老年VAP嗜麦芽寡养单胞菌感染及耐药性分析

Infection and drug-resistance of Stenotrophomonas maltophilia in geriatric patients with ventilator-associated pneumonia

目的研究老年VAP嗜麦芽寡养单胞菌(SMA)感染及耐药特征。方法从161例老年患者分离的30株嗜麦芽寡养单胞菌采用纸片扩散法进行药敏试验,并对抗生素耐药结果进行回顾性分析。结果 30株嗜麦芽寡养单胞菌对氨苄西林、亚胺培南、美罗培南、头孢唑啉、氨曲南、庆大霉素、阿米卡星高度耐药(100%,96.67%,96.67%,93.33%,80.00%,73.33%);对头胞吡肟,头胞他啶,头胞噻肟耐药率较高(50.00%,50.00%and60.00%),对左氧氟沙星,环丙沙星耐药率接近50%(40.00%,46.67%);但对复方新诺明、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药率较低(3.33%,10.00%,16.67%)。结论嗜麦芽寡养单胞菌对常用抗菌药物呈多重耐药,在老年VAP感染已十分严重,它的首选药物为复方新诺明、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦。

To investigate the infectious and resistant characteristics of Stenotrophomonas maltophilia（S.maltophilia） in geriatric patients with ventilator-associated pneumonia（VAP）,and improve the level of clinical prevention and therapy of S.maltophilia infection,161 geriatric patients with ventilator respiration treatment were monitored objectively.The microbial sensitivity of 30 isolates of S.maltophilia and antibiotic test results were retrospectively analyzed.Thirty isolates of S.maltophilia were highly resistant to ampicillin,imipenem,meropenem,cefazolin,aztreonam,gentamicin,and amikacin respectively（100%,96.67%,96.67%,93.33%,80.00% and 73.33%,respectively）;higher resistant to cefepime,ceftazidime,and cefotaxime respectively（50.00%,50.00% and 60.00%,respectively）.The resistance rates to levofloxacin and ciprofloxacin were close to 50.00%（40.00% and 46.67%,respectively）,but lower to trimethoprim-sulfamethoxazole,cefoperazone/sulbactam and piperacillin/ tazobactam（3.33%,10.00 % and 16.67 %,respectively）.It＇s suggested that S.maltophilia shows multi-resistance to commonly used antimicrobial agents.As infection of S.maltophilia in geriatric patients with VAP is extremely severe,trimethoprim-sulfamethoxazole,cefoperazone/sulbactam and piperacillin/tazobactam are the first choices for S.maltophilia infection.