小儿木糖氧化产碱菌感染临床及生物学特性研究

目的探讨木糖氧化产碱菌致感染的临床表现和生物学特性.方法医院采集患者血液、脑脊液、脓液、病灶分泌物和咽拭子分离病菌,经培养及生化反应鉴定取得木糖氧化产碱菌;并对该菌所致感染进行临床流行病学调查;抗生素敏感试验方法采用K-B纸片法,最低抑菌浓度(MIC)采用琼脂稀释法.结果 10例患儿中,医院感染9例,有原发病和诱因者9例,5例死亡;败血症3例,脑膜炎3例,肺炎2例,伤口感染及中耳炎各1例;各种类型感染的临床表现均无特异性;共分离该细菌18个菌株,均为革兰染色阴性菌;该菌对诺氟沙星、头孢噻肟、复方磺胺甲唑、头孢呋肟、头孢哌酮、头孢曲松等敏感.结论木糖氧化产碱菌可致严重的感染,而且临床表现无特异性;早期诊断和治疗可提高患儿的生存率.

Alcaligenes xylosoxidans in Child:Its Biological and Clinical Characteristics

OBJECTIVE To investigate the biological characteristics of Alcaligenes xylosoxidans and clinical features of infections caused by this agent in children. METHODS Eighteen strains of A. xylosoxidans were isolated from blood, cerebrospinal fluid, ear discharge and purulent exudate, respiratory samples of 10 patients and in vitro biological identification were performed. Clinical epidemiological inquiries were also performed. Drug-resistance was tested by Kirby-Bauer disk sensitivity method and MIC by agar doubling dilution. RESULTS The routine cultures of blood, cerebrospinal fluid, and purulent exudate samples yielded growth of A. xylosoxidans. Antimicrobial resistance tests for A. xylosoxidans revealed that the organism was uniformly resistant to aminoglycosides, including amikacin. Trimethoprim-sulfamethoxazole and the newer beta-lactam antibiotics, such as ticarcillin, piperacillin, moxalactam, cefotaxime, cefoperazone and ceftriaxone showed good inhibitory effect against this organism. Nine of 10 patients had nosocomial infections and the primary disease; 3 cases septicemia; 3 cases meningitis, 2 cases had pneumonia, and otitis media and wound infection were found in one patient each. Five of the patients were successfully treated with ticarcillin, piperacillin, moxalactam, cefotaxime, cefoperazone and ceftriaxone. Deaths due to A. xylosoxidans infection occurred in five out of a total of 10 patients. CONCLUSIONS A. xylosoxidans is an uncommon nosocomial pathogen known to cause many serious infections and non-specific clinical manifestations. Early diagnosis and aggressive treatment were critical to improve survival. More attention should be paid to A. xylosoxidans infections in children.