36例解甘露醇罗尔斯顿菌所致老年患者医院获得性肺炎的临床分析

Clinical analysis of 36 elderly Patients with Hospital-acquired Pneumonia caused by Ralstonia mannitolilytica

目的探讨解甘露醇罗尔斯顿菌所致老年患者医院获得性肺炎的临床特点及治疗方法。方法回顾性分析36例解甘露醇罗尔斯顿菌所致老年患者医院获得性肺炎病例。结果解甘露醇罗尔斯顿菌所致肺炎多发生于接受机械通气治疗的患者,25.0%无发热,白细胞计数升高者仅占50.0%,而中性粒细胞百分比升高者为97.2%;胸部影像学主要表现为支气管肺炎;分离菌对氨曲南耐药率为100.0%,对美罗培南、头孢哌酮耐药率分别为97.5%、95.0%;对分离菌较为敏感的抗菌药物分别为复方新诺明(100.0%)、头孢吡肟(100.0%)、左氧氟沙星(97.5%)、头孢哌酮/舒巴坦(95.0%)。初始治疗应用的抗菌药物主要为三代头孢菌素类/酶抑制药(55.6%)、碳青霉烯类(50.0%)、喹诺酮类(30.6%)、哌拉西林/酶抑制药(30.6%)。治疗终点,治愈好转26例(72.2%),30d病死率为25.0%。结论对于解甘露醇罗尔斯顿菌所致老年患者医院获得性肺炎,应用β-内酰胺类/β-内酰胺酶抑制药有一定疗效。

Objective To study the clinical features and therapies of hospital-acquired pneumonia （HAP） caused by R. mannitolilytica. Methods The clinical data on 36 elderly patients with HAP caused by R. mannitolilytica were analyzed retrospectively. Results Pneumonia caused by R. mannitolilytica often occurred in patients who underwent mechanical ventilation treatment. Nonfever patients accounted for 25.0% ,while patients with increased number of WBC accounted for 50.0%, in which the increase of neutrophils was predominant（97.2%）. Chest imaging indentified Bronchopneumonia as the prevalent condition. Resistant rates to aztreon- am, meropenem and cefoperazone were 100.0%, 97.5% and 95.0% respectively. The antibiotics, to which R. mannitolilytica was more sensitive,were the following：trimethoprim-sulfamethoxazole（100.0%）,cefepime （100.0%）,1evofloxacin（97.5%）,and cefoperazone/sul- bactam（95.0%）. The initial use of antibiotics included the 3rd generation cephalosporins/β-laetamase inhibitors（55.6%）, carbopenems （50.0%）, quinolones （30.6%）, and piperacillin/β-1aetamase inhibitors （30.6%）. The condition of 26 patients （72.2%） improved, while 9 patients （25.0%） died in 30 days. Conclusions β-1actams/β-1actamase inhibitors are effective in the treatment of elderly patients with HAP caused by R.mannitolilytica.