22例嗜麦芽窄食单胞菌医院感染分析

目的分析嗜麦芽窄食单胞菌医院感染的特点及9株嗜麦芽窄食单胞菌的同源性调查结果,为控制感染和临床合理使用抗生素提供依据。方法采用美国临床实验室标准化委员会推荐的纸片扩散法,检测从22例感染患者中分离的26株嗜麦芽窄食单胞菌对24种抗生素的耐药特征,通过脉冲场凝胶电泳(pulsed-fieldgelectrophoresis,PFGE)全DNA指纹技术对菌株进行分型。结果嗜麦芽窄食单胞菌感染主要发生在下呼吸道,50岁以上的患者居多,且多数为混合感染。嗜麦芽窄食单胞菌对加替沙星、左氧氟沙星、氧氟沙星、头孢哌酮/舒巴坦敏感性高,而对多数抗菌药物耐药,对头孢曲松、头孢呋辛钠、头孢西丁的耐药率达到了100%,亚胺培南的耐药率为92.3%,对氨曲南、四环素、哌拉西林、庆大霉素的耐药率也高达70%以上。9株嗜麦芽窄食单胞菌中的7株没有同源性,说明该院嗜麦芽窄食单胞菌感染为散发病例。结论PFGE是调查感染来源的快速、有效的方法;加替沙星、左氧氟沙星、氧氟沙星、头孢哌酮/舒巴坦对临床分离的嗜麦芽窄食单胞菌有较高的抗菌活性,是嗜麦芽窄食单胞菌感染治疗最有效的抗生素。

ANALYSIS OF 22 CASES OF HOSPITAL INFECTION CAUSED BY STENOTROPHOMONAS MALTOPHILIA

Objective Analysis the characteristic of hospital infection caused by stenotrophomonas maltophilia,in order to provide basis for the infection control and the clinical rational antibiotic use.Methods Disc diffusion method(standard center of national clinical lab) was used to detect the drug resistance feature of 26 strains of stenotrophomonas maltophilia which isolated from 22 patients.Homology of the isolates were submitted to molecular typing using pulsed-field gel electrophoresis(PFGE).Results The infections of stenotrophomonas maltophilia mainly occured in lower respiratory tract,and most of them were mix infections.The majority of patients were above 50 years old.Among 24 kinds of antibiotics,gatifloxacin,levofloxacin,ofloxacin,cefoperazone and sulbactam had the highest susceptible rates.Stenotrophomonas maltophilia was highly resistant to most antibiotics.The resistance rates to ceftriaxone,cefuroxime and cefoxitin were 100%,and imipenem was 92.3%,the resistance rates to aztreonam,tetracycline,piperacilin and gentamycin were over 70%.Seven strains of these 9 strains displayed different genotype,which indicated that infections of stenotrophomonas maltophilia in the hospital were sporadic.Conclusion PFGE is fast and effective method to identify the source of infection.Gatifloxacin,levofloxacin,ofloxacin,cefoperazone and sulbactam were the most active antibiotics against stenotrophomonas maltophilia,they were the most ideal antimicrobial agents for treating infections of stenotrophomonas maltophilia.