脑膜败血伊丽莎白金菌引发成年患者下呼吸道感染的危险因素及耐药性分析

Risk factors for lower respiratory tract infections caused by Elizabethkingia meningospetica in adult patients and analysis of drug resistance

目的了解医院住院患者下呼吸道感染脑膜败血伊丽莎白金菌的危险因素及其耐药性,为临床合理用药及预防感染提供参考数据。方法采用回顾性调查方法收集医院2010年2月-2012年2月下呼吸道感染脑膜败血伊丽莎白金菌的成年患者。结果共调查60例,其中男性51例,女性9例,平均年龄(65.08±17.7)岁,检出脑膜败血伊丽莎白金菌28d的死亡率为41.67%;感染患者均有严重的基础疾病、长期住院史[(44.8±62.85)d]和使用抗菌药物史(76.67%);危险因素单因素分析显示患者在入住ICU时间、气管切开、中央静脉插管、血液透析、有无近期手术、有无糖尿病6个因素中28d死亡率差异均有统计学意义(P<0.05);进一步进行多因素分析显示,静脉插管、血液透析、使用免疫抑制药物以及有糖尿病4个因素是致死亡率的危险因素;60株脑膜败血伊丽莎白金菌耐药性均较高,仅对环丙沙星等少数药物敏感。结论脑膜败血伊丽莎白金菌引发的医院感染已日益严重,研究证明感染该菌的患者预后不良,临床医务人员应加强无菌操作规范,严格消毒隔离,做好手卫生,合理用药,减少医院感染的发生。

OBJECTIVE To understand the risk factors and antimicrobial susceptibility of Elizabethkingia meningospetica in the hospitalized patients,provide some references for the clinical rational drug use and prevention of nosocomial infections.METHODS A total of 60 patients with this bacterium from Feb 2010 to Feb 2012 were studied by a retrospective survey methodology.RESULTS The patients included 51 males and 9 females,the age was（65.088±17.7） years.The 28 d mortality rate was 41.67%.Many elderly patients had serious underlying diseases,prolonged hospitalization（44.8±62.85） days and the history of drug use（76.67%）.The difference in the risk factors including the ICU stay,tracheostomy,central venous catheter,hemodialysis,recent surgery,and diabetes was statistically significant.Multivariate analysis indicated that the central venous catheter,hemodialysis,use of immunosuppressive drugs and diabetes were the independent risk factors for the mortality.Totally 60 strains of E.meningospetica were highly drug resistant and were only susceptible to few antibiotics like ciprofloxacin.CONCLUSION Nosocomial infections caused by there bacteria have become increasingly serious.Our study indicates that the patients with E.meningospetica face the poor prognosis,the clinical staff should intensify the aseptic practices and perform the strict disinfection and hand hygiene as well as reasonably use of antibiotics so as to reduce the incidence of nosocomial infections.