Retrospective Investigation And Analysis Of Pathogen Distribution And Drug Resistance In Severe Burn Patient

Objective:Through retrospective investigation and analysis of the changes in the source,distribution,drug resistance and infection rate of infectious pathogens in patients with severe burns in the burn center of our hospital from 2011 to 2015 and 2016 to 2020,the changes are summarized,and the clinical use of antimicrobials,To reduce the occurrence of drug-resistant strains and control the prevalence of nosocomial infections to provide detailed evidence to improve the treatment rate of patients with severe burns.Methods:From 2011 to 2020,the gender,age,burn factors,burn area,number of patients with severe burns in the burn center of our hospital and the results of pathogen cultures submitted for inspection were collected for retrospective investigation and analysis.The cases are divided into two groups in chronological order.The case data from 2011 to 2015 is the first five years group,and the case data from 2016 to 2020 is the second five years group.Using SPSS 26 statistical software to analyze the composition ratio of pathogenic bacteria in severe burn patients from 2011 to 2015and 2016 to 2020,the composition ratio of G-,G+and fungi and the distribution of specific pathogens in the two groups,the detection rate of the two groups ranked the top five The distribution of pathogens,the drug resistance of the main pathogens in the two groups of G-and G+,and the changes in the infection rate of pathogens in the two groups of severe burn patients.Results:1.Overall results:From 2011 to 2020,a total of 1176 patients with severe burns were enrolled,and a total of 2682 strains of pathogenic bacteria were detected,including 1173 strains from wound secretions,609 strains from blood,355 strains from respiratory tract,and 437 strains from urine.There are 99 strains of venous catheters and 9 strains of puncture fluid;there are 1895 strains of G-strains,accounting for 70.66%,598 strains of G+strains,accounting for 22.30%,and 189fungal strains,accounting for 7.05%.G-mainly Acinetobacter baumannii(697 strains,accounting for 25.99%),Klebsiella pneumoniae(488 strains,accounting for 18.20%),and Pseudomonas aeruginosa(421 strains,accounting for 15.70%),G+is dominated by Staphylococcus aureus(296 strains,accounting for 11.04%),Staphylococcus epidermidis(105 strains,accounting for 3.91%),Staphylococcus hemolyticus(72strains,accounting for 2.68%),and the fungus is Candida tropicalis(57 strains,accounting for 2.13%),Candida albicans(46 strains,accounting for 1.72%),and Candida glabrata(45 strains,accounting for 1.68%).2.The comparison results of the two groups in the first and last five years:(1)The order of the top five pathogens with detection rates in the first and last five years has not changed,and they are still Acinetobacter baumannii,Klebsiella pneumoniae,Pseudomonas aeruginosa,Staphylococcus aureus,and epidermis.staphylococcus.(2)Sources of pathogenic bacteria in the two groups:Compared with the previous five years,the strains derived from wound secretions in the second five years decreased significantly,while the strains derived from blood,respiratory tract,urine,and intravenous catheters showed an upward trend,with significant differences in changes.Statistically significant(?~2=114.071,P<0.001).(3)The composition ratio of the two groups of G-,G+and fungi:Compared with the previous five years,the G-composition ratio in the last five years has basically stabilized,the G+composition ratio has been significantly reduced,and the fungus composition ratio has been significantly increased.The difference was statistically significant(?~2=9.266,P=0.01<0.05).(4)The composition ratio of the specific distribution of pathogenic bacteria in the two groups:Compared with the previous five years,the composition ratio of Acinetobacter baumannii,Enterobacter aerogenes,and Candida tropicalis was significantly higher in the second five years(P<0.05),while the patina The composition ratios of Pseudomonas,Enterococcus faecalis,and Candida glabrata were significantly reduced(P<0.05),while the composition ratios of other pathogens such as Staphylococcus aureus and Klebsiella pneumoniae showed no significant change.(5)The resistance rate of the two main groups of G-:Compared with the previous five years,the second five years of G-Acinetobacter baumannii versus ampicillin/sulbactam,cefoperazone/sulbactam,levofloxacin,and The resistance rate of bramycin and gentamicin was significantly increased(P<0.05),but it was completely sensitive to tigecycline,and the resistance rate of other antibacterial drugs did not change significantly,and the resistance rate was greater than 85%;pneumonia The resistance rate of Klebsiella to ampicillin/sulbactam,cefepime,compound trimethoprim,levofloxacin,meropenem,imipenem,tigecycline,and gentamicin increased significantly(P<0.05),But it is more sensitive to tigecycline,its resistance rate does not exceed 20%,and its resistance rate to other antibacterial drugs exceeds60%;Pseudomonas aeruginosa is resistant to gentamicin,aztreonam,tobramycin,The drug resistance rate of levofloxacin and ciprofloxacin decreased significantly(P<0.01),and the drug resistance rate to cefoperazone/sulbactam and cefepime was significantly increased(P<0.01),and the drug resistance rate to other antibacterial drugs was greater than 60%.(6)The resistance rate of the two main groups of G+:Compared with the previous five years,the resistance of Staphylococcus aureus to compound trimethoprim,ciprofloxacin,gentamicin,tetracycline,oxacillin,The resistance rate of rifampicin was significantly reduced(P<0.05),and the resistance rate to moxifloxacin,ampicillin/sulbactam was significantly increased(P<0.01);Staphylococcus epidermidis was resistant to ampicillin/sulbactam,levofloxacin,The resistance rate of moxifloxacin and ciprofloxacin increased significantly(P<0.05),and the resistance rate to tetracycline decreased significantly(P<0.01);the resistance rate of Staphylococcus haemolyticus to ampicillin/sulbactam increased significantly(P<0.05),the drug resistance rate to compound trimethoprim decreased significantly(P<0.05).The three main types of G+are almost completely sensitive to linezolid,vancomycin,quinupristin/dalfopristin,and daptomycin,but the resistance rate to penicillin G is as high as 90%.(7)The infection rate of the two groups of patients with severe burns:Compared with the previous five years,the number of patients with severe burns infected with pathogenic bacteria decreased significantly in the last five years,and the infection rate showed a significant downward trend.The difference in changes was statistically significant(?~2=57.105),P<0.001).Conclusions:1.In the first and second five years,the percentages of pathogenic bacteria specimens were different.In severely burned patients,the source of pathogenic bacteria was still mainly from wound secretions;there was no significant difference in the G-composition ratio.G-dominates,while the G+composition ratio is reduced to a certain extent,and the proportion of fungal infections has increased.2.At present,Acinetobacter baumannii is still the main pathogen for severe burn patients,followed by Klebsiella pneumoniae,Pseudomonas aeruginosa,Staphylococcus aureus,and Staphylococcus epidermidis.3.In the first and second five years,the drug resistance of Acinetobacter baumannii and Klebsiella pneumoniae in G-medium was serious,and the drug resistance rate of the former was more obvious,and the drug resistance rate of the two showed a significant upward trend,which should cause Highly vigilant,but the two are currently more sensitive to tigecycline;on the contrary,Pseudomonas aeruginosa is resistant to fluoroquinolones(levofloxacin,ciprofloxacin),aminoglycosides(gentamicin,tobramycin)The resistance rate of monoamide ringβ-lactam(aztreonam)antibacterial drugs has shown a downward trend,which shows that the burn center of our hospital has achieved staged results in the treatment of Pseudomonas aeruginosa in the past five years.The three main types of G+have very low resistance rates to linezolid,vancomycin,quinupristin/dalfopristin,and daptomycin,and have high sensitivity,and have good curative effects in the treatment of severe burns and infections.4.In the first and second five years,the pathogen infection rate of severe burn patients in our hospital’s burn center showed a downward trend,and this trend needs to be analyzed from multiple angles.