嗜麦芽窄食单胞菌医院感染危险因素及预后分析

Nosocomial Infection with Stenotrophomonas Maltophilia in a Teaching Hospital: Characteristics,Risk factors and Outcom

目的：研究本院嗜麦芽窄食单胞菌（Stenotrophomonas maltophilia,SMA）医院感染特征,探讨SMA医院感染患者的预后及感染危险因素,为有效控制和减少SMA医院感染,降低患者病死率提供依据。方法：对本院2008-2013年临床分离的238株SMA流行病学资料进行回顾性研究。采用1∶2成组病例对照方法选取同时期非SMA感染患者作为对照组,分析SMA感染的危险因素。结果：238株SMA对常用的β-内酰胺类、氨基糖苷类抗生素的耐药率高。对19个与SMA感染相关的因素进行单变量分析和非条件多元Logistic回归分析发现含β-内酰胺酶抑制剂抗生素使用（OR=2.015,95%CI=1.420-2.858）、碳青霉烯类抗生素使用（OR=2.249,95%CI=1.501-3.372）和ICU入住〉7 d（OR=2.216,95%CI=1.530-3.208）是SMA医院感染的独立危险因素,但喹诺酮类抗生素的使用具有一定的保护性作用（OR=0.459,95%CI=0.307-0.688）。结论：医院感染SMA耐药性强,感染者的平均住院时间明显长于对照组。SMA医院感染具有多个独立危险因素,加强对这些独立危险因素的控制可有效预防其感染扩散。

Objective To investigate the clinical outcome and risk factors of SMA infection through analyzing the characteristics of stenotrophoraonas maltophilia （SMA） hospital infection in our hospital,in order to provide a basis for effectively controlling and reducing the SMA nosocomial infection and the mortality. Methods The epidemiological data of 238 isolated strains of SMA from 2008 to 2013 were retrospectively analyzed. Meanwhile,476 patients with non-SMA infection were selected as control group based on the 1：2 easeontrol study rule. The risk factors of the SMA infection were analyzed. Results The 238 isolated strains of SMA showed high rate of resistance to commonly used beta lactams, aminogiycosides drugs. The univariate analysis and multivariant Logistic regression analysis was undertaken around 19 SMA infection related facton,and the results demonstrated that the using of antibiotics with β-laetamase inhibitor（ OR = 2. 015,95% CI = 1. 420 - 2. 858） ,carbapenems antibiotics（ OR = 2. 249,95% CI = 1. 501 - 3. 372 ）, and ICU hospitalization time 〉 7 d （ OR = 2.216,95%CI = 1.530 -3.208） was the independent risk factor of SMA infection,bnt the using of quinolones may be a protective factor（ OR = 0. 459,95% CI = 0. 307 - 0.688 ）. Conclusion The drug resistance of SMA is strong, patients with SMA infection showed the prolonged average stay days in hospital. The SMA infection had multiple independent risk factors, effective control of these factors could better prevent from nosocomial infection and spread.