老年肿瘤患者嗜麦芽窄食单胞菌致院内获得性肺炎的临床特点及其危险因素

Stenotrophomonas maltophilia induced nosocomial acquined pneumonia in elderly patients with tumor: clinical characteristics and risk factors

目的探讨老年肿瘤患者嗜麦芽窄食单胞菌（Stenotrophomonasmaltophilia,Sm）致院内获得性肺炎的临床特点及其危险因素,以指导临床诊治。方法以解放军第306医院血液肿瘤科2007-08至2015-01发生Sm院内获得性肺炎老年肿瘤患者34例为病例组,以同期未发生Sm院内获得性肺炎老年肿瘤患者102例为对照组,回顾性分析临床资料。结果 34例Sm致院内获得性肺炎老年肿瘤患者男24例,女10例,年龄60～91岁,平均（77±11）岁。均合并基础疾病,均有发热,中度发热为主,高热患者常合并真菌感染或合并多药耐药、泛耐药菌感染;均有呼吸道症状,胸部X线或肺部CT提示炎性改变;82.4%患者分离出2种以上病原菌;50%患者合并多药耐药、泛耐药菌感染;肺癌及淋巴瘤比例偏高;均应用2种以上抗生素,7例（20.6%）患者同时行抗真菌治疗,28例（82.4%）患者应用碳青霉烯类抗生素治疗,17例（50%）应用喹诺酮类抗生素治疗。住院时间长、接受化疗及贫血是老年肿瘤患者Sm致院内获得性肺炎危险因素。结论对有基础疾病老年肿瘤患者伴有发热及呼吸道症状时,应警惕Sm致院内获得性肺炎,住院时间长、接受化疗及贫血是老年肿瘤患者Sm致院内获得性肺炎的危险因素。

Objective To investigate the Stenotrophomonas maltophilia induced noxocomial acquired pneumonia in elderly tumor patients,its clinical characteristics and risk factors,and to guide clinical diagnosis and treatment. Methods Thirty-four elderly patients with stenotrophonas maltophilia induced nosocomial acquired pneumonia admitted in 306 th Hospital Blood Oncology Department from August 2007 to January 2007 were recruited as study group,and 102 elderly tumor patients without nosocomial acquired pneumonia admitted in the same period were as control group; their clinical data were retrospectively analyzed. Results Of 34 elderly tumor patients with such pneumonia,24 were male,10 female,aged 60 to 91 years old,average age 77 ± 11. All patients had accompanied basic diseases,fever（ mainly moderate）. Accompaniod fungal infection was common in patients with high fever or with multi-resistant,generic drug resistant bacterial infections. All patients had respiratory symptoms,chest X-ray or CT of the lung inflammation change. From more than 82. 4% of patients,2 strains of pathogenic bacteria were isolated. 50% of patients had multi-resistant,generic drug resistant bacteria infections. High proportion of patients had lung cancer and lymphoma. More than 2 kinds of antibiotics were used,7 patients（ 20. 6%） received antifungal therapy at the same time,28 patients（ 82. 4%） used carbabenems antibiotic treatment,17 patients（ 50%）,used quinolones. Long length of hospital stay,chemotherapy,and anemia were risk factors to elderly tumor patients with nosocomial acquired pneumonia. Conclusion For elderly tumor patients with basic diseases,accompanied by fever and respiratory symptoms,we should be alert to Stenotrophomonas maltophilia induced nosocomial acquired pneumonia. Long duration of hospital stay,chemotherapy and anemia are the risk factors contributory nosocomia acquired pneumonia in elderly patients with tumor.