嗜麦芽窄食单胞菌感染的临床特征、高危因素及预后分析

目的了解嗜麦芽窄食单胞菌感染的临床特点、危险因素、预后及耐药现状,为有效预防和治疗该病原菌感染提供依据。方法收集2013年11月至2014年4月浙江大学医学院附属第一医院收治的129例细菌培养为嗜麦芽窄食单胞菌患者的临床资料进行回顾性统计分析。结果 129例细菌培养确诊嗜麦芽窄食单胞菌感染患者平均年龄（65.1±17.0）岁,包括下呼吸道感染和非呼吸道感染患者分别为100例和29例,下呼吸道感染患者存在原发肺部疾病的患病率、ICU入住率、气管切开比例、广谱抗生素的使用率、患病年龄等均高于非呼吸道感染患者（P〈0.05）。而非呼吸道感染患者的外科手术、无菌腔内置管比例及免疫抑制剂使用率高于下呼吸道感染患者（P〈0.05）。嗜麦芽窄食单胞菌感染后选择敏感抗生素治疗的患者的死亡率明显低于未选择敏感抗生素的患者（15.0%/30.4%,P〈0.05）。结论原发肺部疾病、入住ICU、气管切开、广谱抗生素使用、年龄大是下呼吸道感染嗜麦芽窄食单胞菌的高危因素,外科手术、无菌腔内置管、免疫抑制剂使用是非呼吸道感染嗜麦芽窄食单胞菌的高危因素。使用敏感抗生素可以降低嗜麦芽窄食单胞菌感染患者的死亡率。

Stenotrophomonas maltophilia infections: an analysis of clinical characteristics, risk factors and the prognosis

Objective To investigate the clinical characteristics,risk factors,prognosis and antibiotic resistance of Stenotrophomonas maltophilia（ SMA） infections,and provide evidence for rational antimicrobial use and prevention of SMA infections. Methods A retrospective analysis was carried out on 129 inpatients with SMA infections in our hosptial from November 2013 to April 2014. Results The average age of the 129 cases was（ 65. 1 ± 17. 0） years,including 100 cases of lower respiratory tract infection and 29 cases of nonrespiratory tract infection patients. The rates of primary pulmonary diseases,length of ICU stay,tracheotomy,usage of broad-spectrum antibiotics and age of onset were higher in patients with lower respiratory tract infection. However,among non-respiratory tract infection patients,the rates of usage of immunosuppressive agents,surgical operation and aseptic intra-cavity catheterization were higher. The mortality of patients treated with susceptible antibiotics after infection was lower than that without effective therapy. Conclusion The risk factors of the patients with lower respiratory tract infection are primary pulmonary diseases,ICU admission,tracheotomy,usage of antibiotics,and old age. The risk factors of the patients with non-respiratory tract SMA infection are surgical operation,aseptic indwelling catheterization,and intake of immunosuppressive agents. The use of susceptible antibiotics therapy can effectively reduce the mortality of the patients with SMA infection.