医院获得性嗜麦芽寡养单胞菌感染或定植128例临床分析

Nosocomial Infection or Colonization of Stenotrophomonas maltophilia:Clinical Analysis of 128 Cases

目的探讨医院获得性嗜麦芽寡养单胞菌感染或定植的临床特点及药敏情况,为预防与控制医院感染及治疗提供依据。方法回顾性分析1988年1月-2006年8月128份标本培养嗜麦芽寡养单胞菌阳性病例临床、检验资料。结果嗜麦芽寡养单胞菌培养阳性病例下呼吸道占94.5%,病原菌定植占68.8%;3个科室的ICU、有侵入性操作、有严重基础疾病、曾应用广谱抗菌药物的病例分别占88.3%、97.7%、100.0%、100.0%;嗜麦芽寡养单胞菌对多种抗菌药物耐药,其中,对庆大霉素、妥布霉素、阿米卡星、头孢吡肟、头孢他啶、头孢曲松、亚胺培南、氨曲南、哌拉西林耐药率分别为92.2%、87.5%、82.0%、79.5%、55.1%、93.7%、99.2%、97.7%、73.4%。结论嗜麦芽寡养单胞菌培养阳性以下呼吸道为主并且多为定植情况;入住ICU及应用广谱抗菌药物尤其是碳青酶烯类药物,分别是嗜麦芽寡养单胞菌感染或定植的重要的独立危险因素;做好ICU环境、器械的消毒灭菌、工作人员的无菌意识及规范操作和合理应用抗菌药物是减少嗜麦芽寡养单胞菌医院感染的有效措施。

OBJECTIVE To investigate the clinical feature and antimicrobial susceptibility of Stenotrophornonas maltophilia nosocomial infection or colonization, so as to give guidence of preventing and treating of it. METHODS The clinical and laboratory data of 128 cases with S. maltophilia nosocomial infection or colonization from Jan 1998 to Aug 2006 were reviewed retrospectively. RESULTS Of the total 128 strains, 94. 5% were isolated from lower respiratory tract and 68.8% were colonization. All of the strains, 88.3% were isolated from intensive care unit, 97.7% had the invasive operation, 100% had the serious underlying diseases and 100% once applied the broad spectrum antibiotics, S. maltophilia was multi-drug resistant, its resistance rate to gentamicin, tobramycin, amikacin, cefepime, ceftazidine, ceftriuxone, imipenem, aztreonam, piperacillin were 92. 2%, 87.5%,82.0%,79.5%,55.1%,93.7%,99.2%,97. 7% and 73.4% respectively. CONCLUSIONS The most of infections are in lower respiratory tract and the pathogens were colonized. The independent risk factor is staying in the ICU and another is treatment with broad spectrum antibiotics,especially used carbapenems. The S. maltophilia isolates are multi-drug resistant. ICU environment disinfection and the medical appliance sterilization, staff＇ s aseptic consciousness, the standardized operation and the reasonable antibiotics application are the effective actions for reducing S. maltophilia nosocomial infection or colonization.