重症患者继发脑膜败血伊丽莎白菌感染的临床病因与耐药性

Risk factors and drug resistance among ICU patients with secondary Flavobacterium meningosepticuminfection

目的分析重症监护病房患者继发脑膜败血伊丽莎白菌感染的临床病因和耐药特点,为临床治疗和预防脑膜败血伊丽莎白菌感染提供依据。方法收集2011年1月至2014年12月重症监护病房患者临床标本,常规分离培养细菌,K-B纸片法进行药敏试验,利用WHONET 5.6软件分析处理试验数据。结果造成脑膜败血伊丽莎白菌主要危险因素有中央静脉插管、应用广谱抗生素、严重的基础疾病、使用免疫抑制剂、入住ICU时间等;检出的71例阳性标本以下呼吸道为主,占87.3%,其次为血液和尿液,分别占5.6%和2.8%;药敏试验表明脑膜败血伊丽莎白菌对万古霉素、磺胺甲唑/甲氧苄啶、利福平和米诺环素的耐药率最低,分别为0.0%、15.5%、16.9%和18.3%,对三种含酶抑制剂的耐药率均<30.0%,其余抗菌药物除环丙沙星、左氧氟沙星外,均>85.0%。结论脑膜败血伊丽莎白菌引发的医院感染已日益严重,该菌对临床常用的头孢类、碳青霉烯类、氨基糖苷类及多种β-内酰胺类抗生素呈高度耐药,临床应加强耐药性监测,防止医院感染,治疗脑膜败血伊丽莎白菌感染首选万古霉素、磺胺甲唑/甲氧苄啶、米诺环素、利福平和含酶抑制剂。

Objective To analyze the risk factors and drug resistance of the pathogens in ICU patients with secondary bacterial infection of Flavobacterium meningosepticum and provide the basis for clinical treatment and prevention of the infection.Methods Clinical specimens of ICU patients from January 2011 to December2014were collected to isolate the pathogens;K-B disk diffusion method was used to determine the drug susceptibility;WHONET 5.6software was used to process data.Results The main risk factors for sepsis caused by Flavobacterium meningosepticum were central venous catheter,use of broad-spectrum antibiotics,severe underlying diseases,use of immune inhibitors,ICU stay length and so on.The 71 cases of positive samples were of lower respiratory tract（87.3%）,blood（5.6%）and urine（2.8%）.The resistance rates of Flavobacterium meningosepticum to Vancomycin,Sulfamethoxazole/trimethoprim,Rifampin and Minocycline were 0.0%,15.5%,16.9%and 18.3%respectively;the resistance rates to three enzyme inhibitors were lower than 30.0%,while those to the other antimicrobial agents（except to Ciprofloxacin and Levofloxacin）were higher than 〉85.0%.Conclusion Nosocomial infection caused by Flavobacterium meningosepticum has become increasingly serious.Clinicians should strengthen the monitoring of the drug resistance.Vancomycin,Sulfamethoxazole/trimethoprim,Rifampin,Minocycline and enzyme inhibitors are the first choice drugs for the treatment.