Clinical Retrospective Analysis Of Treatment Of Acinetobacter Baumannii Infection In Severely Burned Patients

Background:The destruction of normal skin barrier and the existence of necrotic tissue in burn patients are important factors leading to local and even systemic infection.In recent years,the types and cycles of antibiotics used in clinic have changed greatly,and the types of bacterial resistance in burn patients have also changed.According to literature reports,the top six pathogens of burn infections in recent years are Staphylococcus aureus,Pseudomonas aeruginosa,Acinetobacter baumannii,Klebsiella pneumoniae,Escherichia coli and Enterococcus faecalis.Among them,Acinetobacter baumannii has the strongest resistance to antibiotics,which is one of the difficult points in current treatment and an important factor leading to death.In recent years,the detection rate of Acinetobacter baumannii in Gram-negative bacteria has increased significantly.Drug sensitivity tests of Acinetobacter baumannii often show multiple drug resistance,pan-drug resistance,or even total drug resistance,which makes it difficult for clinical drug use and greatly affects the cure rate of patients.Objectives:By retrospectively summarizing and analyzing the data of severe burn patients with Acinetobacter baumannii infection admitted to burn department of Nanfang Hospital of Southern Medical University from January 2012 to December 2018,the author understands the treatment measures of severe bum patients with Acinetobacter baumannii infection,and analyses some related risk factors affecting the prognosis,so as to provide reasonable antibiotic treatment scheme and reduce the incidence of Acinetobacter baumannii infection in the future The mortality rate provides some references.Methods:1.Case selection:From January 2012 to December 2018,39 burn patients with Acinetobacter baumannii infection were admitted to the Nanfang Hospital of Southern Medical University,excluding Acinetobacter baumannii infection caused by chronic wounds and other traumas.2.General data:gender,age.length of stay(days),total burn area(%TBSA),third degree burn area(%TBSA),burn index,cause of burn,source of samples,assisted breathing,tracheotomy.mixed infection,whether the pathogenic bacteria are more than three,underlying diseases or multiple injuries,resistance of Acinetobacter baumannii,use of antibiotics,infection.The mortality rate of patients,the causes of death and so on.3.Judgment of nosocomial and out-of-hospital infections:According to the samples,the time of detection of Acinetobacter baumannii was divided into two groups:those less than 48 hours were out-of-hospital infections,and those greater than or equal to 48 hours were in-hospital infections.4.Burn severity grading:According to the seventh edition of Surgery,it can be divided into mild,moderate,severe and extremely severe burns.5.Therapeutic effect judgement:(1)No Acinetobacter baumannii was cultured in the reexamination specimens after treatment(2)White blood cells,neutrophils,C-reactive protein and PCT decreased to the normal range or significantly decreased,and at least one of the above 2 points was satisfied as effective treatment.6.Statistical method:All data were processed and analyzed by SPSS23.0software package.Measurement data were expressed as mean standard deviation and counting data were expressed as frequency or percentage.Regarding death as a binary dependent variable,single-factor logistic regression analysis was performed first,and then multifactor logistic regression analysis was used to screen out the related risk factors affecting the prognosis of Acinetobacter baumannii infection in severely burned patients.When P<0.05,the difference was significant.Results1.General situation:The patients with severe burn complicated with Acinetobacter baumannii infection were mainly middle-aged males aged 40-50 years,mainly from flame burns,accounting for 76.9%.The main sources of specimens were burn wounds and sputum,accounting for 33.3%and 25.6%respectively.The severity of burn was mainly severe burn and severe burn,accounting for 74.4%and 25.6%respectively.2.The mortality rate was 28.2%in 9 males and 2 females.Among them,7 died of multiple organ dysfunction syndrome(MODS)with septic shock,2 died of cerebral hernia and 2 died of ARDS.3.Drug resistance of Acinetobacter baumannii:The sensitivity to polymyxins is good,the drug resistance rate is 0,but the resistance rate to carbapenems(imipenem,meropenem)is as high as 92.3%,and to other antibiotics is more than 70%,and the drug resistance rate of Acinetobacter baumannii in nosocomial infections is significantly higher than that of out-hospital infections.4.Antibiotic treatment:The main antibiotic treatment is the combined anti-infection based on tegacycline.The effective rate is 70.8%(17/24)with the synergistic effect of drugs.In recent years,the combination of polymyxin B and carbapenems has also achieved good results.5.Tube incision and assisted breathing were independent risk factors affecting the prognosis of Acinetobacter baumannii infection in burn patients(p<0.05).Conclusions1.Severe burn patients with Acinetobacter baumannii infection were mainly 40-50 years old men with severe and very severe burns.Flame burns were the main cause of infection.The main cause of death was multiple organ dysfunction syndrome combined with septic shock.2.The resistance spectrum of Acinetobacter baumannii is wide.Except for the sensitivity to polymyxins and tegacycline,the resistance rate to carbapenems and cephalosporins of the third and fourth generations is over 90%.The resistance rate of Acinetobacter baumannii in nosocomial infection is obviously higher than that of non-nosocomial infection.3.Antibiotics are the first choice for the treatment of Acinetobacter baumannii infection.Polymyxins have good sensitivity,but their side effects are greater.Clinical treatment often chooses a combined anti-infection regimen based on tigacycline,which can achieve better therapeutic effect.4.Reducing tracheotomy and assisted breathing may reduce the risk of death.