2016-2020年三亚市三级综合医院嗜麦芽寡养单胞菌感染特征和影响因素及耐药分析

Characteristics and influencing factors for Stenotrophomonas maltophilia infection in a tertiary general hospital of Sanya City and drug resistance from 2016 to 2020

目的 分析三亚市嗜麦芽寡养单胞菌(SMA)感染特征、影响因素及耐药性分析,为制定医疗机构内感染预防与控制措施提供参考依据。方法 收集2016年-2020年三亚市3家三级综合医院SMA感染患者的住院资料,回顾性分析SMA感染特征、呼吸道和非呼吸道SMA感染的影响因素及药敏试验结果。结果 SMA感染共753例次,呼吸道感染和非呼吸道感染分别为606例次(80.48%)和147例次(19.52%),呼吸内科检出率(16.73%)最高,其次分别是重症医学科(15.67%)、神经外科(12.35%),呼吸道感染组高龄、合并高血压及肺部疾病、气管切开患者占比高于非呼吸道感染组(P<0.05),而非呼吸道感染组恶性肿瘤、菌血症、外科手术、泌尿道插管及免疫力低下、抗菌药物及免疫抑制剂使用患者占比均高于呼吸道感染组(P<0.05),药敏试验结果,SMA对磺胺甲噁唑/甲氧苄啶最敏感,耐药率仅为2.39%,而对头孢他啶的耐药率高达74.50%。结论 呼吸道感染SMA的影响因素主要是肺部疾病、高血压、高龄、气管切开;恶性肿瘤、免疫力低下、免疫抑制剂及广谱抗菌药物的长期大量使用、菌血症、外科手术、泌尿道插管是非呼吸道感染SMA的影响因素。本市SMA对磺胺甲噁唑/甲氧苄啶高度敏感,而对头孢他啶、氯霉素耐药性较高,临床应结合实际合理使用抗菌药物。

OBJECTIVE To investigate the characteristics and influencing factors for Stenotrophomonas maltophilia(SMA) infection in Sanya and analyze the drug resistance so as to provide guidance for prevention and control of infection in medical institutions. METHODS The hospitalization data were collected from the patients with SMA infection who were hospitalized in three tertiary general hospitals of Sanya from 2016 to 2020. The characteristics of SMA infection and influencing factors for respiratory tract and non-respiratory tract SMA infection were retrospectively analyzed, and the result of drug susceptibility testing was observed. RESULTS A total of 753 case times of patients had SMA infection, including 606(80.48%) case times of respiratory tract infection and 147(19.52%) case times of non-respiratory tract infection. The isolation rate was the highest in respiratory medicine department(16.73%), followed by critical care medicine department(15.67%) and neurosurgery department(12.35%). The percentages of the patients with advanced age, complications with hypertension and pulmonary diseases, tracheotomy were the higher in the respiratory tract infection group than in the non-respiratory tract infection group(P<0.05);while the percentages of the patients with malignant tumors, bacteremia, surgery, urinary tract intubation, low immunity and use of antibiotics and immunosuppressants were the higher in the non-respiratory tract infection group than in the respiratory tract infection group(P<0.05). The result of drug susceptibility testing showed that the drug resistance rate of the SMA strains to sulfamethoxazole-trimethoprim was only 2.39%, while the drug resistance rate to ceftazidime was as high as 74.50%. CONCLUSION The major influencing factors for the respiratory tract SMA infection include pulmonary diseases, hypertension, advanced age and tracheotomy;the influencing factors for the non-respiratory tract SMA infection include malignant tumors, low immunity, long-term excessive use of immunosuppressants and broad-spectrum antibiotics, bacteremia, surgery and urinary tract intubation. The SMA strains isolated from the city are highly sensitive to sulfamethoxazole-trimethoprim but are highly resistant to ceftazidime and chloramphenicol. It is necessary for the hospital to reasonably use antibiotics based on the result of drug susceptibility testing.