重症监护病房下呼吸道嗜麦芽寡养单胞菌感染的临床和药敏分析

Lower Respiratory Tract Infection by Stenotrophomonas maltophilia in ICU:A Clinical and Drug Sensitivity Analysis

目的 了解重症监护病房 (ICU)下呼吸道嗜麦芽寡养单胞菌 (SMA)感染的临床特点和药敏情况 ,为临床防治提供依据。方法 回顾性总结 1996年 1月～ 2 0 0 0年 12月期间ICU中 6 8例SMA下呼吸道感染的临床资料及药敏结果。结果 全部患者均使用过广谱抗菌药物 ,全部有严重基础疾患史 ,83 1%患者免疫功能受损 ,78 6 %患者曾经或正接受气管插管操作 ;药敏结果显示SMA对一、二代头孢菌素大多耐药 ,对亚胺培南高度耐药 ,对替卡西林钠 /克拉维酸钾、环丙沙星、头孢他啶有较高的体外敏感性 ,分别为 77 2 %、6 4 7%和 6 0 7%。结论 严重基础疾病、长期应用广谱抗菌药物是SMA下呼吸道感染的主要危险因素 ;SMA对多种抗菌药物耐药 ,替卡西林钠 /克拉维酸钾、环丙沙星、头孢他啶对SMA体外呈现较好的抗菌活性 ,可作为临床治疗SMA下呼吸道感染的有效抗菌药物。

OBJECTIVE To investigate the clinical characteristic and drug sensitivity status of lower respiratory tract infection by Stenotrophomonas maltophilia in intensive care unit(ICU), in order to provide essential basis for preventing and treating it. METHODS Retrospective survey of the clinical data of 68 cases with lower respiratory tract infection by S.maltophilia during Jan 1996 to Dec 2000,including the drug sensitivity results was conducted. RESULTS Critical underlying diseases(100%), decreased immunological function(83.1%), tracheal cannula and tracheotomy(78.6%), broad-spectrum antibiotics use for a long time(100%) were the primary risk factors related to the lower respiratory tract infection by S. maltophilia in ICU. The drug sensitivity tests results showed that S.maltophilia were multi-resistant to the first and second generations cephalosporins, the highest resistant to imipenem, but S.maltophilia was sensitive to ticarcillin sodium/potassium clavulanate (77.2%), ciprofloxacin (64.7%), and ceftazidime(60.7%). CONCLUSIONS The main risk factors of the lower respiratory tract infection by S.maltophilia in ICU are critical underlying diseases and long-term inappropriate use of broad-spectrum antibiotics. S.maltophilia is multi-drug resistant. Ticarcillin sodium /potassium clavulanate,ciprofloxacin, and ceftazidime are the effective antibiotics against S.maltophilia.