嗜麦芽窄食单胞菌老年下呼吸道感染48例临床分析  

Clinical analysis of 48 cases of lower respiratory tract infection caused by Stenotrophomonas maltophilia in aged patients

作　　者：陈凤娟[1] 李兴华[1] 尹涛[1] 唐秀忠[1] 徐贵华[1] 

机构地区：[1]上海市第八人民医院呼吸内科,200235

出　　处：《中国感染与化疗杂志》2006年第2期82-84,共3页Chinese Journal of Infection and Chemotherapy

摘　　要：目的分析嗜麦芽窄食单胞菌老年下呼吸道感染的临床特点及对抗菌药物的敏感度。方法分析48例嗜麦芽窄食单胞菌老年下呼吸道感染的临床资料。采用美国DADE公司全自动微生物分析系统MicroScan Walkaway40系统鉴定细菌,PCIZ和NC11复合鉴定板进行体外药物敏感试验。结果48例中47例(97.9%)患有1种以上基础疾病,其中慢性阻塞性肺疾病急性加重期(AECOPD)最常见,占79%,免疫功能低下者68.8%,血浆白蛋白降低者79.2%,先期曾使用广谱抗生素者100%,曾行介入性导管治疗者72.9%。临床表现发热75%,咳嗽咳痰81.3%,肺部闻及哮鸣音或湿啰音89.6%,X线胸片多表现为两下肺片状、斑片状浸润性阴影,部分患者有胸腔积液。白细胞和中性粒细胞明显增高,C反应蛋白(CRP)增高。药敏试验结果表明该菌株耐药率高,除亚胺培南外,对氨基苷类和头孢菌素类亦普遍耐药。细菌对左氧氟沙星、环丙沙星、复方磺胺甲噁唑的敏感度分别为89.6%、79.2%和68.8%。结论嗜麦芽窄食单胞菌老年下呼吸道感染易发生在患有多种基础疾病、免疫功能低下、血浆白蛋白降低和先期使用广谱抗菌药物及临床有介入性导管治疗患者,细菌耐药现象严重。临床上应尽早进行病原学检查,根据药敏试验结果选用合适的抗菌药物。Objective To analyze the clinical characteristics of lower respiratory tract infection caused by Stenotrophomonas maltophilia in aged patients and investigate the antibiotic sensitivity of S. maltophilia strains. Methods The clinical data of 48 cases of lower respiratory tract infection by S. maltophilia in the aged were reviewed retrospectively. The pathogens were identified with the automatic system （MicroScan Walkaway 40;DADE; US） and susceptibility of S. maltophilia strains was tested with PCIZ and NC11 system. Results About 97.9% （47/48） of the patients had more than one underlying diseases, 79% of which were acute exacerbation of COPD, 68.8% were immunocompromised. Decreased level of albumin, prior use of broadspectrum antibiotics and invasive treatment were found in 79.2%, 100% and 72.9% of the cases respectively. Clinical manifestations include fever （75 % ）, wheezing （89.6 % ）, cough and expectoration （81.3 % ）. The chest X-ray in most cases revealed infiltration in lower lobes of both lungs. Pleural fluid was found in some of the cases. White blood cell count and neutrophil count increased significantly, with a higher level of CRP. The susceptibility testing showed that these strains （n=48） had high antibiotic resistance. In addition to imipenem, they were also multiresistant to aminoglycosides and cephalosporins. The susceptibility rates of these strains to levofloxacin, ciprofloxacin and SMZ-TMP were 89.6 %, 79.2 % and 68.8 % respectively. Conclusions The lower respiratory tract infection caused by S. maltophilia occurred in the aged patients who had various underlying diseases, immunocompromised status, decreased level of albumin, prior use of broad-spectrum antibiotics or invasive treatment. Antibiotic resistance is common in this pathogen. Etiology and antibiotic susceptibility should be confirmed as early as possible for rational antibiotic prescription.

关 键 词：嗜麦芽窄食单胞菌 老年下呼吸道感染 药物敏感性 

分 类 号：R56[医药卫生—呼吸系统]