木糖氧化无色杆菌所致患者医院获得性肺炎28例

Clinical analysis of elderly patients with hospital-acquired pneumonia caused by achromobacter xylosoxidans

目的探讨木糖氧化无色杆菌所致患者医院获得性肺炎(HAP)的临床特点及抗菌药物治疗方法。方法回顾性分析解放军总医院老年病房28例木糖氧化无色杆菌所致老年患者HAP的临床资料。结果木糖氧化无色杆菌所致老年患者HAP均发生在有基础疾病的患者,其中20例(71.4%)接受机械通气治疗;发热17例(60.7%),呼吸困难20例(71.4%),肺部啰音或实变体征20例(71.4%)。9例(32.1%)出现白细胞升高,但是中性粒细胞百分比升高者却有25例(89.3%),C-反应蛋白升高者有24例(85.7%);分离菌对阿米卡星、庆大霉素的耐药率高达100.0%,氨曲南的耐药率为89.3%。对复方新诺明、头孢哌酮/舒巴坦、哌拉西林钠/他唑巴坦较为敏感,药物敏感率分别为82.1%、83.3%、89.3%。初始治疗药物主要为β-内酰胺类/β-内酰胺酶抑制药(42.8%)、碳青霉烯类(46.4%)、喹诺酮类(42.9%),治疗终点好转率85.7%,30 d死亡4例,病死率为14.3%。结论对于木糖氧化无色杆菌所致老年患者HAP,β-内酰胺类/β-内酰胺酶抑制药有一定疗效。

Objective To study the clinical features of hospital-acquired pneumonia（HAP） caused by Achromobacter xylosoxidans and the sensitivity to antibiotics. Methods The clinical data of 28 elderly patients with HAP caused by Achromobacter xylosoxidans were analyzed retrospectively. Results Pneumonia caused by Achromobacter xylosoxidans often occurred in patients complicated with foundamental diseases. Twenty patients（71.4%） were conducted with mechanical ventilation before infected with Achromobacter xylosoxidans. Fever and the higher WBC level accounted for 60.7%（17/28） and 32.1%（9/28）. However,the increase of neutrophils was predominant（89.3%） and the increase of CRP accounted for 85.7%（24/28）. Occurrence of resistant rate to amikacin and gentamicin was attained to 100.0% and the resistant rate to aztreonam was approached to 90.0%. The more effective antibiotics were as followings：trimethoprim and sulfame-thoxazole（82.1%）,cefoperazone and sulbactam（83.3%）,piperacillin and tazobactam（89.3%）. The initial description of antibiotics included carbopenems（46.4%）,quinolones（42.9%）,piperacillin/β-lactamase inhibitors（21.4%） and the third generation cephalosporins/β-lactamase inhibitors（21.4%）. Twenty-four patients（85.7%） improved,and 4 patients（14.3%） died in 30 days. Conclusion β-lactams/β-lactamase inhibitors are effective in the treatment of elderly patients suffered from HAP caused by Achromobacter xylosoxidans.