK-MS)鉴定病原菌种类，并用VITEK 2 Compact测定排在前三位病原菌的药物敏感度。采用SPSS 27.0和WHONET 5.6统计软件对数据进行分析。

结果

本研究共纳入2 434例烧伤患者，男女比例为2.29:1，平均年龄（29.8±25.95）岁。成人和老人夏季最易发生烧伤，儿童多见于春季。热水烫伤是主要致病原因。共收集952株感染病原菌，且均为非重复首次分离株，前五位的病原菌依次为铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌和阴沟肠杆菌。从创面分泌物中分离出的病原菌数量最多，占83.93%(799/952)。铜绿假单胞菌对一、二代头孢耐药率为100%，但对氨曲南、妥布霉素、哌拉西林等耐药率有下降趋势。鲍曼不动杆菌对多黏菌素B、米诺环素和替加环素耐药率均为0，对其它试验的抗生素耐药率均≥50.0%。对青霉素，金黄色葡萄球菌的耐药率超出90.0%，但对万古霉素、利奈唑胺、替加环素和氨苄西林/舒巴坦完全敏感。

结论

基于年龄段划分，患者在性别、受伤原因、院前是否处理、烧伤严重程度和烧伤部位这些方面存在明显差异。烫伤是主要的受伤原因，四肢是最容易烧伤部位，病患在夏季最为常见。烧伤患者感染的主要病原菌是铜绿假单胞菌，主要来源于创面分泌物。

烧伤  /  流行病学  /  病原菌
Objective

To investigate the epidemiological characteristics and pathogen distribution of burn patients at the hospital.

Methods

The medical records of 2 434 burn patients who met the inclusion criteria in the First Affiliated Hospital of Anhui Medical University from 2019 to 2022 were analyzed, including sex, age, injury factors, burn site, burn severity, and seasonal distribution of burns, as well as the type of pathogen of infection, the source of tissue/body fluid and its drug resistance. The species of pathogens were identified by Matter-assisted Laser Desorption Time-of-flight Mass Spectrometry (VITEK-MS), and the drug sensitivity of the top three pathogens was determined by VITEK2 Compact. SPSS27.0 and WHONET5.6 statistical software were used to analyze the data.

Results

A total of 2 434 burn patients were enrolled in this study, with a male-to-female ratio of 2.2915. The average age was 29.8 ±25.95 years old. Adults and the elderly were most likely to have burns in summer, while children were more likely to suffer from burns in spring. Hot water scald was the main cause of disease. A total of 952 strains of pathogenic bacteria were collected, all of which were isolated for the first time. The top five pathogens were Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Klebsiella pneumoniae, and Enterobacter cloacae. The number of pathogens isolated from wound secretions was the largest, accounting for 83.93% (799/952). The resistance rate of Pseudomonas aeruginosa to the first and second generation cephalosporins was 100%, but the resistance rate to aztreonam, tobramycin,and piperacillin decreased. The resistance rates of Acinetobacter baumannii to polymyxin B, minocycline, and tigecyclines were all 0, and the resistance rates to other antibiotics were all ≥ 50.0%. The resistance rate to penicillin and Staphylococcus aureus was more than 90%, but it was completely sensitive to vancomycin, linezolid, tigecyclines, and ampicillin/sulbactam.

Conclusion

Based on the age range division, there are significant differences in gender, cause of injury, prehospital treatment, burn severity, and burn site. Scald is the main cause of injury, limbs are the most prone to burn, and cases occur in summer most commonly. The main pathogen of burn infection is Pseudomonas aeruginosa, which mainly comes from wound secretions.

Burn  /  Epidemiology  /  Pathogenic bacteria
丁守甫, 李聪, 潘亚萍, 王中新. 2 434例住院烧伤患者的流行病学特征及其感染的病原学分析. 现代预防医学, 2024 , 51 (7) : 1295 -1301 . DOI: 10.20043/j.cnki.MPM.202310175
Shou-fu DING, Cong LI, Ya-ping PAN, Zhong-xin WANG. The epidemiological characteristics and etiological analysis of infection in 2 434 hospitalized burn patients[J]. Modern Preventive Medicine, 2024 , 51 (7) : 1295 -1301 . DOI: 10.20043/j.cnki.MPM.202310175
正文
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烧伤是最常见的意外之一，烧伤流行病学的调查研究对于开展本地区的烧伤防止体系的建立有重要的指导意义。研究表明，开展有针对性地防治工作，可以有效的降低烧伤造成的负担[1]。烧伤在年龄、地区分布上表现明显的差异性。针对不同年龄段的人群应采用不同的预防措施。烧伤造成的复杂创面及浸入性的治疗等其它因素，使病人具有很高的感染风险[2]。感染是引发烧伤致死的主要因素[3]。在烧伤科，抗菌药物的选择通常基于经验，而不是等待细菌培养结果。但烧伤感染的病原菌种类和耐药性在不同地区和医院之间差异较大，因此定期监控本地烧伤患者感染的病原菌类型和耐药性是防止院内感染和提高治愈率的核心措施[4]。本项研究通过研究分析医院烧伤病人的致伤原因、感染部位以及菌种分布的特征，以提供对烧伤预防和治疗有益的信息，进而有助于降低烧伤的发病和死亡率。
1　对象与方法
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1.1　病例纳入与排除标准
1.1.1　纳入标准
因烧伤、电击伤等原因首次住院的患者。
1.1.2　排除标准：
（1）病历资料不齐全。（2）仅进行门诊治疗和住院时间不足24 h的患者。（3）同一烧伤患者只计入首次住院病历资料。（4）慢性创面或瘢痕住院治疗者需排除。
1.2　调查对象
2019—2022年在安徽医科大学第一附属医院接受治疗的2 434例患者信息。本次调查研究获得安徽医科大学第一附属医院临床医学研究伦理委员会批准（批准文号：PJ2023-14-90）。收集的信息包括年龄、性别、烧伤部位、致伤因素、烧伤严重程度及烧伤季节分布等基本信息和感染的病原菌种类及来源，以及病原菌的耐药情况来进行分析。烧伤严重程度依据我国烧伤严重程度分类标准，分为轻度、中度、重度及特重度。此外，在总烧伤面积低于16%体表面积的情况下，如若患者全身状况恶化或陷入休克、存在严重创伤或药品中毒，或者伴有眼部、面部、颈部、手部、会阴部烧伤或吸入性伤害等，也会被视作为为重度烧伤。患者被分为三个年龄组：儿童（14岁或以下）、成人（15～59岁）和老年人（60岁或以上）。
1.3　菌株的分离鉴定
根据《全国临床检验操作规程》的各项规章，采集患者的标本立即接种于培养皿，置于35～37 ℃体积分数5%二氧化碳的培养箱里进行恒温培养18～24 h。用VITEK-MS对分离出的菌种进行病原学鉴定。
1.4　菌株的药物敏感试验
VITEK-2 Compact全自动微生物分析系统（法国梅里埃公司）进行药敏试验，并参照美国临床实验室标准化研究所标准（CLSI）进行结果判读。
1.5　数据处理
采用SPSS 27.0统计软件和WHONET 5.6统计软件对数据进行分析。计数资料数据采用频数（百分比）表示。检验水准α=0.05。
2　结果
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2.1　年龄和性别
总收治住院患者2 434例，男性占62.12%，女性占37.88%，男女比例为1.64∶1（1 512∶922）（χ2=26.36，P<0.001）；患者年龄为0～102（29.8±25.95）岁。见表1。
2.2　受伤季节
夏季烧伤者占比最高，为25.50%；其后依次是春、冬、秋季。春季，儿童多于成人，其余季节均为成人多于儿童，儿童多于老人。见表1、图1。
2.3　致伤因素
热水烫伤的比例最高，为54.48%，其次火焰烧伤占35.33%、电击烧伤占8.40%、化学烧伤占1.79%，各个年龄组的烧伤原因差异有统计学意义（χ2=811.967,P<0.001）。见表1、图2。
2.4　烧伤后处理
烧伤后在院外未行任何处理者有2 069例(85.00%)，院外处理者有365例(15.00%)。热水烫伤后处理的有269例（20.29%），火焰烫伤后处理的有82例（9.53%），化学烫伤后处理的有11例（25.59%），电击烫伤后处理的有3例（1.46%）。三个年龄组的患者在就医前是否处理的比例差异有统计学意义(χ2=46.549，P<0.001)。见表1、图3。
2.5　烧伤严重程度
创面呈重度烧伤者287例(11.79%)，呈特重度烧伤者220例(9.04%)，重度烧伤以儿童最为多见135例。特重度患者以火焰烧伤最为多见，其他烧伤程度患者均是热水烫伤>火焰烧伤>电击烧伤>化学烧伤。见表1、图4。
2.6　烧伤部位
本组患者烧伤部位以四肢烧伤为常见。共收集4 342处烧伤部位，其中有1 368例（占56.20%）存在两处或更多的烧伤，1 066例（43.80%）仅有一处烧伤。研究显示，四肢最易受烧伤，有2 051例（占84.27%）；其他依次为躯干1 080例（44.37%）、头面颈部1 025例（42.11%）、臀部及会阴186例（7.64%）。三个年龄段患者在烧伤部位上存在显著的统计学差异（χ2= 92.287，P<0.001）。见表1、图5。
2.7　病原菌分布情况
2 434例烧伤患者共收集到952株病原菌，均为非重复首次分离株。依次为铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌、阴沟肠杆菌、大肠埃希菌、溶血葡萄球菌、粪肠球菌等。见表2。
2.8　菌株来源
大部分的病原菌主要来自于患者的创面分泌物，其比例超过80%；后依次是创面组织、导尿管、咽拭子、痰液、导管和脓液等。见表3。
创面分泌物中分离出的最常见病原菌为铜绿假单胞菌，咽拭子、痰液和导尿管中常见病原菌是鲍曼不动杆菌，脓液和血液中常见的病原菌是金黄色葡萄球菌，而在创面组织中，多为大肠埃希菌。在导管和尿液及其他部位，阴沟肠杆菌、溶血葡萄球菌、肺炎克雷伯菌等病原菌检出较少且分散。见表4。
2.9　病原菌耐药情况
铜绿假单胞菌对一、二代头孢耐药率为100%，但对氨曲南、妥布霉素、哌拉西林等耐药率有下降趋势。鲍曼不动杆菌对多黏菌素B、米诺环素和替加环素完全敏感，对其余所试抗生素耐药率均≥50.0%。金黄色葡萄球菌对青霉素的耐药率均>90.0%，对万古霉素、利奈唑胺、替加环素和氨苄西林/舒巴坦耐药率为0。见表5。
3　讨论
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本研究对本院2019—2020年的烧伤患者的基本信息以及病原菌分布情况进行了分析。研究发现，儿童和老年人占严重烧伤患者的比例分别为39.98%和13.60%。因此，对于儿童，老人烧伤的预防需要进一步重视。
本研究中，男女烧伤的性别比例为1.64∶1。60岁及以上年龄组女性接近甚至多于男性，这可能是因为退休后，男性不再有工作场所烧伤的风险，而大部分家务劳动是由女性完成的，使他们在家中面临烧伤的风险[5]。
烧伤的高发时期为夏季，占据了33.70%，紧随其后的是春季，比例为25.50%。而在秋季，患病率最低，只有15.7%。这个结果与我国其他学者的研究成果一致[6]。夏季天气闷热，人们穿的防护衣服较少，洗澡的频率也会加大，从而提高了被烫伤的可能性。
本研究中，儿童以烫伤为主，占88.7%，可能原因是儿童缺乏安全意识，导致烫伤发生。成人的主要致伤原因是火焰烧伤，占51.2%，大多数是在工作场所发生。有研究表明，烧伤的病因影响损伤的严重程度，应采取不同的措施来防止儿童和老年人的烫伤，防止成人的火焰烧伤[7]。合理的院前急救管理对于有效减轻烧伤严重程度和改善预后具有重要作用，大部分大面积烧伤患者被立即送往医院会诊，但目前中国烧伤急救管理水平相对较低[8]。很大一部分患者对院前急救一无所知。本研究中轻度烧伤后处理的有35例（11.95%），中度烧伤后处理的有252例（15.41%),重度烧伤后处理的有54例（18.89%），特重度烧伤后处理的有24例（10.9%）。正确的院前烧伤急救护理相对不理想。因此，应该发起公众教育运动，提醒人们烧伤可能造成的严重损害以及大多数烧伤的可预防性。作为一项长期战略，必须加强院前急救管理教育。烧伤病者最常受伤的部分是四肢和躯干，这可能是因为这两个部位的占比在身体中是最大的。因此，进行有风险的操作时，应尽可能采取必要的预防措施以保护身体。
创面分泌物感染通常是烧伤患者感染的主要来源。研究表明烧伤患者的皮肤损伤和机体免疫系统被抑制，创面分泌物和坏死组织为病原菌提供营养，这导致烧伤患者易先发生创面感染[9]。我院创面分泌物感染逐年减少，可能是治疗中尽早的切除坏死组织和生物敷料的使用，并针对性的使用抗菌药物。本研究中最多感染的为铜绿假单胞菌，第一可能与其复杂的耐药机制有关，其次铜绿假单胞菌感染的来源很多，如污染的诊疗设备及生活设备（空调、马桶等）[10]。第二感染率高的为鲍曼不动杆菌，其高感染率可能依旧和复杂的耐药机制有关和生长条件要求低及其强大的克隆传播能力[11]。国内外均有报道，医源性的感染导致院内鲍曼不动杆菌的大爆发[12]。严格的手卫生、环境消毒和适当的隔离可以有效的防治其院内感染。金黄色葡萄球菌是皮肤移植成活率低和伤口长期不愈的重要因素之一。近些年其检出率有降低趋势，可能是随着新型材料技术的应用，缩短了创面愈合时间[13]。本研究中金黄色葡萄球菌对万古霉素、利奈唑胺、替加环素和氨苄西林/舒巴坦耐药率为0，但是，研究指出长时间使用万古霉素可能引发耐药[14]，所以在实际临床的运用中，万古霉素并未被建议作为预防和治疗的首选药品。
烧伤重在于预防，对儿童和老人加强照看及提高自身安全意识，对于工作中有危险的岗位，加强管理和培训。社会对于此类相关知识加强宣传教育力度，从而减少烧伤事故。烧伤后感染病原菌存在动态的变化。研究表明，烧伤患者感染病原菌的种类、分布及耐药情况在不同国家、不同地区、不同医院，以及同一医院的不同时间段，甚至不同病房之间都存在差异[15]。监测抗生素的使用和细菌流行病学，能有效地认识到细菌的耐药情况和抗生素的实际使用情况，避免不合理使用抗生素带来的危害。
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2024年第51卷第7期
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doi: 10.20043/j.cnki.MPM.202310175
  • 接收时间：2023-10-12
  • 首发时间：2026-03-18
  • 出版时间：2024-04-10
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  • 收稿日期：2023-10-12
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    安徽医科大学第一附属医院，安徽 合肥 230000

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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