title: Large-area burns with pandrug-resistant Pseudomonas aeruginosa infection and respiratory failure.
abstract: BACKGROUND
  Infection due to pandrug-resistant Pseudomonas aeruginosa (PDRPA) has become a challenge in clinical practice. The aim of this research was to summarize the treatment of large-area burns (60% - 80%) with PDRPA infection and respiratory failure in our hospital over the last two years, and to explore a feasible treatment protocol for such patients.
  
  
  METHODS
  We retrospectively analyzed the treatment of five patients with large-area burns accompanied by PDRPA infection and respiratory failure transferred to our hospital from burn units in hospitals in other Chinese cities from January 2008 to February 2010. Before PDRPA infection occurred, all five patients had open wounds with large areas of granulation because of the failure of surgery and dissolving of scar tissue; they had also undergone long-term administration of carbapenems. This therapy included ventilatory support, rigorous repair of wounds, and combined antibiotic therapy targeted at drug-resistance mechanisms, including carbapenems, ciprofloxacin, macrolide antibiotics and β-lactamase inhibitors.
  
  
  RESULTS
  Four patients recovered from burns and one died after therapy.
  
  
  CONCLUSIONS
  First, compromised immunity caused by delayed healing of burn wounds in patients with large-area burns and long-term administration of carbapenems may be the important factors in the initiation and progression of PDRPA infection. Second, if targeted at drug-resistance mechanisms, combined antibiotic therapy using carbapenems, ciprofloxacin, macrolide antibiotics and β-lactamase inhibitors could effectively control PDRPA infection. Third, although patients with large-area burns suffered respiratory failure and had high risks from anesthesia and surgery, only aggressive skin grafting with ventilatory support could control the infection and save lives. Patients may not be able to tolerate a long surgical procedure, so the duration of surgery should be minimized, and the frequency of surgery increased.
authors.affiliation: Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, China.
authors.forename: Fang-Gang
authors.initials: FG
authors.lastname: Ning
authors.forename: Xiao-Zhuo
authors.initials: XZ
authors.lastname: Zhao
authors.forename: Jing
authors.initials: J
authors.lastname: Bian
authors.forename: Guo-An
authors.initials: GA
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002056:Burns / Q000188:drug therapy / Q000382:microbiology*; D015780:Carbapenems / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000472:pathogenicity*; D012131:Respiratory Insufficiency / Q000188:drug therapy* / Q000382:microbiology*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D018942:Macrolides; D002939:Ciprofloxacin