PMID- 34689464
OWN - NLM
STAT- MEDLINE
DCOM- 20211026
LR  - 20211026
IS  - 1009-2587 (Print)
IS  - 1009-2587 (Linking)
VI  - 37
IP  - 10
DP  - 2021 Oct 20
TI  - [Microbiological characteristics of patients with severe burns caused by blast 
      and application of meta- genomics next-generation sequencing in the detection of 
      pathogenic microorganisms].
PG  - 946-952
LID - 10.3760/cma.j.cn501120-20201017-00440 [doi]
AB  - 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, APACHE Ⅱ score 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 stream infection were significantly lower than that of </=7 d after 
      admission (P<0.01). Within 21-30 d after admission, the incidences of multiple 
      organ failure and acute respiratory distress syndrome were low, the incidence of 
      inhalation injury was significantly lower than that of </=7 d after admission 
      (P<0.01), and the incidence of septic shock was significantly lower than that of 
      </=7 d after admission (P<0.01) and 8-20 d after admission (P<0.01). There were 
      only low bloodstream infections, and the incidence of wound infection was 
      significantly lower than that of </=7 d after admission (P<0.01) and 8-20 d after 
      admission (P<0.05), and the incidences of lung and blood stream infection were 
      significantly lower than those of </=7 d after admission (P<0.01). Within </=7 d 
      after admission, gram-positive bacteria were mainly Staphylococcus aureus. 
      Gram-negative bacteria were mainly Klebsiella pneumoniae and Stenotrophomonas 
      maltophilia. The fungi contained only Candida. Within 8-20 d after admission, 
      Staphylococcus aureus was mainly the gram-positive bacteria, and the detection 
      rate of Enterococcus was significantly lower than that of </=7 d after admission 
      (P<0.01). Pseudomonas aeruginosa and Acinetobacter baumannii were the main 
      gram-negative bacteria, and their detection rates were significantly lower than 
      those of </=7 d after admission (P<0.01).There was a new detection of Fusarium. 
      Within 21-30 d after admission, Staphylococcus aureus was the mainly 
      gram-positive bacteria, and the detection rates of Enterococcus and Bacillus were 
      significantly lower than those of </=7 d after admission (P<0.01). Pseudomonas 
      aeruginosa and Acinetobacter baumannii were still the main gram-negative 
      bacteria, and increased with the extension of time after admission. The detection 
      rate of Pseudomonas aeruginosa was significantly higher than that of </=7 d after 
      admission (P<0.01) and 8-20 d after admission (P<0.01), and the detection rate of 
      Acinetobacter baumannii was significantly higher than that of </=7 d after 
      admission (P<0.01). The detection rate of Klebsiella pneumoniae was significantly 
      lower than those of </=7 d after admission (P<0.01) and 8-20 d after admission 
      (P<0.01). All Candida, Mould, Fusarium were detected. Within </=7 d and 8-20 d, the 
      consistency between mNGS and bacterial culture was high (kappa=0.659, 0.596). Within 
      21-30 d after admission, the consistency between mNGS and bacterial culture was 
      moderate (kappa=0.407). In different time periods, the positive test rate of mNGS was 
      basically constant, while that of microbial culture showed a decline with the 
      extension time after admission. Five hundred and six strains of pathogenic 
      microorganisms were isolated from wound, blood, sputum, and indwelling catheter, 
      and Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, 
      Klebsiella pneumoniae were the main pathogenic microorganisms. Pseudomonas 
      aeruginosa and Acinetobacter baumannii were the most common in the wound samples, 
      Klebsiella pneumoniae was more often seen in blood samples while Pseudomonas 
      aeruginosa and Acinetobacter baumannii in sputum samples, and Acinetobacter 
      baumannii in indwelling catheter samples were the most common. The detection 
      rates of Pseudomonas aeruginosa in wound and sputum were significantly higher 
      than those of blood (P<0.05 or P<0.01) and indwelling catheter (P<0.01), 
      respectively. The consistency between the overall results of mNGS and microbial 
      culture were moderate (kappa=0.556). The consistency between mNGS and microbial 
      culture was high in samples of blood and indwelling catheter (kappa=0.631, 0.619), 
      but those were moderate in sputum and wound (kappa=0.558, 0.528). Conclusions: The 
      most common infections of patients with severe burn caused by blast injury were 
      wound infection and blood stream infection. With the extension of time after 
      admission, the main pathogenic bacterial strains of patients changed from 
      Staphylococcus aureus, Klebsiella pneumoniae, and Stenotrophomonas maltophilia to 
      Acinetobacter baumannii and Pseudomonas aeruginosa. mNGS showed a higher positive 
      rate of detecting pathogenic microorganisms than conventional microbial culture.
FAU - Luo, R B
AU  - Luo RB
AD  - Department of Surgery Intensive Care Unit, the Second Affiliated Hospital of 
      Zhejiang University School of Medicine, Hangzhou 310009, China.
FAU - Huang, M
AU  - Huang M
AD  - Department of General Intensive Care Unit, the Second Affiliated Hospital of 
      Zhejiang University School of Medicine, Hangzhou 310009, China.
FAU - Hu, H
AU  - Hu H
AD  - 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.
FAU - Zhang, R
AU  - Zhang R
AD  - Department of Laboratory, the Second Affiliated Hospital of Zhejiang University 
      School of Medicine, Hangzhou 310009, China.
FAU - Han, C M
AU  - Han CM
AD  - 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.
LA  - chi
GR  - 81601687/National Natural Science Foundation of China for Youth/
PT  - Journal Article
PT  - Observational Study
PL  - China
TA  - Zhonghua Shao Shang Za Zhi
JT  - Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns
JID - 100959418
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Aged
MH  - *Anti-Bacterial Agents/therapeutic use
MH  - *Burns/drug therapy
MH  - Female
MH  - Genomics
MH  - High-Throughput Nucleotide Sequencing
MH  - Humans
MH  - Male
MH  - Microbial Sensitivity Tests
MH  - Middle Aged
MH  - Retrospective Studies
EDAT- 2021/10/25 06:00
MHDA- 2021/10/27 06:00
CRDT- 2021/10/24 22:05
PHST- 2021/10/24 22:05 [entrez]
PHST- 2021/10/25 06:00 [pubmed]
PHST- 2021/10/27 06:00 [medline]
AID - 10.3760/cma.j.cn501120-20201017-00440 [doi]
PST - ppublish
SO  - Zhonghua Shao Shang Za Zhi. 2021 Oct 20;37(10):946-952. doi: 
      10.3760/cma.j.cn501120-20201017-00440.