异基因造血干细胞移植患者嗜麦芽窄食单胞菌感染的临床分析

Clinical analysis of the stenotrophomonas maltohpilia infection after allogeneic hematopoietic stem cell transplantation

目的探讨异基因造血干细胞移植（allo—HSCT）患者发生嗜麦芽窄食单胞菌（SMA）感染的临床特点及抗感染疗效，指导临床治疗。方法回顾性分析北京军区总医院120例行allo-HSCT患者的临床资料，分析SMA病原学依据和抗SMA治疗效果。结果120例患者的SMA感染率为6．7％（8／120），血液占25．0％（2／8），下呼吸道感染占75．0％（6／8）。SMA对美罗培南、亚胺培南等β内酰胺酶类药物的耐药率为100％；对头孢曲松、头孢他啶耐药例数均为7例，敏感例数均为1例；对莫西沙星和左氧氟沙星的敏感例数分别为7和6例。结论SMA是allo-HSCT后感染的重要病原菌之一，对β内酰胺酶、头孢菌素类药物敏感率低，对喹诺酮类较为敏感，临床抗感染治疗中，应根据药物敏感试验结果合理选择抗感染药物。

Objective To improve diagnosis and therapy with the stenotrophomonas maltohpilia （SMA） infection after allogeneic hematopoietic stem cell transplantation. Methods SMA etiological basis and anti-SMA therapeutic effect were analyzed through the retrospective study of the clinical data of 120 cases of allogeneic hematopoietic stem cell transplantation patients. Results A total of eight cases had stenotrophomonas maltohpilia infection （6.7%） which mainly occurred in the blood and lower respiratory tract, followed by sepsis in 6 patients （6/8） and 2 cases （2/8） of lung infection. SMA meropenem, imipenem and other β-lactamase enzymes drug resistance showed high resistance to ceftriaxone. Sensitive rate of moxifloxacin and levofloxacin was 87.5% and 75.0% respectively. Conclusions Application results show that SMA is the important pathogenic bacteria infection after allo-geneic hematopoietic stem cell transplantation. SMA is more sensitive to quinolones and clinical anti-infective therapy; rational selection of antibiotics should be based on susceptibility test results.