重症加强治疗病房内嗜麦芽窄食单胞菌呼吸机相关性肺炎临床特征调查

Clinical features of ventilator associated pneumonia caused by Stenotrophomonas maltophilia in intensive care unit

目的调查ICU内嗜麦芽窄食单胞菌呼吸机相关性肺炎（VAP）的临床特征。方法回顾性调查2001年1月-2006年12月ICU内发生的39例嗜麦芽窄食单胞菌VAP的临床资料。结果在15种抗生素药敏试验中,分离的嗜麦芽窄食单胞菌对12种抗生素100%耐药。其对复方新诺明、替卡西林＋棒酸及环丙沙星的敏感率分别为46.2%、30.8%和12.8%。嗜麦芽窄食单胞菌VAP混合感染率为92.30%。79.5%的嗜麦芽窄食单胞菌VAP为晚发VAP。使用广谱抗生素尤其是碳青霉烯类以及机械通气时间7 d以上是发生嗜麦芽窄食单胞菌VAP的高危因素。34例嗜麦芽窄食单胞菌VAP患者死亡,病死率87.2%。结论嗜麦芽窄食单胞菌VAP在ICU院内感染中占有重要地位,其混合感染率高、病死率高。ICU内使用碳青霉烯类、机械通气7 d以上者要考虑发生嗜麦芽窄食单胞菌感染,应进行针对性预防及治疗。

Objective To investigate the characteristics of ventilator associated pneumonia （VAP） caused by Stenotrophomonas maltophilia（Sin） in ICU. Methods The clinical data of 39 patients with VAP caused by Sin, from Jan 2001 to Dec 2006, were retrospectively investigated. Results In 15 kinds of antibiotics sensitivity test, all cases showed 100% resistance to 12 kinds of antibiotics except sulfamethoxazole/trimethoprim, ticarcillin/clavulanic acid and ciprofloxacin with sensitivity rate of 46. 2% , 30. 8% and 12. 8%, respectively. 92. 30% of Sm VAP were co-infected with other microorganisms and 79.5% of VAP were late-onset. The use of broad-spectrum antibiotics, especially carbapenem, and prolonged mechanical ventilation more than 7 days were risk factors for Sm VAP. Morbidity of Sm VAP was 87.2%. Conclusions Sm VAP has an important role in ICU infections with high morbidity and co-infection rate. It should be alerted to the possibility of Sm VAP in the case of when prolonged ventilation （ 〉7 days） or carbapenem is used.