严重爆炸致烧伤患者感染病原微生物的特征及宏基因组学第二代测序技术在病原微生物检测中的应用  

Microbiological characteristics of patients with severe burns caused by blast and application of meta-genomics next-generation sequencing in the detection of pathogenic microorganisms

作　　者：罗汝斌[1] 黄曼[2] 胡行[3] 张嵘[4] 韩春茂[3] Luo Rubin;Huang Man;Hu Hang;Zhang Rong;Han Chunmao(Department of Surgery Intensive Care Unit,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of General Intensive Care Unit,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Burn and Wound Repair,the Second Affiliated Hospital of Zhejiang University School of Medicine,Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province,Hangzhou 310009,China;Department of Laboratory,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院外科重症医学科,杭州310009 [2]浙江大学医学院附属第二医院综合ICU,杭州310009 [3]浙江大学医学院附属第二医院烧伤与创面修复科,浙江省严重创伤与烧伤诊治重点实验室,杭州310009 [4]浙江大学医学院附属第二医院检验科,杭州310009

出　　处：《中华烧伤杂志》2021年第10期946-952,共7页Chinese Journal of Burns

基　　金：国家自然科学基金青年科学基金项目(81601687)。

摘　　要：目的分析严重爆炸致烧伤患者在不同时间段感染病原微生物的特征,同时探讨宏基因组学第二代测序(mNGS)技术在病原微生物检测中的应用价值。方法采用回顾性观察性研究方法。2020年6月13日—9月13日浙江大学医学院附属第二医院收治符合入选标准的23例严重爆炸致烧伤患者,其中男21例、女2例,年龄(64±5)岁,烧伤总面积(86±14)%体表总面积。统计入院时,患者的简明烧伤严重指数(ABSI)评分、修订Baux评分、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分和序贯器官衰竭(SOFA)评分。记录患者入院后≤7 d、8~20 d、21~30 d并发症及病原微生物感染来源分布情况,统计病原微生物检出情况并比较微生物培养法与mNGS检测效能的差异。统计患者入院后感染的病原微生物来源分布总体情况并比较微生物培养法与mNGS检测效能差异。对数据行McNemar和Fisher确切概率法检验。结果入院时,患者ABSI评分、修订Baux评分、APACHEⅡ评分和SOFA评分分别为(12.6±2.4)、(91±22)、(26±4)和(10.3±2.3)分。入院后≤7 d,患者的并发症主要为吸入性损伤、脓毒症休克和低蛋白血症;患者感染病原微生物的来源主要为创面、血流和肺部。入院后8~20 d,患者脓毒症休克的发生率最高,吸入性损伤的发生率明显低于入院后≤7 d(P<0.01);病原微生物感染来源仍然以创面、肺部和血流为主,其中创面和血流感染发生率均明显低于入院后≤7 d(P<0.01)。入院后21~30 d,患者仅有多器官功能衰竭和急性呼吸窘迫综合征存在且发生率低,吸入性损伤的发生率明显低于入院后≤7 d(P<0.01),脓毒症休克的发生率明显低于入院后≤7 d(P<0.01)和入院后8~20 d(P<0.01);仅存在较低的血流感染,创面感染发生率明显低于入院后≤7 d(P<0.01)和入院后8~20 d(P<0.05),肺部和血流感染发生率明显低于入院后≤7 d(P<0.01)。入院后≤7 d,革兰阳性菌以金黄色葡萄�Objective To analyze the microbiological characteristics of patients with severe burns caused by blast in different periods and explore the application value of metagenomics next-generation sequencing(mNGS)in detecting pathogenic microorganisms.Methods The retrospective observational study was applied.From June 13 to September 13,2020,twenty-three patients(21 males and 2 females)with severe burns caused by blast who met the inclusion criteria were admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,with age of(64±5)years and total burn area of(86±14)%total body surface area.Abbreviated burn severity index(ABSI)score,revised Baux score,acute physiology and chronic health status evaluation(APACHE)Ⅱscore,and sequential organ failure assessment(SOFA)score were counted on admission.Within 7,8-20 and 21-30 d after admission,the complications,infection source and distribution of pathogenic microorganisms in patients were recorded.The detection of pathogenic microorganisms was analyzed,and the difference in detection efficiency between microbial culture method and mNGS was compared.After admission,the infection of overall source distribution of pathogenic microorganisms in patients was analyzed,and the difference in detection efficiency between microbial culture method and mNGS was compared.Data were statistically analyzed with McNemar and Fisher exact probability test.Results On admission,ABSI score,revised Baux score,APACHEⅡscore and SOFA score were(12.6±2.4),(91±22),(26±4),and(10.3±2.3)respectively.Within 7 d after admission,the main complications of patients were inhalation injury,septic shock,and hypoproteinemia.Patients were mainly infected with pathogenic microorganism on wound,blood stream,and lung.Within 8-20 d after admission,the incidence of septic shock was the highest.The incidence of inhalation injury was significantly lower than that of≤7 d after admission(P<0.01),the main source of infection were wound,lung,and blood stream,and the incidence of wound and blood

关 键 词：烧伤 感染 宏基因组 爆炸伤 微生物学特征 二代测序 

分 类 号：R322.99[医药卫生—人体解剖和组织胚胎学] R730.41[医药卫生—基础医学]