Changes Of Wound Flora Distribution And Analysis Of Risk Factor Of Wound Infection In Burn Patients

Objective: To analyze the wound flora distribution trend, drug resistance,the usage of antimicrobial drugs and the risk factors of wound infection in burn patients in our hospital, and to provied a basis for the rational use of antibiotics and for the prevention and control of wound infection.Methods: 1、456 wound flora secretion specimens of burn patients from January 2010 to December 2013 were collected from burn plastic surgical department of Tianjin first central hospital. 2、The bacteria were cultured and identified by using automatic microbial identification and drug susceptibility analysis system. 22 clinical commonly used antimicrobial drugs including amikacin, the first- and second-generation cephalosporin were used for drug-sensitive test by means of K-B disk-diffusion method. 3、Defined day dose per one hundred hospitalization days of 6 commonly used antimicrobial drugs such as cefathiamidine and imipenem was used as antibacterial use density. 4、SPSS 19.0 for Windows was used for data analysis. 12 risk factors that related with wound infection were identified by case survey and these factors were analyzed by univariant analysis and multi factor logistical regression analysis with p<0.05 considered statistically significant.Results: 1、From 2010 to 2013, the positive rate of samples was during in 22.92% 2、The top five detected pathogens were pseudomonas aeruginosa(19.52%), acinetobacter baumannii(19.25%), staphylococcus aureus(18.45%), epidermis staphylococcus(12.30%), and enterobacter cloacae(12.30%), respectively. There were some differences between the result of this study and that of the study carried on2005 to 2008. From 2005 to 2008, Staphylococcus aureus detection rate has been high, followed by pseudomonas aeruginosa and Acinetobacter Bauman. In contrast, the detection rate of acinetobacter baumannii was high during the period of 2010 to 2013(17.82%-20.88%). Although the detection rate of Pseudomonas aeruginosa had slightly deceased in 2013, the overall detection rate had increased and was already higher than that of Acinetobacter baumannii. 3、Since 2010, the resistance of staphylococcus aureus, pseudomonas aeruginosa, acinetobacter baumannii to clindamycin, fisrt- and second-generation cephalosporins had increased. 4、At the same time, the use density of cefathiamidine, levofloxacin and other commonly used antimicrobial drug had slightly increased while that of imipenem had decreased. 5、 Logistical analysis showed that :delayed resuscitation,inhalation injury,with diabetes before admission, hypoproteinemia, were the high risk factors of wound infection in burn.Conclusions: The positive rate of pathogenic bacteria in burn patients of that hospital with other hospital from 2010-2013 was low, but bacteria resistance had increased in this years. The top five detected pathogens were pseudomonas aeruginosa(19.52%), acinetobacter baumannii(19.25%), staphylococcus aureus(18.45%), epidermis staphylococcus(12.30%), and enterobacter cloacae(12.30%), respectively.Since 2010, the resistance of staphylococcus aureus, pseudomonas aeruginosa, acinetobacter baumannii to clindamycin, fisrt- and second-generation cephalosporins had increased.This may related to the use density of antibacterial drug. Logistical analysis showed that :delayed resuscitation,inhalation injury,with diabetes before admission, hypoproteinemia, were the high risk factors of wound infection in burn The empirical and rational use of antimicrobial drugs for early period burn patients should be strengthened. Hypoproteinemia, early shock, inhalation injury, with diabetes before admission and diagnosed of hemoglobinuria after injury were the risk factors of wound infection. The early shock and inhalation injury have already been recognized risk factors of wound infection. In addition, enough atterntion should be paid to other three newly identified factors. Carrying on positive anti shock treatment after admission and strengthen nutrition test for burn patients, starting enteral nutrition as soon as possible, and, using antibiotics rationally are effective measures to reduce risk of infection.