新生儿重症监护病房嗜麦芽窄食单胞菌感染临床分析

Clinical analysis of stenotrophomonas maltophilia infection in NICU

目的探讨新生儿重症监护病房（NICU）嗜麦芽窄食单胞菌（SMA）感染的临床特点、耐药情况及治疗。方法对2008年1月至2012年12月我院NICU收治的SMA感染患儿进行回顾性分析,对其临床特征、细菌耐药性及治疗情况进行总结。结果本院NICU近5年共收治新生儿20463例,其中SMA感染54例,发生率2.63‰,2008—2012年发生率分别为4.17‰、2.80‰、3.05‰、2.50‰、0.94‰。其中新生儿败血症36例,新生儿肺炎18例;早产儿与足月儿发生率差异无统计学意义（2.61‰比2.65‰,P〉0.05）。临床主要表现为气促（27例）、黄疸（22例）、青紫（17例）、消化道出血（7例）、腹胀（8例）、呕吐（7例）等,常见并发症有呼吸衰竭（18例）、心力衰竭（13例）、坏死性小肠结肠炎（6例）、弥散性血管内凝血（4例）、休克（3例）等;13例（24.1%）考虑为医院感染,早产儿及气管插管机械通气患儿医院感染发生率分别高于足月儿及鼻塞无创辅助通气患儿（1.63‰比0.2‰,7.21‰比0.75‰,P均〈0.01）。SMA对头孢哌酮/舒巴坦、替卡西林/克拉维酸钾敏感度较高,均〉70%,对哌拉西林/他唑巴坦、头孢他啶耐药率在30%~40%。结论SMA是新生儿医院感染的重要病原菌,新生儿SMA感染主要表现为新生儿败血症和新生儿肺炎,耐药率高,早产儿医院感染SMA发生率高于足月儿。

Objective To study the clinical characteristics, drug resistance and treatment of Stenotrophomonas mahophilia （SMA） infection in neonates. Methods Neonates with SMA infection admitted to NICU of our hospital from January 2008 to December 2012 were retrospectively analyzed. Clinical characteristics, drug resistance and treatment were summarized. Results A total of 20 463 neonatal cases were treated in NICU during last 5 years, including 54 cases of SMA infection, and the total prevalence was 2. 63‰, the yearly incidence from 2008 to 2012 were 4. 17 ‰, 2.80 ‰,3.05 ‰, 2. 50 ‰,0.94‰ respectively. The 36 cases were diagnosed as neonatal sepsis, 18 cases pneumonia of the newborn. There was no statistically significant differences between premature group （2.61‰） and full-term group （2.65‰） （P 〉 0. 05 ）. The main clinical manifestations were dyspnea （27 cases）, jaundice （22 cases） , cyanosis （ 17 cases）, gastrointestinal bleeding （7 cases）, abdominal distension （ 8 cases） and vomiting （7 cases）. The most common complications were respiratory failure （ 18 cases）, heart failure （13 cases ）, necrotizing enterocolitis （6 cases ）, disseminated intravascular coagulation（4 cases）, and shock （3 cases）. 13 cases （24. 1% ） were considered as hospital acquired infection, Infection rates in preterm group （ 1.63 ‰） and endotracheal intubation with mechanical ventilation group （7.21‰） were higher than full-term group （0. 2‰） and nasal noninvasive ventilation group （0. 75‰） （all P 〈 0. 01 ）. Cefoperazone/sulbactam, ticarcillin/clavulanate potassium were highly sensitive, all 〉70%, and piperacillin/tazobactam, ceftazidime resistance rates were 30% -40%. Conclusions SMA is an important pathogen of neonatal nosocomial infection. The neonatal SMA infection mainly manifests as neonatal sepsis and neonatal pneumonia. Drug resistance rate is high. Nosocomial infection rate of SMA in premature infants is higher than that of full-term infants.