安徽省859株嗜麦芽窄食单胞菌临床感染特征及耐药性分析

Clinical characteristics and drug resistance of 859 strains of Stenotrophomonas maltophilia in Anhui province

目的了解安徽省嗜麦芽窄食单胞菌的临床分布特征及耐药情况,为该菌感染的临床诊断及合理用药提供科学依据。方法收集安徽医科大学第一附属医院2008—2017年住院患者分离的嗜麦芽窄食单胞菌859株,采用纸片法测定菌株对多种抗菌药物的敏感性。分析菌株药敏结果、感染临床分布及药物耐药性变化。结果该院分离的嗜麦芽窄食单胞菌主要来源为痰样本(682株,79.39%),其次是尿液样本(39株,4.54%)和血液样本(33株,3.84%);主要分布在重症监护病房(256株,29.80%)和干部病房(112株,13.04%);448株(52.15%)菌株来源于65岁以上患者,且随着年龄增长,菌株对抗菌药物的耐药率略有增高。该菌对米诺环素、复方磺胺甲噁唑和头孢哌酮/舒巴坦耐药率较低,敏感率分别达到93.73%、88.60%和82.17%。2008—2017年间该菌对妥布霉素、左氧氟沙星、替卡西林/克拉维酸和头孢他啶的耐药性变化较大,差异有统计学意义(χ2=72.246、18.513、38.500和40.570,P均<0.05)。结论长期住院的老年患者需警惕嗜麦芽窄食单胞菌的感染的发生。米诺环素、复方磺胺甲噁唑和头孢哌酮/舒巴坦对该菌敏感,可供临床选择。

Objective To investigate the clinical distribution and drug resistance of Stenotrophomonas maltophilia in Anhui province,so as to provide scientific basis for the diagnosis and rational treatment of this pathogen.Methods A total of 859 strains of Stenotrophomonas maltopia were isolated from hospitalized patients in the First Affiliated Hospital of Anhui Medical University from 2008 to 2017.The susceptibilities of strains to multiple drugs were tested by disk method.The results of drug sensitivity,clinical distribution and changes of drug resistance were analyzed.Results The isolates of Stenotrophomonas maltophilia were mainly from sputum samples(682 strains,79.39%),followed by urine samples(39 strains,4.54%)and blood samples(33 strains,3.84%).It was mainly distributed in the intensive care unit(256 strains,29.80%)and the cadre ward(112 strains,13.04%).There were 448 Stenotrophomonas maltophilia strains(52.15%)originated from patients over 65 years old,and the antimicrobial resistance rate increased slightly with age.The resistance rates of Stenotrophomonas maltophilia to minocycline,cotrimoxazole and cefoperazone/sulbactan were low,with the sensitivity rates of 93.73%,88.60%and 82.17%,respectively.From 2008 to 2017,the resistance rates to tobramycin,levofloxacin,ticarcillin/clavulanic acid and ceftazidime changed greatly,with significant differences(χ2=72.246,18.513,38.500 and 40.570,P all<0.05).Conclusions The elderly patients in hospital for a long time should be alert to the occurrence of Stenotrophomonas maltophilia infection.Minocycline,cotrimoxazole and cefoperazone/sulbactan are sensitive to this bacterium,and are available for clinical treatment.