心脏术后继发嗜麦芽窄食单胞菌肺部感染临床及药敏分析

目的:分析和总结体外循环心脏手术后嗜麦芽窄食单胞菌(SMA)肺部感染的临床特点及药敏情况。方法:对36例体外循环心脏手术后继发SMA肺部感染的临床资料进行统计分析,分析所收集的术后经气管插管吸出物培养分离出的36株SMA的药敏材料。结果:36例患者均存在呼吸机应用时间超过3d、应用了广谱抗生素;伴有多器官功能不全综合症(MODS,83.3%)、混合感染(61.1%)、体外循环时间超过2h(58.3%)也是本病高危因素;该菌对常用抗生素广泛耐药,敏感率大于50%的抗生素依次为米诺环素(85.2%),替卡西林 克拉维酸(81.5%),复方磺胺甲唑(74.2%),加替沙星(68.8%),头孢哌酮 舒巴坦(64.9%),环丙沙星(63.5%),哌拉西林 三唑巴坦(63.0%),左氧氟沙星(56.9%)。结论:嗜麦芽窄食单胞菌已成为体外循环心脏手术后呼吸机相关性肺炎的重要致病原菌之一,多发生在心功能差、体外循环时间长、术后呼吸机使用时间长、合并MODS、混合感染及术后应用碳青霉烯类抗生素的病人。感染后,可选用抗菌药物的范围较窄,治疗相对困难。

Analysis of clinical characteristics and drug sensitivity tests of pulmonary infection caused by stenotrophomonas maltophilia following cardiosurgery

Objective:To analyze the clinical characteristics of pulmonary infection caused by stenotrophomonas maltophilia(SMA) following cardiosurgery and to investigate the antibiotic sensitivity of SMA strains.Methods:Retrospective study of the clinical data of 36 cases with pulmonary infection caused by SMA following cardiosurgery was perfprmed.The data of drug sensitivity against SMA strains by culture of sputum from the tips of tracheal tub were analyzed.Results:All of 36 cases use the mechanical ventilation was more than 3 days and used with extend-spectrum antibiotics.The MODS(83.3%),mixed infection(61.1%) and time of cardiopulmonary bypass(CPB) more 2 h(58.3%) were also the risk factors. The drug sensitivity test in vitro showed that these strains were multiresistant to commonly used antibiotics,and drugs whose sensitive rate were over 50% included minocycline(85.2%),ticarcillin/clavulanate (81.5%),SMZco(74.2%),gatifloxacin(68.8%),cefoperazone/sulbactam (64.9%),ciprofloxacin (63.5%),piperacilli tazobactam (63.0%),levofloxacin(56.9%).Conclusion:These data indicate that SMA is an important pathogenic bacterium of breathing machine-associated pneumonia following cardiosurgery of cardiopulmonary bypass.It is easy to happen at heart failure, long time cardiopulmonary bypass and mechanical ventilation,complicated MODS, mixed infection and using carbapenem antibiotics.After infection, little antibiotics can be selected and more difficult to remedy.