重症监护病房患者洋葱伯克霍尔德菌感染临床特点及耐药性

Clinical characteristics and antimicrobial resistance of Burkholderia cepacia causing infection in intensive care unit patients

目的：了解重症监护病房（ICU）洋葱伯克霍尔德菌（BC）感染患者标本来源、临床特点及菌株耐药性，为指导临床合理用药提供依据。方法回顾性分析2011—2014年入住某院 ICU 发生 BC 感染患者的临床资料，并对菌株耐药性进行分析。结果共分离 BC 267株，主要标本来源为痰（80．15％，214株），血（14．23％，38株），尿（3．37％，9株）。2011—2014年药敏试验结果显示，BC 具有多重耐药性，对临床常用的多种抗菌药物因具有天然耐药性，如氨苄西林、头孢唑林、氨苄西林／舒巴坦、呋喃妥因、头孢呋辛耐药率均为100％；对头孢他啶、左氧氟沙星耐药率分别为4．12％，3．00％；对复方磺胺甲口恶唑耐药率呈升高趋势（χ2＝5．885，P ＝0．015）。结论 ICU 检出 BC 逐年增多，耐药情况严重，应加强医院感染防控管理与目标性监测，根据药敏试验结果合理选择抗菌药物，减低细菌耐药压力。

Objective To understand the specimen sources,clinical characteristics,and antimicrobial resistance of Burkholderia cepacia （B .cepacia ）isolated from infected patients in intensive care unit（ICU）,so as to provide reference for guiding rational use of antimicrobial agents.Methods Clinical data of patients with B .cepacia infec-tion in an ICU between 2011 and 2014 were analyzed retrospectively,antimicrobial resistance of strains was ana-lyzed.Results A total of 267 B .cepacia strains were isolated,the major specimen sources were sputum （80.15%, n=214）,blood（14.23%,n =38）,and urine（3.37%,n =9）.Antimicrobial susceptibility testing results revealed that B .cepacia had multiple resistance,and was naturally resistant to multiple clinically used antimicrobial agents, such as ampicillin,cefazolin,ampicillin/sulbactam,nitrofurantoin,and cefuroxime,resistant rates were all 100%;resistant rates to ceftazidime and levofloxacin were 4.12% and 3.00% respectively;resistant rate to compound sulfa-methoxazole had increased tendency（χ2 =5.885,P =0.015）.Conclusion Isolation of B .cepacia in ICU increased year by year,antimicrobial resistance is serious,management and targeted monitoring of prevention and control of healthcare-associated infection should be strengthened,antimicrobial agents should be chosen according to antimi-crobial susceptibility testing results.