木糖氧化无色杆菌致新生儿血流感染的临床特征及耐药性研究

Clinical characteristics and drug resistance of neonatal bloodstream infection caused by Achromobacter xyloxidans

目的探讨木糖氧化无色杆菌致新生儿血流感染的临床特征及菌株耐药性,为该菌感染的临床诊断和治疗提供依据。方法对2016—2019年西北妇女儿童医院新生儿科收治的31例木糖氧化无色杆菌血流感染患儿的临床特征、易感因素、实验室检测结果及临床结局进行回顾性分析。结果31例患儿中19例有临床症状,其中呼吸窘迫14例(45.2%)、肺炎3例(9.7%)、发热2例(6.5%)。早产、低体质量、肠外营养、静脉置管及既往广谱抗菌药物治疗为木糖氧化无色杆菌感染的主要易感因素。所有菌株对四环素类和磺胺类药物敏感,对除氨曲南和头孢吡肟的其他β-内酰胺类/酶抑制剂类药物均敏感。菌株对氨基糖苷类和氨曲南的耐药率较高,均超过了90.0%。结论木糖氧化无色杆菌可能引起住院新生儿血流感染或造成医院感染暴发,临床应根据药敏结果选用合适的抗菌药物进行治疗以获得较好的临床结局,并加强环境监测和清洁消毒以防止出现医院感染暴发。

Objective To explore the clinical characteristics and drug resistance of Achromobacter xyloxidans in neonatal bloodstream infection,so as to provide basis for clinical diagnosis and treatment of this bacterial infection.Methods The clinical characteristics,predisposing factors,laboratory test results and clinical outcomes of 31 children with colourless Bacillus xyloxidans bloodstream infection treated in the Neonatology Department of Northwest women's and children's Hospital from 2016 to 2019 were retrospectively analyzed.Results Among the 31 cases,19 cases had clinical symptoms,including 14 cases of respiratory distress(45.2%),3 cases of pneumonia(9.7%)and 2 cases of fever(6.5%).Preterm birth,low body weight,parenteral nutrition,intravenous catheterization and previous broad-spectrum antibiotic treatment were the main susceptible factors of Achromobacter xyloxydans infection.All strains were sensitive to tetracyclines and sulfonamides.Except aztreonam and cefepime,the strains were sensitive to other β Lactam/enzyme inhibitors antibiotics.The resistance rates of aminoglycosides and aztreonam were higher than 90.0%.Conclusion Achromobacter xyloxydans may cause bacterial infection or outbreak of nosocomial infection in hospitalized newborns.Appropriate antibiotics should be selected according to the drug sensitivity results in order to obtain better clinical outcomes,and environmental monitoring and disinfection should be strengthened to prevent the outbreak of nosocomial infection.