海南省类鼻疽病151例流行病学特征及其病原菌耐药性

Epidemiological characteristics and antimicrobial resistance of 151 cases of melioidosis in Hainan Province

目的分析海南省151例类鼻疽病例的流行病学特征及类鼻疽伯克霍尔德菌(Burkholderia pseudomallei,BP)耐药性情况,为类鼻疽病的诊断治疗以及合理预防提供依据。方法收集海南医学院第二附属医院2013年1月1日—2022年8月31日门诊就诊和住院151患者和送检标本分离及鉴定的BP株类鼻疽病例的临床资料及其病原菌的耐药特性,并采用SPSS26.0软件进行统计学分析。结果151例BP感染患者中,男性138例(91.4%),女性13例(8.6%),45~<60岁患者最多,共74例(49.0%);类鼻疽病发病时间集中于10月(19.2%)、11月(19.2%)、8月(9.9%)、7月(8.6%),确诊人数呈上升趋势且确诊时间均<10 d。来自内科(31.1%)、外科(26.5%)和重症医学科(20.5%)是收治类鼻疽病常见的科室。血液(49.0%)、痰液(9.9%)、伤口分泌物(8.6%)是检出BP的主要临床标本。BP感染患者以肺部感染(68.2%)、脓毒血症(35.1%)、局部化脓性感染(23.8%)位居临床表现的前列。类鼻疽病治疗有效率为74.8%,肝功能异常是影响类鼻疽病疗效的危险因素(χ^(2)=5.010,P<0.05),BP菌株对甲氧苄啶/磺胺甲恶唑(SXT)、多西环素(DOX)、亚胺培南(IPM)、头孢他啶(CAZ)、阿莫西林/克拉维酸(AMC)和四环素(TCY)的敏感率分别为98.7%、97.2%、96.7%、94.0%、93.2%和90.7%。结论类鼻疽病容易造成误诊或漏诊,应加强本地区类鼻疽病流行性特征和危险因素的认识;BP对常用抗菌药物的敏感性呈现一定水平的下滑趋势,临床应规范用药并加强耐药性的监测,以提高类鼻疽病治疗的有效率。

Objective To analyze the epidemiological characteristics of 151 cases of melioidosis and the drug resistance of Burkholderia pseudomallei(BP),in order to provide the basis for diagnosis,treatment and reasonable prevention of melioidosis.Methods A total of 151 inpatients and outpatients from the Second Affiliated Hospital of Hainan Medical University from January 1,2013 to August 31,2022 were collected,and clinical specimens were submitted for examination to isolate and identify BP strains.The clinical data of 151cases of melioidosis and the drug resistance characteristics of pathogenic bacteria were retrospectively analyzed,and using SPSS26.0 software for statistical analysis.Results Among 151 cases with BP infection,there were 138 males(91.4%)and 13 females(8.6%);the most patients were aged from 45-<60 years old,accounting for 74 cases(49.0%);melioidosis incidence was concentrated in October(19.2%),November(19.2%),August(9.9%)and July(8.6%),and;the number of confirmed cases showed an increasing trend and the time for confirmation was<10 d;Internal medicine system(31.1%),surgery system(26.5%)and intensive care department(20.5%)were the common departments for treating melioidosis;blood(49.0%),sputum(9.9%)and wound secretion(8.6%)were the main clinical specimens for detecting BP;pulmonary infection(68.2%),sepsis(35.1%)and local suppurative infection(23.8%)were the top clinical manifestations in patients with BP infection;the effective rate of treating melioidosis was 74.8%;abnormal liver function was a risk factor for the curative effect of melioidosis(χ^(2)=5.010,P<0.05);the sensitivity rates of BP strains to sulfamethoxazole-trimethoprim(SXT),doxycycline(DOX),imipenem(IPM),ceftazidime(CAZ),amoxicillin/clavulanate(AMC)and tetracycline(TCY)were generally more than 90%,with sensitivities of 98.7%,97.2%,96.7%,94.0%,93.2%and 90.7%,respectively.Conclusions It can be concluded that misdiagnosis or missed diagnosis of melioidosis is easy to occur,and the understanding of the epidemiological characteristics and risk factors in this area should be strengthened.The sensitivity of BP to commonly used antibiotics has shown a certain downward trend,clinical use should be standardized,and drug resistance monitoring should be strengthened to improve the efficacy of melioidosis treatment.