嗜麦芽寡养单胞菌医院感染危险因素和临床分析

Stenotrophomonas maltophilia Nosocomial Infections: the Clinical and Risk Factor Analysis of 70 Cases

目的 调查我院院内嗜麦芽寡养单胞菌感染的临床特点、危险因素和药敏结果 ,以掌握其防治措施。方法收集我院 1998年 1月～ 2 0 0 0年 12月的 3年间 98883例出院患者中 70例医院内嗜麦芽寡养单胞菌感染者的临床和检验资料 ,进行回顾性统计分析。结果 嗜麦芽寡养单胞菌医院感染好发于下呼吸道 (97.0 % ) ,感染者均有严重基础疾病 ,10 0 .0 0 %接受抗菌药物治疗 ,接受各种侵入性操作包括机械通气、气管切开、留置尿管、全麻手术等 ,OR值分别为 18.4 5、2 5 .4 5、10 .5 6、5 .39;嗜麦芽寡养单胞菌对多种抗菌药物耐药 ,对阿米卡星、头孢噻肟钠、亚胺培南、环丙沙星等的耐药率分别为 :85 .9%、92 .0 %、97.7%、4 6 .3% ;且病情重 ,死亡率高达 39.7%。结论 严格掌握各种侵入性诊断、治疗指征 ,作好各种器械的消毒、灭菌工作 ,积极治疗基础疾病 ,掌握抗菌药物合理使用原则 ,根据药敏试验结果选用抗菌药物 ,有利于防治该类菌所致的医院感染。

OBJECTIVE To investigate the clinical feature and risk of Stenotrophomonas maltophilia nosocomial infections. METHODS The retrospective analysis on 98 883 inpatients from Jan 1998 to Dec 2000 was carried out. RESULTS Most S. maltophilia nosocomial infections occurred in lower respitatory tract based on severe diseases, antibotic therapy and invasive operation, such as mechanical ventilation, tracheal insection, retaining urine catheter and general anesthasia (OR value was 18.45, 25.45, 10.56 and 5.39, respectively). The clinical strains of S. maltophilia  were most resistant to amikacin (67.4%), cefuroxime (92.4%), imipenem (97.7%) and ciprofloxacin (46.3%). CONCLUSIONS Invasive operation limitation, medical facility sterilization, basic diseases control and rational urilixation of antibiotics were very important for reducing S. maltophilia nosocomial infections.