阴沟肠杆菌医院下呼吸道感染临床特点及耐药性监测

Clinical features of lower respiratory tract infections caused by Enterobacter cloacae and monitoring of drug resistance

目的调查阴沟肠杆菌医院下呼吸道感染的临床特点及其对抗菌药物的耐药性,为临床诊断及治疗提供依据。方法回顾性分析2008年1月-2010年5月75例阴沟肠杆菌医院下呼吸道感染病例。结果 75例患者中年龄≥65岁59例,存在基础疾病的71例,使用抗菌药物56例,住院时间≥20d的31例;除亚胺培南、阿米卡星、头孢吡肟和哌拉西林/他唑巴坦外,阴沟肠杆菌对其他抗菌药物的耐药率均≥46.7%。结论阴沟肠杆菌医院下呼吸道感染与高龄、基础疾病、住院时间及免疫力低下等因素关系密切,临床表现及实验室检查缺乏特异性;阴沟肠杆菌对抗菌药物耐药性严重,亚胺培南可作为阴沟肠杆菌重症感染的首选抗菌药物。

OBJECTIVE To provide reference for the clinical diagnosis and therapy by investigating the clinical features of nosocomial lower respiratory tract infections caused by Enterobacter cloacae and the drug resistance.METHODS A total of 75 cases with nosocomial lower respiratory tract infections caused by E.cloacae from Jan 2008 to May 2010 were analyzed retrospectively.RESULTS Of the 75 cases,there were 59 cases older than 65,71 cases had underlying diseases,56 cases used antibacterial agents,and 31 cases stayed at hospital more than 20 days;the drug susceptibility testing displayed that the drug resistance rates of E.cloacae to all antibiotics were higher than 46.7% except for imipenem,amikacin,cefepime,and piperacillin/tazobactam.CONCLUSION The lower respiratory tract infection caused by E.cloacae concerns closely with advanced age,underlying diseases,length of stay,and low immunity and so on,the clinical manifestations and the laboratory examination lack specificity;the antibiotic resistance of E.cloacae is severe,and imipenem can be regarded as the fist choice to treat severe E.cloacae infections.