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

Luo Rubin; Huang Man; Hu Hang; Zhang Rong; Han Chunmao

doi:10.3760/cma.j.cn501120-20201017-00440

Volume 37 Issue 10

Oct. 2021

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2021 > 37(10): 946-952

Luo RB,Huang M,Hu H,et al.Microbiological characteristics of patients with severe burns caused by blast and application of metagenomics next-generation sequencing in the detection of pathogenic microorganisms[J].Chin J Burns,2021,37(10):946-952.DOI: 10.3760/cma.j.cn501120-20201017-00440.

Citation:

PDF( 746 KB)

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

doi: 10.3760/cma.j.cn501120-20201017-00440

1.
Department of Surgery Intensive Care Unit, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
2.
Department of General Intensive Care Unit, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
3.
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
4.
Department of Laboratory, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China

Funds:

National Natural Science Foundation of China for Youth 81601687

More Information

Corresponding author: Han Chunmao, Email: zrssk@zju.edu.cn
Received Date: 2020-10-17

Abstract

Abstract

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 (κ=0.659, 0.596). Within 21-30 d after admission, the consistency between mNGS and bacterial culture was moderate (κ=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 (κ=0.556). The consistency between mNGS and microbial culture was high in samples of blood and indwelling catheter (κ=0.631, 0.619), but those were moderate in sputum and wound (κ=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.
- Burns,
- Infection,
- Metagenome,
- Blast injury,
- Microbiological characteristics,
- Next-generation sequencing

FullText(HTML)

References(20)

References

[1]	GiannellaM,BartolettiM,GattiM,et al.Advances in the therapy of bacterial bloodstream infections[J].Clin Microbiol Infect,2020,26(2):158-167.DOI: 10.1016/j.cmi.2019.11.001.
[2]	LamyB,SundqvistM,IdelevichEA.Bloodstream infections-standard and progress in pathogen diagnostics[J].Clin Microbiol Infect,2020,26(2):142-150.DOI: 10.1016/j.cmi.2019.11.017.
[3]	GreningerAL,NaccacheSN.Metagenomics to assist in the diagnosis of bloodstream infection[J].J Appl Lab Med,2019,3(4):643-653.DOI: 10.1373/jalm.2018.026120.
[4]	BartelsP,ThammOC,ElrodJ,et al.The ABSI is dead, long live the ABSI-reliable prediction of survival in burns with a modified Abbreviated Burn Severity Index[J].Burns,2020,46(6):1272-1279.DOI: 10.1016/j.burns.2020.05.003.
[5]	OslerT,GlanceLG,HosmerDW.Simplified estimates of the probability of death after burn injuries: extending and updating the baux score[J].J Trauma,2010,68(3):690-697.DOI: 10.1097/TA.0b013e3181c453b3.
[6]	BlantonRE.Population structure and dynamics of helminthic infection: schistosomiasis[J].Microbiol Spectr,2019,7(4): 10.1128/microbiolspec.AME-0009-2019.DOI: 10.1128/microbiolspec.AME-0009-2019.
[7]	DialloK,ThillyN,LucA,et al.Management of bloodstream infections by infection specialists: an international ESCMID cross-sectional survey[J].Int J Antimicrob Agents,2018,51(5):794-798.DOI: 10.1016/j.ijantimicag.2017.12.010.
[8]	BlauwkampTA,ThairS,RosenMJ,et al.Analytical and clinical validation of a microbial cell-free DNA sequencing test for infectious disease[J].Nat Microbiol,2019,4(4):663-674.DOI: 10.1038/s41564-018-0349-6.
[9]	ParizeP,MuthE,RichaudC,et al.Untargeted next-generation sequencing-based first-line diagnosis of infection in immunocompromised adults: a multicentre, blinded, prospective study[J].Clin Microbiol Infect,2017,23(8):574.e1-574.e6.DOI: 10.1016/j.cmi.2017.02.006.
[10]	TimsitJF,RuppéE,BarbierF,et al.Bloodstream infections in critically ill patients: an expert statement[J].Intensive Care Med,2020,46(2):266-284.DOI: 10.1007/s00134-020-05950-6.
[11]	SeymourCW,GestenF,PrescottHC,et al.Time to treatment and mortality during mandated emergency care for sepsis[J].N Engl J Med,2017,376(23):2235-2244.DOI: 10.1056/NEJMoa1703058.
[12]	PatelBM,ParatzJD,MalletA,et al.Characteristics of bloodstream infections in burn patients: an 11-year retrospective study[J].Burns,2012,38(5):685-690.DOI: 10.1016/j.burns.2011.12.018.
[13]	KwiecinskiJM,HorswillAR.Staphylococcus aureus bloodstream infections: pathogenesis and regulatory mechanisms[J].Curr Opin Microbiol,2020,53:51-60.DOI: 10.1016/j.mib.2020.02.005.
[14]	SousaD,CenicerosA,GaleirasR,et al.Microbiology in burns patients with blood stream infections: trends over time and during the course of hospitalization[J].Infect Dis (Lond),2018,50(4):289-296.DOI: 10.1080/23744235.2017.1397738.
[15]	AltoparlakU,ErolS,AkcayMN,et al.The time-related changes of antimicrobial resistance patterns and predominant bacterial profiles of burn wounds and body flora of burned patients[J].Burns,2004,30(7):660-664.DOI: 10.1016/j.burns.2004.03.005.
[16]	NagpalR,YadavH.Bacterial translocation from the gut to the distant organs: an overview[J].Ann Nutr Metab,2017,71 (Suppl 1):S11-16.DOI: 10.1159/000479918.
[17]	PoolR, GomezH, KellumJA. Mechanisms of organ dysfunction in sepsis[J]. Crit Care Clin,2018,34(1): 63-80.DOI: 10.1016/j.ccc.2017.08.003.
[18]	Bermejo-MartinJF, Martin-FernandezM, LopezMestanzaC, et al. Shared features of endothelial dysfunction between sepsis and its preceding risk factors (aging and chronic disease)[J]. J Clin Med,2018,7(11):1-15.DOI: 10.3390/jcm7110400.
[19]	Conway-MorrisA, WilsonJ, Shankar-HariM.Immune activation in sepsis[J]. Crit Care Clin,2018,34(1):29-42.DOI: 10.1016/j.ccc.2017.08.002.
[20]	GrumazS, GrumazC, VainshteinY, et al. Enhanced performance of next-generation sequencing diagnostics compared with standard of care microbiological diagnostics in patients suffering from septic shock[J]. Crit Care Med,2019,47(5):e394-e402.DOI: 10.1097/CCM.0000000000003658.

Relative Articles

Supplements(0)

Cited By

Cited by

Periodical cited type(5)

1.	中国初级卫生保健基金会检验医学研究与转化专业委员会，中国医院协会临床微生物实验室专业委员会，全国真菌病监测网侵袭性霉菌感染监测项目组. 侵袭性霉菌感染实验室诊断临床应用专家共识. 中华检验医学杂志. 2024(06): 597-609 .
2.	刘庆. 宏基因组学第二代测序技术与传统实验室微生物培养在支气管扩张病原学诊断中的比较. 大医生. 2023(11): 98-100 .
3.	刘波，许利娟，陈士建. 医院感染控制中应用微生物检验的价值研究. 系统医学. 2023(03): 48-50+58 .
4.	刘双庆，姚咏明. 撤稿：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(中华烧伤杂志, 2021, 37(10)：946-952). 中华烧伤与创面修复杂志. 2022(03): 286-286 . 本站查看
5.	李方蕊，张永标. 病原微生物检测联合药敏试验对慢性前列腺病患抗生素合理使用的影响. 中国药物滥用防治杂志. 2022(04): 514-518 .

Other cited types(3)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Tables(6)

Get Citation

PDF

XML

Article Metrics

Article views (174) PDF downloads(15)

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

doi: 10.3760/cma.j.cn501120-20201017-00440