Abstract
Amaç: Ağır yanık nedeniyle hastanede uzun süre tedavi gören çocuklarda yara yeri bakteri kolonizasyonu ve
bakteriyemi riski artmaktadır. Bu çalışmada ağır yanık nedeniyle hastanede tedavi gören çocuk hastalarda
yanık yeri ve kan kültürleri sonuçlarının irdelenmesi ve yanık yeri kolonizasyonunun bakteriyemi gelişmesine
etkisinin araştırılması amaçlanmıştır.
Yöntem: Çalışmaya Ocak 2019 ile Eylül 2023 arasında ikinci derece ve üzeri yanık nedeniyle hastanemiz
yanık kliniğinde ya da yanık yoğun bakım ünitesinde tedavi gören ve yara kültürü yapılan 84 çocuk hasta
dâhil edildi. Kültür sonuçları hastane kayıtlarından elde edildi.
Bulgular: Hastaların 51’i (%60,7) erkekti. Hastaların ortalama yaşı 10,62±6,21 yıl, ortalama hastanede yatış
süreleri 19,98±17,46 gün idi. Yara kültüründe üreme olanlarda kan kültürü pozitifliği oranı yara kültüründe
üreme görülmeyenlere göre anlamlı düzeyde yüksek bulundu (%20,7 vs. %5,5; p=0,032).
Kültürlerden en çok izole edilen bakteri türleri (Pseudomonas aeruginosa (15 örnek; %17,9) ve Acinetobacter
baumannii (dokuz örnek; %10,7) idi. Sadece bir hastanın yara ve kan kültürlerinden aynı bakteri türü izole
edildi (Acinetobacter baumannii). Kültür pozitif grupta ortalama hastanede yatış süresi kültür negatif gruba
göre anlamlı düzeyde yüksek bulundu (30,66 vs. 13,40; p<0,001). Lojistik regresyon analizinde hastanede
yatış süresi kültür pozitifliği açısından bağımsız risk faktörü olarak saptandı (p<0,001) ve buna göre hastanede
yatış süresinin kültür pozitifliği riski açısından risk katsayısı 1,092 (1,044-1,142) olarak bulundu. Ayrıca yara
kültürü pozitifliği kan kültürü pozitifliği açısından bağımsız risk faktörü olarak saptandı (p=0,044) ve buna
göre yara kültürü pozitif olanlarda kan kültürü pozitifliği riskinin 4,522 (1,033-19,671) kat artmış olduğu
hesaplandı.
Sonuç: Çalışmamızdan elde edilen bulgular ağır yanık nedeniyle hospitalize edilen çocuk hastalarda
hastanede kalış süresinin hastane kaynaklı yanık yeri kolonizasyonu veya enfeksiyonu ve/veya bakteriyemi
gelişmesi açılarından riski belirgin olarak arttırdığını göstermektedir.
Anahtar Kelimeler: Çocuk, yanık, yara kültürü, kan kültürü, Acinetobacter, Pseudomonas
References
- Sheridan RL. Burn Care for Children. Pediatr Rev. 2018 Jun;39(6):273-286. doi: 10.1542/ pir.2016-0179. PMID: 29858290.
- Jeschke MG, Herndon DN. Burns in children: standard and new treatments. Lancet. 2014 Mar 29;383(9923):1168-78. doi: 10.1016/ S0140-6736(13)61093-4. Epub 2013 Sep 11. PMID: 24034453; PMCID: PMC7859869.
- Palmieri TL. Pediatric Burn Resuscitation. Crit Care Clin. 2016 Oct;32(4):547-59. doi: 10.1016/j.ccc.2016.06.004. Epub 2016 Aug 2. PMID: 27600126.
- Rafla K, Tredget EE. Infection control in the burn unit. Burns. 2011 Feb;37(1):5-15. doi: 10.1016/j.burns.2009.06.198. Epub 2010 Jun 18. PMID: 20561750.
- Kalligeros M, Shehadeh F, Karageorgos SA, Zacharioudakis IM, Mylonakis E. MRSA colonization and acquisition in the burn unit: A systematic review and meta-analysis. Burns. 2019 Nov;45(7):1528-1536. doi: 10.1016/j.burns.2019.05.014. Epub 2019 Jun 13. PMID: 31202530.
- Gallaher JR, Banda W, Lachiewicz AM, Krysiak R, Cairns BA, Charles AG. Colonization with Multidrug-Resistant Enterobacteriaceae is Associated with Increased Mortality Following Burn Injury in Sub-Saharan Africa. World J Surg. 2018 Oct;42(10):3089-3096. doi: 10.1007/s00268-018-4633-7. PMID: 29696325; PMCID: PMC6128739.
- Williams FN, Lee JO. Pediatric Burn Infection. Surg Infect (Larchmt). 2021 Feb;22(1):54- 57. doi: 10.1089/sur.2020.218. Epub 2020 Aug 13. PMID: 32790497.
- Nunez Lopez O, Cambiaso-Daniel J, Branski LK, Norbury WB, Herndon DN. Predicting and managing sepsis in burn patients: current perspectives. Ther Clin Risk Manag. 2017 Aug 29;13:1107-1117. doi: 10.2147/ TCRM.S119938. PMID: 28894374; PMCID: PMC5584891.
- Alqarni MS, Attar M, Alshammari S, Ambon B, Al Zhrani AA, Alghamdi A, Naebulharam A, Al-Amri A, Altayib H. Common Resistance Patterns in the Burn Unit of a Tertiary Care Center: A Retrospective Observational Study. Cureus. 2023 Aug 22;15(8):e43896. doi: 10.7759/cureus.43896. PMID: 37746476; PMCID: PMC10511942.
- Sobouti B, Khosravi N, Daneshvar A, Fallah S, Moradi M, Ghavami Y. Prevalence of beta lactamase producing species of pseudomonas and acinetobacter in pediatric burn patients. Ann Burns Fire Disasters. 2015 Sep 30;28(3):171-7. PMID: 27279802; PMCID: PMC4883600.
- Tahbaz SV, Azimi L, Lari AR. Characterization of aminoglycoside resistance mechanisms in Acinetobacter Baumannii isolates from burn wound colonization. Ann Burns Fire Disasters. 2019 Jun 30;32(2):115-121. PMID: 31528151; PMCID: PMC6733215.
- Morand A, Morand JJ. Pseudomonas aeruginosa en dermatologie [Pseudomonas 98 JICM 2023;8(4):92-99 aeruginosa in dermatology]. Ann Dermatol Venereol. 2017 Nov;144(11):666-675. French. doi: 10.1016/j.annder.2017.06.015. Epub 2017 Aug 2. PMID: 28778416.
- Nanvazadeh F, Khosravi AD, Zolfaghari MR, Parhizgari N. Genotyping of Pseudomonas aeruginosa strains isolated from burn patients by RAPD-PCR. Burns. 2013 Nov;39(7):1409- 13. doi: 10.1016/j.burns.2013.03.008. Epub 2013 Jun 14. PMID: 23773789.
- Oncul O, Ulkur E, Acar A, Turhan V, Yeniz E, Karacaer Z, Yildiz F. Prospective analysis of nosocomial infections in a burn care unit, Turkey. Indian J Med Res. 2009 Dec;130(6):758-64. PMID: 20090139.
- Ganesamoni S, Kate V, Sadasivan J. Epidemiology of hospitalized burn patients in a tertiary care hospital in South India. Burns. 2010 May;36(3):422-9. doi: 10.1016/j.burns.2009.06.212. Epub 2009 Sep 25. PMID: 19782475.
- Essayagh T, Zohoun A, Tourabi K, Ennouhi MA, Boumaarouf A, Ihrai H, Elhamzaoui S. Burn unit: colonization of burn wounds and local environment. Ulus Travma Acil Cerrahi Derg. 2012 Jul;18(4):296-300. doi: 10.5505/ tjtes.2012.26928. PMID: 23138994.
- Al Laham NA, Elmanama AA, Tayh GA. Possible risk factors associated with burn wound colonization in burn units of Gaza strip hospitals, Palestine. Ann Burns Fire Disasters. 2013 Jun 30;26(2):68-75. PMID: 24133399; PMCID: PMC3793881.
- Belba MK, Petrela EY, Belba AG. Epidemiology of infections in a burn unit, Albania. Burns. 2013 Nov;39(7):1456-67. doi: 10.1016/j. burns.2013.03.013. Epub 2013 Apr 28. PMID: 23632302.
- Orsi GB, Di Stefano L, Noah N. Hospitalacquired, laboratory-confirmed bloodstream infection: increased hospital stay and direct costs. Infect Control Hosp Epidemiol. 2002 Apr;23(4):190-7. doi: 10.1086/502034. PMID: 12002233.
- Hassan M, Tuckman HP, Patrick RH, Kountz DS, Kohn JL. Cost of hospital-acquired infection. Hosp Top. 2010 Jul-Sep;88(3):82-9. doi: 10.1080/00185868.2010.507124. PMID: 20805070.
- Trentino KM, Leahy MF, Erber WN, Mace H, Symons K, Budgeon CA, Murray K. HospitalAcquired Infection, Length of Stay, and Readmission in Elective Surgery Patients Transfused 1 Unit of Red Blood Cells: A Retrospective Cohort Study. Anesth Analg. 2022 Sep 1;135(3):586-591. doi: 10.1213/ ANE.0000000000006133. Epub 2022 Aug 17. PMID: 35977367.
- Olaechea PM, Ulibarrena MA, Alvarez-Lerma F, Insausti J, Palomar M, De la Cal MA; ENVINUCI Study Group. Factors related to hospital stay among patients with nosocomial infection acquired in the intensive care unit. Infect Control Hosp Epidemiol. 2003 Mar;24(3):207-13. doi: 10.1086/502191. PMID: 12683514.
- Gallaher JR, Banda W, Lachiewicz AM, Krysiak R, Purcell LN, Charles AG. Predictors of multidrug resistance in burn wound colonization following burn injury in a resource-limited setting. Burns. 2021 Sep;47(6):1308-1313. doi: 10.1016/j.burns.2020.12.007. Epub 2020 Dec 10. PMID: 33371978; PMCID: PMC8190188
Abstract
Background: The risk of wound bacterial colonization and bacteremia increases in children who are
treated in the hospital for a long time due to severe burns. The aim of this study was to examine the
results of burn site and blood cultures in pediatric patients treated in hospital due to severe burns and to
investigate the effect of burn site colonization on the development of bacteremia.
Material adn Method: The study included 84 pediatric patients who were treated in our hospital’s burn
clinic or burn intensive care unit due to second-degree or higher burns and had wound cultures performed
between January 2019 and September 2023. Culture results were obtained from hospital records.
Results: 51 (60.7%) of the patients were male. The average age of the patients was 10.62±6.21 years and
the average hospital stay was 19.98±17.46 days. The rate of blood culture positivity in those with growth
in the wound culture was found to be significantly higher than in those with no growth in the wound
culture (20.7% vs. 5.5%; p = 0.032). The bacterial species most frequently isolated from cultures were
Pseudomonas aeruginosa (15 samples; 17.9%) and Acinetobacter baumannii (nine samples; 10.7%). The
same bacterial species was isolated from wound and blood cultures of only one patient (Acinetobacter
baumannii). The average hospital stay in the culture-positive group was significantly higher than the
culture-negative group (30.66 vs. 13.40; p<0.001). In logistic regression analysis, hospitalization duration
was determined to be an independent risk factor for culture positivity (p<0.001) and accordingly, the risk
coefficient of hospitalization duration in terms of culture positivity risk was found to be 1.092 (1.044-
1.142). Additionally, wound culture positivity was determined to be an independent risk factor for blood
culture positivity (p=0.044), and accordingly, the risk of blood culture positivity was calculated to be
increased by 4.522 (1.033-19.671) times in those with positive wound cultures.
Conclusion: The findings obtained from our study show that the duration of hospital stay in pediatric
patients hospitalized due to severe burns significantly increases the risk of hospital-acquired burn site
colonization or infection and/or bacteremia development.
Keywords: Child, burn, wound culture, blood culture, Acinetobacter, Pseudomonas
Ethical Statement
Bu retrospektif kohort çalışma yerel etik kurul tarafından onaylandı.
References
- Sheridan RL. Burn Care for Children. Pediatr Rev. 2018 Jun;39(6):273-286. doi: 10.1542/ pir.2016-0179. PMID: 29858290.
- Jeschke MG, Herndon DN. Burns in children: standard and new treatments. Lancet. 2014 Mar 29;383(9923):1168-78. doi: 10.1016/ S0140-6736(13)61093-4. Epub 2013 Sep 11. PMID: 24034453; PMCID: PMC7859869.
- Palmieri TL. Pediatric Burn Resuscitation. Crit Care Clin. 2016 Oct;32(4):547-59. doi: 10.1016/j.ccc.2016.06.004. Epub 2016 Aug 2. PMID: 27600126.
- Rafla K, Tredget EE. Infection control in the burn unit. Burns. 2011 Feb;37(1):5-15. doi: 10.1016/j.burns.2009.06.198. Epub 2010 Jun 18. PMID: 20561750.
- Kalligeros M, Shehadeh F, Karageorgos SA, Zacharioudakis IM, Mylonakis E. MRSA colonization and acquisition in the burn unit: A systematic review and meta-analysis. Burns. 2019 Nov;45(7):1528-1536. doi: 10.1016/j.burns.2019.05.014. Epub 2019 Jun 13. PMID: 31202530.
- Gallaher JR, Banda W, Lachiewicz AM, Krysiak R, Cairns BA, Charles AG. Colonization with Multidrug-Resistant Enterobacteriaceae is Associated with Increased Mortality Following Burn Injury in Sub-Saharan Africa. World J Surg. 2018 Oct;42(10):3089-3096. doi: 10.1007/s00268-018-4633-7. PMID: 29696325; PMCID: PMC6128739.
- Williams FN, Lee JO. Pediatric Burn Infection. Surg Infect (Larchmt). 2021 Feb;22(1):54- 57. doi: 10.1089/sur.2020.218. Epub 2020 Aug 13. PMID: 32790497.
- Nunez Lopez O, Cambiaso-Daniel J, Branski LK, Norbury WB, Herndon DN. Predicting and managing sepsis in burn patients: current perspectives. Ther Clin Risk Manag. 2017 Aug 29;13:1107-1117. doi: 10.2147/ TCRM.S119938. PMID: 28894374; PMCID: PMC5584891.
- Alqarni MS, Attar M, Alshammari S, Ambon B, Al Zhrani AA, Alghamdi A, Naebulharam A, Al-Amri A, Altayib H. Common Resistance Patterns in the Burn Unit of a Tertiary Care Center: A Retrospective Observational Study. Cureus. 2023 Aug 22;15(8):e43896. doi: 10.7759/cureus.43896. PMID: 37746476; PMCID: PMC10511942.
- Sobouti B, Khosravi N, Daneshvar A, Fallah S, Moradi M, Ghavami Y. Prevalence of beta lactamase producing species of pseudomonas and acinetobacter in pediatric burn patients. Ann Burns Fire Disasters. 2015 Sep 30;28(3):171-7. PMID: 27279802; PMCID: PMC4883600.
- Tahbaz SV, Azimi L, Lari AR. Characterization of aminoglycoside resistance mechanisms in Acinetobacter Baumannii isolates from burn wound colonization. Ann Burns Fire Disasters. 2019 Jun 30;32(2):115-121. PMID: 31528151; PMCID: PMC6733215.
- Morand A, Morand JJ. Pseudomonas aeruginosa en dermatologie [Pseudomonas 98 JICM 2023;8(4):92-99 aeruginosa in dermatology]. Ann Dermatol Venereol. 2017 Nov;144(11):666-675. French. doi: 10.1016/j.annder.2017.06.015. Epub 2017 Aug 2. PMID: 28778416.
- Nanvazadeh F, Khosravi AD, Zolfaghari MR, Parhizgari N. Genotyping of Pseudomonas aeruginosa strains isolated from burn patients by RAPD-PCR. Burns. 2013 Nov;39(7):1409- 13. doi: 10.1016/j.burns.2013.03.008. Epub 2013 Jun 14. PMID: 23773789.
- Oncul O, Ulkur E, Acar A, Turhan V, Yeniz E, Karacaer Z, Yildiz F. Prospective analysis of nosocomial infections in a burn care unit, Turkey. Indian J Med Res. 2009 Dec;130(6):758-64. PMID: 20090139.
- Ganesamoni S, Kate V, Sadasivan J. Epidemiology of hospitalized burn patients in a tertiary care hospital in South India. Burns. 2010 May;36(3):422-9. doi: 10.1016/j.burns.2009.06.212. Epub 2009 Sep 25. PMID: 19782475.
- Essayagh T, Zohoun A, Tourabi K, Ennouhi MA, Boumaarouf A, Ihrai H, Elhamzaoui S. Burn unit: colonization of burn wounds and local environment. Ulus Travma Acil Cerrahi Derg. 2012 Jul;18(4):296-300. doi: 10.5505/ tjtes.2012.26928. PMID: 23138994.
- Al Laham NA, Elmanama AA, Tayh GA. Possible risk factors associated with burn wound colonization in burn units of Gaza strip hospitals, Palestine. Ann Burns Fire Disasters. 2013 Jun 30;26(2):68-75. PMID: 24133399; PMCID: PMC3793881.
- Belba MK, Petrela EY, Belba AG. Epidemiology of infections in a burn unit, Albania. Burns. 2013 Nov;39(7):1456-67. doi: 10.1016/j. burns.2013.03.013. Epub 2013 Apr 28. PMID: 23632302.
- Orsi GB, Di Stefano L, Noah N. Hospitalacquired, laboratory-confirmed bloodstream infection: increased hospital stay and direct costs. Infect Control Hosp Epidemiol. 2002 Apr;23(4):190-7. doi: 10.1086/502034. PMID: 12002233.
- Hassan M, Tuckman HP, Patrick RH, Kountz DS, Kohn JL. Cost of hospital-acquired infection. Hosp Top. 2010 Jul-Sep;88(3):82-9. doi: 10.1080/00185868.2010.507124. PMID: 20805070.
- Trentino KM, Leahy MF, Erber WN, Mace H, Symons K, Budgeon CA, Murray K. HospitalAcquired Infection, Length of Stay, and Readmission in Elective Surgery Patients Transfused 1 Unit of Red Blood Cells: A Retrospective Cohort Study. Anesth Analg. 2022 Sep 1;135(3):586-591. doi: 10.1213/ ANE.0000000000006133. Epub 2022 Aug 17. PMID: 35977367.
- Olaechea PM, Ulibarrena MA, Alvarez-Lerma F, Insausti J, Palomar M, De la Cal MA; ENVINUCI Study Group. Factors related to hospital stay among patients with nosocomial infection acquired in the intensive care unit. Infect Control Hosp Epidemiol. 2003 Mar;24(3):207-13. doi: 10.1086/502191. PMID: 12683514.
- Gallaher JR, Banda W, Lachiewicz AM, Krysiak R, Purcell LN, Charles AG. Predictors of multidrug resistance in burn wound colonization following burn injury in a resource-limited setting. Burns. 2021 Sep;47(6):1308-1313. doi: 10.1016/j.burns.2020.12.007. Epub 2020 Dec 10. PMID: 33371978; PMCID: PMC8190188
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences (Other) |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | December 31, 2023 |
| Submission Date | November 20, 2023 |
| Acceptance Date | December 15, 2023 |
| Published in Issue | Year 2023 Volume: 8 Issue: 4 |
Cite
Creative Commons Attribution Non-Commercial License: The articles in the Journal of Immunology and Clinical Microbiology are open access articles licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-sa/4.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.