嗜麦芽窄食单胞菌下呼吸道感染30例临床分析

Lower respiratory tract infection caused by stenotrophomonas maltophilia:Clinical analysis of 30 cases

目的分析嗜麦芽窄食单胞菌下呼吸道感染的临床特点及对抗菌药物的敏感度。方法分析30例嗜麦芽窄食单胞菌下呼吸道感染的临床资料。采用VITK2全自动微生物分析系统鉴定细菌,K-B纸片法进行药物敏感试验。结果 30例中所有患者均有1种以上基础疾病,其中慢性阻塞性肺疾病急性加重最常见,占53.33%。临床表现为发热、咳嗽、咳痰,肺部闻及哮鸣音或湿啰音。X线胸片表现为两下肺片状和斑片状浸润性阴影,部分患者有胸腔积液。白细胞和中性粒细胞明显升高。药敏试验结果表明该菌株耐药率高,除亚胺培南外,对氨基糖苷类和三代头孢菌素类亦普遍耐药,耐药率>80%,细菌对头孢哌酮/舒巴坦、复方新诺明、左氧氟沙星、米诺环素的敏感度分别为83.33%、86.67%、83.33%和90.00%。结论嗜麦芽窄食单胞菌下呼吸道感染易发生在患有多种基础疾病、使用广谱抗菌药物及侵入性操作患者,细菌耐药现象严重。临床上应尽早进行病原学检查,根据药敏试验结果 ,选用合适的抗菌药物。

Aim To analyze the clinical characteristics of lower respiratory tract infection caused by stenotrophomonas maltophilia and investigate the antibiotic sensitivity of stenotrophomonas maltophilia strains.Methods The clinical data of 30 cases of lower respiratory tract infection by S.maltophilia were reviewed retrospectively.The pathogens were identified with the automatic system（VITK2）and susceptibility of S.maltophilia strains was tested with disc diffusion method.Results All of the patients had more than one underlying diseases,53.33% of which were acute exacerbation of COPD.Clinical manifestations include fever,wheezing,cough and expectoration.The chest X-ray in most cases revealed infiltration in lower lobes of both lungs.Pleural fluid was found in some of the cases.White blood cell count and neutrophil count increased significantly.The susceptibility testing showed that these strains（n=30）had high antibiotic resistance.In addition to imipenem,they were also multiresistant to aminoglycosides and cephalosporins.The susceptibility rates of these strains to sulperazon,SMZ-TMP,levofloxacin and minocycline were 83.33%,86.67%,83.33% and 90.00% respectively.Conclusions The lower respiratory tract infection caused by S.maltophilia occurred in the patients who had various underlying diseases,prior use of broad-spectrum antibiotics and invasive treatment.Antibiotic resistance is common in this pathogen.Etiology and antibiotic susceptibility should be confirmed as early as possible for rational antibiotic prescription.