儿童医院32株脑膜炎败血性黄杆菌医院感染临床特征及耐药性分析

Clinical characteristics of nosocomial infection caused by 32 strains of Flavobacteriummeningosepticumin a children′s hospital and analysis of drug resistance

目的探讨脑膜炎败血性黄杆菌儿童医院感染特点及耐药性,为临床诊疗护理提供参考,为医院感染预防控制提供循证依据。方法回顾性分析医院2014年6月-2016年5月住院患者送检标本中分离的32株脑膜炎败血性黄杆菌医院感染特点和耐药性;采用法国生物梅里埃公司ATB-Experession型仪器进行细菌鉴定;采用K-B法进行药敏试验。结果医院感染主要发生在重症医学科,感染部位以呼吸道为主;感染对象主要为年龄<1岁、疾病危险等级评分≥4分、住院时间及抗菌药物使用≥4周、有人工气道的患者;合并其他感染比例为81.25%,感染病原菌以革兰阴性菌为主;药敏试验显示,脑膜炎败血性黄杆菌对多种抗菌药物表现为高度耐药和多药耐药。结论脑膜炎败血性黄杆菌医院感染主要是住院及抗菌药物使用时间长、有人工气道情况下发生,诊疗中应根据细菌药敏试验结果合理选用抗菌药物,医院感染预防控制重点在于规范侵入性操作,重视手卫生及环境清洁消毒,加强呼吸道及呼吸机管路管理。

OBJECTIVE To explore the characteristics of nosocomial infection caused by Flavobacterium meningo- septicum and analyze the drug resistance so as to provide guidance for clinical diagnosis, treatment, and care as well as provide evidence-based data for prevention and control of the nosocomial infection. METHODS Totally 32 strains of F. meningosepticum were isolated from submitted specimens that were obtained from the patients who were hospitalized from Jun 2014 to May 2016, then the characteristics of the nosocomial infection and drug resist- ance of the strains were retrospectively analyzed, the bacterial identification was conducted by using ATB-Experes- sion instrument of BioMerieux, France, and the drug susceptibility testing was performed with the use of K-B method. RESULTS The nosocomial infection mainly occurred in department of critical care medicine, and the re- spiratory tract was the major infection site. The patients with the less than 1 year of age, disease risk rating score no less than 4 points, hospitalization duration and time of use of antibiotics no less than 4 weeks or artificial airway were dominant among the patients with the infection; the proportion of the patients complicated with other infec- tions was 81.25%. The gram-negative bacteria were dominant among the pathogens causing the infection. The drug susceptibility testing showed that the F. meningosepticum were highly resistant to multiple antibiotics and were multidrug-resistant. CONCLUSION The nosocomial infection caused by the F. meningosepticum mainly occurs in the patients with long hospitalization duration, long time of use of antibiotics, or artificial airway. It is necessary to reasonably use antibiotics based on the result of the drug susceptibility testing, standardize the invasive operation by focusing on the prevention and control of the nosocomial infection, pay attention to the hand hygiene and envi- ronmental cleaning and disinfection, and strengthen the management of respiratory tract and ventilator circuits.