长期机械通气患者脓肿分枝杆菌感染临床特征与病原学分析

Clinical characteristics of long-term mechanical ventilation patients infected with Mycobacterium abscessus and etiological analysis

目的分析研究重症监护病房(ICU)发生呼吸道脓肿分枝杆菌感染病例的临床特点,提高临床医师分枝杆菌肺病的认识。方法采集2014年1-3月ICU 7例长期机械通气有发热等疑似感染患者呼吸道标本进行检测,同时进行抗酸染色镜检和接种培养,培养阳性的菌株采用GenoType MTBDR plus、Genotype CM和Genotype AS探针法以及基因测序等方法进行鉴定,并开展流行病学调查。结果 7例患者均确诊为脓肿分枝杆菌肺病,其中5例给予克拉霉素、莫西沙星、阿米卡星治疗,2例给予克拉霉素、莫西沙星、头孢西丁联合治疗,4个月后,6例患者症状好转、痰菌转阴、影像学改善,仅有1例患者死于基础疾病加重,所有环境样本培养均未检出脓肿分枝杆菌。结论脓肿分枝杆菌肺病均来自ICU且长期机械通气的老年患者,成为长期机械通气患者的潜在威胁,应加强医院感染预防控制措施。

OBJECTIVE To investigate the case reports of respiratory tract Mycobacterium abscessus infection in the intensive care unit （ICU） and analyze the clinical characteristics so as to improve the clinicians＇awareness of M .ab‐scessus pulmonary disease .METHODS From Jan 2014 to Mar 2014 ,the respiratory tract specimens were collected from the long‐term mechanical ventilation patients with suspected infections like fever ,malaise ,and weight loss , then the specimens were cultured ,meanwhile ,the acid‐fast staining microscopy and inoculated culture were carried out ,the strains that were cultured positive were identified by using GenoType MTBDR plus ,Genotype CM and Genotype AS probe assay as well as DNA sequencing ;the epidemiological survey was conducted . RESULTS Totally 7 patients were confirmed as the M .abscessus pulmonary disease ,of whom 5 were treated with clarithromycin ,moxifloxacin , and amikacin , and 2 were given the combination therapy of clarithromycin , moxifloxacin ,and cefoxitin .After the treatment for 4 months ,the symptoms of 6 patients were improved ,the sputum specimens were cultured negative for bacteria ,and the imaging findings were improved ;only 1 case died of the exacerbation of underlying disease ,and all the environmental specimens were cultured negative for the M .ab‐scessus .CONCLUSIONS The elderly patients undergoing the long‐term mechanical ventilation in the ICU are complicated with the M .abscessus pulmonary disease , which has become a potential threat to the patients undergoing long‐term mechanical ventilation .It is necessary to strengthen the control and prevention of nosocomial infections .