嗜麦芽寡养单胞菌医院感染现状及耐药性分析

Nosocomial infection and drug resistance of stenotrophomonas maltophilia

目的了解嗜麦芽寡养单胞菌(SMA)医院感染现状,并对其耐药性进行分析。方法调查2008年1月-2009年12月临床分离的SMA的来源和病区分布,用K-B法检测对16种抗菌药物的耐药性。结果共分离SMA 104株;有7类标本检出SMA,其中检出最多的标本是痰(46.2%)、创面(24.1%)和尿液(12.5%);有11个临床科室分离到SMA,菌株构成比最高的是ICU(37.5%)、烧伤科(24.0%)和中医科(10.5%);药敏结果表明,SMA对亚胺培南和美罗培南的耐药率分别为97.1%和95.2%,头孢他啶、头孢哌酮和头孢吡肟的耐药率为50.0%～71.2%,氨基糖苷类为76.0%～93.3%,耐药率较低的药物有头孢哌酮/舒巴坦(18.3%)、磺胺甲噁唑/甲氧苄啶(18.3%)和环丙沙星(28.8%)。结论下呼吸道和烧伤创面是SMA感染的最常见临床类型;ICU、烧伤科是SMA医院感染的高危病区,SMA对常用抗菌药耐药,临床治疗应根据药敏试验结果选用。

OBJECTIVE To investigate and analyze the clinical distribution and drug resistance of Stenotrophomonas maltophilia （SMA）. METHODS The source and distribution of SMA isolated from Jan. 2008 to Dec. 2009 were investogated and to the drug resistance were tested by means of K-B method. RESULTS There were 104 strains of SMA isolated from 7 kinds of specimen. The prevalence in sputum, wound surface and urine were higher than other specimen. SMA were isolated in l 1 clinical sections, such as ICU （constituent ration, 37.5 %） , burn section （constituent ration, 24.0 %） and traditional chinese medicine section （constituent ration, 10.5 % ）. Drug sensitivity test showed that the drug resistant rates of SMA to imipenem and meropenem were 97.1% and 95.2%. the rates to ceftazidime, cefotaxime and cefepime were 50. 0% -71. 2% ; the rates to aminoglycoside were 76. 0% 93.3 %. The rates to cefoperazone/sulbactam （ 18. 3 % ）, sulfamethoxazole compound （ 18. 3 %） and ciprofloxacin （28.8%）were lower. CONCLUSION SMA infection in lower respiratory tract and burn surface is common. ICU and burn section have the highest prevalence of SMA nosocomial infection. The treatment for SMA should depend on the drug sensitivity test for its strong resistance to normal antibiotics.