多重耐药菌人苍白杆菌致外科重症患者感染的危险因素与耐药性研究

Analysis of risk factors and drug resistance in surgical critically ill patients with infection caused by multidrug-resistant bacteria Ochrobactrum anthropi

目的探讨人苍白杆菌致外科重症患者感染的临床特点、危险因素与耐药性,为有效预防和控制感染提供指导。方法 2007年1月-2017年2月金华市3家医院细菌培养为人苍白杆菌34例外科重症患者作为感染组,50例同期未发生人苍白杆菌感染的外科重症患者作为对照组,比较分析引起该菌感染的危险因素。结果 34例人苍白杆菌感染者临床表现无特异,严重的基础疾病、侵入性操作和使用免疫抑制药物是引起感染的主要危险因素;该菌对青霉素类、含酶抑制剂、1代~3代头孢菌素类、其他β-内酰胺类等高度耐药,耐药率均高于90.0%,对氨基糖苷类、复方磺胺类、喹诺酮类、4代头孢菌素类头孢吡肟保持低度耐药,对四环素类、碳青酶烯类均不耐药。结论人苍白杆菌主要引起免疫力低下的肿瘤患者发生血流感染,临床应尽量减少不必要的侵入性操作,该菌对β-内酰胺类抗菌药物高度耐药,治疗该菌感染首选头孢吡肟、米诺环素、亚胺培南等耐药率较低的药物。

Objective To investigate the clinical characteristics, risk factors and drug resistance of the patients with severe sur- gical infection caused by Ochrobactrum anthropi, so as to provide guidance for effective prevention and control of infection. Methods 34 patients with Ochrobactrum anthropi infection in three hospitals from January 2007 to February 2017 in Jinhua were selected as the infection group, at the same time, 50 cases of surgical critically ill patients without infection were selected as the control group, and to compare and analyze the risk factors of the infection. Results 34 cases of Ochrobactrum anthropi had no specific clinical manifestations, and severe underlying diseases, invasive procedures and the use of immunosuppressive drugs were the major risk factors for causing infection; Ochrobactrum anthropi was mainly resistant to ampicillin, piperacillin, ampicillin/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftriaxone, aztreonam, cefoxitin and other β- lactam, with the resistance rates higher than 90.0% ; but its resistance rate to cefepime, minocycline, carbapenem, quinolones was low, and it is not resistant to tetracyclines and carbapenems. Conclusion Ochrobactrum anthropi mainly caused tumor patients with bloodstream infection in low immunity, so clinical should try to reduce the unnecessary invasive operation. Ochrobactrum anthropi is highly resistant to β- lactam antibiotics, and treatment of the bacterial infection preferred cefepime, minocycline, imipenem and other antibiotic with lower resistance rate.