老年嗜麦芽窄食单胞菌院内肺炎92例临床分析

CLINICAL ANALYSIS OF 92 CASES IN THE ELDERLY WITH NOSOCOMIAL PNEUMONIA CAUSED BY XANTHOMONAS MALTOPHILIA

目的 :分析和总结老年嗜麦芽窄食单胞菌医院获得性肺炎的临床特点及对抗生素耐药情况。方法 :对 92例老年嗜麦芽窄食单胞菌医院获得性肺炎的临床资料进行统计、分析。用 VITEK- AMS微生物自动鉴定仪鉴定细菌 ,并用其配套 GNS- KI或 GNS- 2 0 1卡测定该菌体外药敏及 MIC50 、MIC90 。结果 :92例患者均有基础疾病 ,以恶性肿瘤 (占 2 7.2 % )最常见 ,其次为 COPD伴呼吸衰竭 (占 2 3.9% )、脑血管意外 (占17.4% )及糖尿病 (占 14.1% )。其中重症监护病号 (ICU)病房患者占 72 % (6 6 / 92 )。不合理使用广谱抗生素、激素使用、气管切开、意识障碍、化疗、放疗等为本病高危因素。临床表现 :发热 (97.8% ) ;咯嗽、咳痰(5 3.3% ) ;肺部影像学显示 :89%患者表现为双下肺斑片状阴影。药敏试验 ,该菌耐药严重。结论 :老年嗜麦芽窄食单胞菌医院获得性肺炎多发生在有各种基础疾病、免疫功能低下者 ,各种高危因素又促成本病发生 ,临床表现危重、复杂。该菌耐药率高 。

Objective:To analyze the clinical characterisitcs of nosocomial pneumonia(NP)in the elderly caused by Xanthomonas maltophilia(XM) and to investigate the antibiotics susceptibility of XM strains Methods:Retrospective study of 92 cases in the elderly with NP by XM,including risk factors of morbidity,clinical symptoms and signs,X ray or CT findings,blood routine test,treatment and prognosis VITEK AMS microorganism autoanalysis system was used to appraise strains Drug sensitivity tests of XM were studied by affiliated GNS KI or GNS 201 cards of microorganism autoanalysis system Results:100% of 92 cases in elderly had underlying diseases such as carcionms(27 2%),COPD with respiratory failure (23 9%),cerebral vessel accident(17 4%),Diabetes mellitus(14 1%) 72% of there cases were in ICU Inappropriate use of broad spectrum antibiotics,corticosteroids,chemotherapy,radiotherapy,catheterization and invasive intervention were the risk factors Clinical manifestations included fever(97 8%),cough and expectoration(53 3%) The chest X ray or CT revealed infiltration in lower lobes of the lungs(89%) The drug sensitivity tests in vitroshowed that these strains had highly resistant rates Conclusion:The nosocomial pneumonia by XM in the elderly developed in patients with various underlying diseases and risk factors The clinical manifestations were serious and complex Correct and appropriate treatment depends on antibiotics susceptibility