外科重症监护病房嗜麦芽寡养单胞菌暴发流行调查

Fulminate Stenotrophomonas maltophilia Infection in SICU-An Epidemiological Study

目的对外科重症监护病房(SICU)嗜麦芽寡养单胞菌暴发感染进行流行病学调查分析,为预防和控制医院感染提供参考资料。方法对2003年12月25～30日的4例医院感染嗜麦芽寡养单胞菌患者进行流行病学调查分析。结果在SICU同一病房内6d陆续发现4例嗜麦芽寡养单胞菌感染病例,感染者均有相同耐药菌谱,对头孢他啶、头孢吡肟、亚胺培南多种抗生素耐药,对左氧氟沙星、加替沙星、复方新诺明等敏感;其中3例痊愈,1例死亡。结论此次嗜麦芽寡养单胞菌感染为局部暴发流行;危重患者气管插管和住院时间较长是造成此次感染的主要因素,应根据药敏试验结果选用抗菌药物,一旦发现病房有局部暴发流行,应立即关闭病房,进行终末消毒,将转出的患者分别单间隔离。

OBJECTIVE To find out fulminate epidemiological features of Stenotrophomonas maltophilia in SICU and the ways to preventing and treating this nosocomial infection. METHODS The case histories from 4 inpatients who developed S. maltophilia infection in the same ward from Dec 25 to 30,2003,were studied retrospectively to find out the reason of the epidemia and its treatment based on the sputum culture results. RESULTS These 4 patients developed lower respiratory infection on top of their original severe diseases. Within 6 days,their sputum cultures were positive for S. maltophilia, which were resistant to antibiotics like ceftazidime,cefotaxime,and imipenem. They all had antibiotic therapies for invasive operation beforehand.They were immediately isolated in a clean ward and treated with levofloxacin and 3 of them recovered but one died of MOF. CONCLUSIONS These patients got the same nosocomial infections within the same period because of lowered resistance owing to their original weakness from various invasive operation like long duration mechanical ventilation, etc. Levofloxacin,gatifloxacin, and SMZ/TMP are found effective for this infection.