洋葱伯克霍尔德菌下呼吸道医院感染危险因素及耐药性分析  

Burkholderia cenocepacia associated nosocomial lower respiratory tract infections： risk factors and drug resistance

作　　者：诸葛璐[1] 潘陈为[1] 林巍[1] 方佩佩[1] 郑毅[1] 金玲湘[1] 

机构地区：[1]温州医科大学附属第二医院感染内科,浙江省温州市325000

出　　处：《中华临床感染病杂志》2014年第2期140-144,共5页Chinese Journal of Clinical Infectious Diseases

摘　　要：目的 探讨洋葱伯克霍尔德菌下呼吸道医院感染的危险因素及菌株对抗菌药物的耐药性.方法 选取2009年1月至2012年12月温州医科大学附属第二医院洋葱伯克霍尔德菌下呼吸道医院感染患者138例作为感染组,选择同期住院的40例非洋葱伯克霍尔德菌下呼吸道感染患者作为对照组.对所有研究对象的临床资料和药敏试验结果进行回顾性分析.采用x2检验及多因素Logistic回归分析洋葱伯克霍尔德菌下呼吸道医院感染的危险因素.结果 多因素Logistic回归分析发现,联合使用2种以上抗菌药物,机械通气,住重症监护病房（ICU）时间≥2周,H2受体拮抗剂等制酸剂的使用和深静脉穿刺是洋葱伯克霍尔德菌下呼吸道医院感染的独立危险因素（OR=6.315,5.957,5.254,4.585和2.017,P＜0.05）.洋葱伯克霍尔德菌对左氧氟沙星、头孢他啶、复方磺胺甲噁唑较为敏感;对头孢噻肟、头孢三嗪、头孢吡肟、氨曲南、四环素的耐药率超过40％;对庆大霉素、阿米卡星、妥布霉素的耐药率几乎为100％.结论 联合使用2种以f抗菌药物、机械通气、住ICU时间≥2周、制酸剂的使用、深静脉穿刺的患者是洋葱伯克霍尔德菌下呼吸道医院感染的高危人群,且该菌具有多重耐药性.Objective To identify the risk factors of Burkholderia cenocepacia associated nosocomial lower respiratory tract infections （NLRTIs）,and to investigate the drug resistance of Burkholderia cenocepacia strains.Methods A total of 138 patients with Burkholderia cenocepacia associated NLRTIs and 40 patients with non-Burkholderia cenocepacia associated NLRTIs were enrolled in the study.All patients were collected from the Second Affiliated Hospital of Wenzhou Medical University during January 2009 and December 2012.Clinical data and results of drug sensitivity tests were retrospectively reviewed.Chi-square test and Logistic regression analysis were performed to identify the risk factors of Burkholderia cenocepacia associated NLRTIs.Results Logistic regression analvsis showed that combination use of 2 or more antimicrobial agents,mechanical ventilation,stay in intensive care unit （ICU） for more than two weeks,use of antacid H2 antagonist and deep venous puncture were the independent risk factors of Burkholderia cenocepacia associated NLRTIs （OR =6.315,5.957,5.254,4.585 and 2.017,P ＜0.05）.Burkholderia cenocepacia strains were sensitive to levofloxacin,ceftazidime and sulfamethoxazole; More than 40％ strains were resistant to cefotaxime,ceftriaxone,cefepime,aztreonam and tetracycline; And nearly 100％ strains were resistant to gentamicin,amikacin and tobramycin.Conclusion Burkholderia cenocepacia associated NLRTIs are more likely to occur in patients with combination use of 2 or more antimicrobial agents,mechanical ventilation,and those who stay in ICU for more than two weeks,or received antacid and deep venous punctures,and most Burkholderia cenocepacia strains are multiple drug resistant.

关 键 词：洋葱伯克霍尔德菌 交叉感染 危险因素 抗药性 

分 类 号：R446.5[医药卫生—诊断学]