Sepse no paciente queimado: estudo microbiológico e da sensibilidade antimicrobiana / Sepsis in burn patient: microbiological and antimicrobial susceptibility study

O estudo compreendeu os pacientes internados na Unidade de Queimados do Hospital Regional da Asa Norte, Brasília-DF, no período de 1º de junho de 2001 a 1º de fevereiro de 2005. Cento trinta e nove (15,5 per center) pacientes tiveram sepse, de um total de 895 queimados. Cada paciente teve um ou, no máximo, quatro episódios de sepse durante a internação, totalizando 171 episódios. Setenta e oito (56,1 per cent) eram homens e a idade média foi 21 anos (variação de 1 a 89 anos). A superfície corporal queimada variou de 7 a 88 per cent, com uma média de 34,0 per cent. Os sítios de origem dos episódios de sepse foram: a ferida queimada (45,6 per cent), o pulmão (10,5 per cent), o cateter vascular (8,8 per cent) e origem desconhecida ou não determinada (35,1 per cent). As principais bactérias causadoras de sepse foram Staphylococcus sp. (65,2 per cent), Acinetobacter sp. (12,3 per cent), Pseudomonas aeruginosa (10,5 per cent) e Enterobacter cloacae (7,6 per cent).. Oitenta e sete (62,6 per cent) pacientes tiveram o primeiro episódio de sepse na primeira semana de internação. Em 62 episódios com isolamento de S. aureus, houve resistência à oxacilina em 37,1 per cent. Todos estafilococos se mostraram sensíveis à vancomicina. Em conclusão, o conhecimento das bactérias prevalentes e da sensibilidade antimicrobiana facilitará a elaboração de protocolos de atendimento, esquemas antimicrobianos e medidas terapêuticas mais eficazes, contribuindo para diminuir a morbidade e a letalidade dos pacientes queimados, com sepse.

Sepsis in burned patients

A prospective study was conducted from June 2001 to May 2002 at the Burns Unit of Hospital Regional da Asa Norte, Brasília, Brazil. During the period of the study, 252 patients were treated at the Burns Unit, 49 (19.4 percent) developed clinically and microbiologically proven sepsis. Twenty-six (53.1 percent) were males and 23 (46.9 percent) females with a mean age of 22 years (range one to 89 years) and mean burned body surface area of 37.7 ± 18.4 percent (range 7 to 84 percent). Forty-three patients had flame burns, five a scald and one an electric burn. These 49 patients had a total of 62 septic episodes. Forty (81.6 percent) patients had only one and nine (18.4 percent) had up to three episodes of sepsis. Thirty (61.2 percent) patients had their first septicemic episode either earlier or by one week postburn. Out of 62 septic episodes, 58 were due to bacteria and four due to Candida sp. The most common bacteria isolated from blood culture were Staphylococcus aureus, coagulase-negative Staphylococcus, Acinetobacter baumannii, Enterobacter cloacae and Klebsiella pneumoniae. Eleven (18.9 percent) episodes were due to oxacillin resistant Staphylococcus aureus. Acinetobacter baumannii was sensitive to ampicillin/sulbactam in 71.4 percent and to imipenem in 85.7 percent of the cases. The primary foci of sepsis were the burn wound in 15 ( 24.2 percent ) episodes. The most common clinical findings of sepsis in these patients were fever, dyspnea, hypotension and oliguria. The most common laboratory findings of these patients were anemia, leukocytosis, hypoalbuminemia and thrombocytopenia. Twelve (24.5 percent) patients died. The appropriate knowledge of clinical, epidemiological, laboratorial and microbiological aspects of sepsis in burned patients permits an adequate diagnosis and treatment of this complication.