嗜麦芽窄食单胞菌医院感染特点及耐药性分析  

Stenotrophomonas Maltophilia Infection in Hospital Environment:Its Characters and Drug Resistance

作　　者：史利克[1] 王悦[1] 刘燕[1] 任力[1] 戚小敏[1] 时东彦[2] 

机构地区：[1]河北医科大学第二医院感染控制处,河北省石家庄市050000 [2]河北医科大学第二医院检验科,河北省石家庄市050000

出　　处：《中国全科医学》2012年第11期1250-1253,共4页Chinese General Practice

基　　金：河北省科技攻关计划项目(04276183)

摘　　要：目的分析近2年我院发生的嗜麦芽窄食单胞菌(SMA)医院感染的特点及耐药性,为控制感染和临床合理使用抗菌药物提供依据。方法采用美国临床实验室标准化委员会(NCCLS)推荐的纸片扩散法,检测从40例感染患者中分离的50株SMA对24种抗生素的耐药情况,通过脉冲场凝胶电泳(PFGE)全DNA指纹技术对菌株进行分型。结果 SMA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。SMA对头孢吡肟/舒巴坦、加替沙星、左氧氟沙星、氧氟沙星、敏感性高,而对多数抗菌药物耐药,对头孢曲松、头孢呋辛、头孢西丁的耐药率达到了100.0%,对亚胺培南、氨曲南、四环素、哌拉西林和庆大霉素耐药率分别为92.3%、88.9%、82.4%、75.0%和70.0%。多数SMA(17/21)没有同源性,仅一对同源菌株来自同一病房,另一对同源菌株来自医院的不同病房。结论患者被医院环境中自然存在的SMA定植可能是SMA基因组的多样性和低同源性的原因。头孢吡肟/舒巴坦、加替沙星、左氧氟沙星、氧氟沙星、头孢哌酮/舒巴坦是治疗SMA感染的有效药物。Objective To analyze the characters and drug resistance of nosocomial stenotrophomonas maltophilia infections which took place in our hospital during recent two years.Our purpose is to provide a basis for the infection control and the clinical rational antibiotic use.Methods Disc diffusion method（NCCLS currently recommended methods） was used to detect the drug resistance of 50 strains of stenotrophomonas maltophilia isolated from 40 patients to 24 kinds of antibiotics.Homology of the isolates were submitted to molecular typing using pulsed-field gel electrophoresis（PFGE）.Results These infections of stenotrophomonas maltophilia mainly occured in lower respiratory tract,most of which were mix infections in patients mainly above 50.SMA was very susceptible to cefepime-sulbactam,gatifloxacin,levofloxacin,ofloxacin and cefoperazone-sulbactam,but was resistant to most of the antibiotics.The resistance rates to ceftriaxone,cefuroxime,cefoxitin were up to 100.0%.The resistance rates to imipenem,aztreonam,tetracycline,piperacilin and gentamycin were 92.3%,88.9%,82.4%,75.0% and 70.0%,respectively.Most isolates displayed different PFGE profiles（17/21）,among the clonal isolates,one pairs from the same hospital ward,the other from different wards in the same hospital.ConclusionThe genomic diversity and low clonality within the strains of SMA may be the reasons why patients are infected with SMA existing naturally in the hospital environment.Cefepime-sulbactam,gatifloxacin,levofloxacin,ofloxacin and cefoperazone-sulbactam are the effective drugs against the infections caused by S.maltophilia.

关 键 词：医院感染 嗜麦芽窄食单胞菌 多重耐药 流行病学调查 

分 类 号：R446.51[医药卫生—诊断学]