18例类鼻疽伯克霍尔德菌的分离与耐药性分析

目的了解我院类鼻疽病的临床特征,探讨早期诊断治疗方法及该菌的耐药性。方法回顾性分析2007年1月～2009年1月收治的18例类鼻疽病感染者的临床症状,治疗、愈后及半年后进行电话随访统计。结果患者多以带有基础疾病时起病或是农作时外伤引起,临床症状多以畏寒、高热、肺部感染、败血症以及脏器损害和细菌毒素引起的全身反应为主要表现,病情较为严重,首诊全为误诊,药敏结果类鼻疽伯克霍尔德杆菌对亚胺培南、美洛培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦敏感率达83%以上,头孢他啶敏感率为77.6%;而对广谱青霉素类、氨基糖苷类耐药,头孢类有不同程度的耐药。结论该病临床特征多样,首诊困难,误诊率高,广谱抗生素治疗无效,延误病情,住院时间长,治疗成本高,应提高临床医生对此病的认识和警惕以尽快确诊,目前认为碳青霉烯类为首选抗生素,临床用药应联用以碳青霉烯类为主的两种以上抗生素效果好。

Results of diagnosis and drug Sensitivity test of 18 cases、with Burkholderia mallei infection

Aim To understand the clinical features of Melioidosis in our hospital.and discuss its early diagnosis, treatment and drug resistance.Methods The clinical symptoms,treatment of 18 Burkholderia mallei infected patients from February 2007 to February 2009 were retrospectively analyzed.Results The clinical symptoms of the 18 patients were frequent chills,high fever,lung infection,septicaemia,organ damage and bacterial toxin-induced systemic reaction.The patients＇ condition were severe and all of them were misdiagnosed in first diagnosis.The susceptibility of Burkholderia mallei to imipenem,meropenem,cefoperazone/sulbactam,piperacillin/tazobactam was over 83%,and 77.6%to ceftazidime.But it was resistant to penicillins,aminoglycosides and cephalosporins.Conclusions The misdiagnosis rate of Burkholderia mallei is high and clinical use of antibiotics be selected based on results of drug sensitivity test in orde to enhance the therapeutical efficacy.