嗜麦芽窄食单胞菌下呼吸道感染的临床和药敏分析

Analysis of clinical characteristics and drug sensitivity tests of lower respiratory tract infection by Xanthomonas maltophilia

目的分析和总结嗜麦芽窄食单胞菌下呼吸道感染的临床特点及抗生素敏感性的分布情况。方法对５４例嗜麦芽窄食单胞菌下呼吸道感染的临床资料进行统计分析，采用纸片法（ＫｉｒｂｙＢａｕｅｒ）测定该菌的体外药物敏感性。结果５４例中８７％（４７／５４）患有基础疾病，其中慢性阻塞性肺疾病（ＣＯＰＤ）合并呼吸衰竭最常见。５７％（３１／５４）的患者免疫功能低下，３９％（２１／５４）入住ＩＣＵ或ＣＣＵ病房，５４％（２９／５４）曾接受侵入性治疗，９３％（５０／５４）前期使用过广谱抗生素。临床表现为畏寒（７２％）、发热（８０％）、咳嗽（９４％）、咳痰（９１％），胸部Ｘ线多表现为双下肺淡薄、斑片状阴影。药敏监测表明该菌广泛耐药，敏感率＞５０％者仅有复方磺胺甲唑、头孢他啶、氟哌酸及替卡西林钠／克拉维酸钾。结论嗜麦芽窄食单胞菌下呼吸道感染多发生在患有各种基础疾病、免疫功能低下者。临床表现中毒症状明显，细菌耐药现象严重，诊断与治疗有赖于细菌培养和药物敏感结果。

Objective To analyse the clinical characteristics of lower respiratory tract infection caused by Xanthomonas maltophilia and to investigate the antibiotic sensitivity of Xanthomonas maltophilia strains. Methods Retrospective study of the clinical data of 54 cases with lower respiratory tract infection by Xanthomonas maltophilia, including risk factors of morbidity, clinical symptoms and signs, X ray findings, blood routine test, treatment and prognosis. Drug sensitivity against strains of Xanthomonas maltophilia by K B method was studied. Results There were 39 males and 15 females, the mean age being 51±17 years. 87% of the cases had underlying diseases, most of which were COPD complicated by respiratory failure. 57% of the cases were immunocompromised. 39% of the cases were in ICU or CCU. 54% of the cases accepted invasive treatments, and 93% of the cases were given broad spectrum antibiotics. Clinical manifestations include chill (72%), fever (80%), cough (94%) and expectoration (91%). The chest X ray revealed infiltration in lower lobes of both lungs. 16 cases had consolidations, and 11 cases were complicated with pleural effusions. The drug sensitivity test in vitro showed that these strains were multiresistant to commonly used antibiotics, and drugs whose sensitive rate were over 50% included SMZco, ceftazidine, and timentin. Conclusions The lower respiratory tract infections caused by Xanthomonas maltophilia develop at patients with various underlying diseases, especially in the immunocompromised patients. Risk factors of morbidity were: patients in ICU or CCU, acceptance of invasive treatment and inappropriate use of broad spectrum antibiotics. Clinical manifestations include severely toxic symptoms and some cases had pulmonary consolidations and pleural effusions.