伊拉克苏莱曼尼亚烧伤整形外科医院烧伤后成年住院病人早期的医学调查和临床变化作为及时诊断感染的指标

Dana Abdilkarim
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摘要

背景:烧伤是世界范围内发病率和死亡率的主要原因之一。烧伤相关医院获得性感染是烧伤管理的主要问题之一。目的:阐述成人烧伤住院患者早期实验室和微生物培养的变化,并利用实验室检查的细微变化,在早期阶段预测和发现烧伤患者的感染。患者和方法:一项临床观察性研究随机抽样了2019年4月至2021年1月在苏莱曼尼亚烧伤医院住院的100名成年烧伤住院患者,在研究过程中进行了回顾性和前瞻性随访。结果:男性31例(31%),女性69%,均为成人,年龄≥18岁。II-III度混合烧伤占51%,二度烧伤占38%,三度烧伤占11%。多数患者红细胞压积下降,白细胞总数增加,血小板正常。大多数患者入院前三周尿素升高,血清肌酐水平正常。11例(11%)患者死亡。而36%的死亡患者体表面积烧伤超过60%,72%的死亡患者为II和III度烧伤。90%的患者有感染,分离结果以革兰氏阴性菌(66.8%)和革兰氏阳性菌(33.2%)为主。最常见的革兰氏阴性为铜绿假单胞菌(32.5%)。革兰氏阳性菌为金黄色葡萄球菌(33.2%)。66.6%的患者在第一周出现发热,55.5%的患者在第二周出现发热。大多数发热的患者在烧伤后的第二周感染了金黄色葡萄球菌和铜绿假单胞菌。结论和建议;许多实验室和微生物参数的变化发生在烧伤后的早期阶段,其中白细胞增多可以很好地预测烧伤感染,特别是当它发生在第二周及以后。然而,它不能区分革兰氏阴性和革兰氏阳性细菌感染。为了检测背景实验室参数的任何变化,一旦发生,就可以检测或怀疑烧伤感染
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Medical Investigation and Clinical Changes in the Early Phases of Post Burn Adult Inpatients as Indicators for Prompt Infection Diagnosis, in the Hospital for Burn and Plastic Surgery, Sulaimanyah, Iraq
Background: Burn injury is one of the leading causes of morbidity and mortality worldwide. Burn related hospital acquired infections is one of the major problems in the management of these injuries. Aim of the study: To elaborate on the early laboratory and microbial culture changes in adult burn inpatients, and to make use of subtle changes in the laboratory investigations, to predict and detect infections in burn victims, in its early phases. Patients and Methods: A Clinical observational study included a random sample of one hundred adult burn inpatients from Sulaymaniyah Burn Hospital, admitted from April 2019 to January 2021, retrospectively and prospectively followed up during the course of the study. Results: thirty one (31%) patients were male and 69% were female, all patients were adults and aged ≥18 years. 51 % of them had mix II-III degree burns, while 38% second and 11% third degree burns. Hematocrit decreased, total WBC count increased while platelet in most of the patients was normal. Blood urea was increased, Serum creatinine levels were normal in most of the patient in first three weeks of their admission. Eleven patients  (11%) died. Whereas 36% of the patients who died had Total Body Surface Area burn of more than 60%, while 72% of them had II and III degree burns. Also 90% of the patients had infections, majority of the isolate results were Gram-negative bacteria (66.8%), and (33.2%) were Gram-positive. Pseudomonas aeruginosa (32.5%) was the most common gram negative. The Staphylococcus aureus (33.2%) was the gram positive organism recovered. While 66.6% of patients had fever during the first week, 55.5% of patients had fever in second week. Most of the patients, who had fever, were infected with S.aureus and Pseudomonas aeruginosa throughout the second week post burn. Conclusion and recommendations; Many laboratories and microbial parameter changes occur in the early phases of post burning, of which Leukocytosis can be a good predictor for infection in burns, especially when it happens in the second week and beyond. Yet it cannot distinguish gram negative from gram positive bacterial infections. To detect any change in the back ground laboratory parameters, as soon as they happen, infections in burns can be detected or suspected
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