脑膜败血伊丽莎白菌致医院感染的临床特点与耐药性分析  

Clinical characteristics of nosocomial infection caused by Elizabethkingia meningospetica and drug resistance

作　　者：宁兴旺[1] 谢小兵[1] 朱惠斌[1] 钱纯[1] 匡敏[1] NING Xing--wang;XIE Xiao-bing;ZHU Hui-bin;QIAN Chun;KUANG Min(The First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha,Hunan 410007,China)

机构地区：[1]湖南中医药大学第一附属医院医学检验中心,湖南长沙410007

出　　处：《中华医院感染学杂志》2018年第13期1933-1936,1961,共5页Chinese Journal of Nosocomiology

基　　金：湖南省教育厅科学研究项目(17B195)

摘　　要：目的探讨脑膜败血伊丽莎白菌(EM)致医院感染的临床特点及耐药性,并检测其产超广谱β-内酰胺酶(ESBLs)和金属β-内酰胺酶(MBL)情况,为临床科学治疗提供参考。方法回顾性分析2015年1月-2017年4月医院EM所致医院感染81例,对其相关临床资料、体外药敏试验和ESBLs、MBL检测结果进行分析。结果 EM主要感染对象为年龄≥60岁、住院时间≥28天、存在严重的基础疾病、疾病危险等级评分≥4分、接受有创操作、应用广谱抗菌药物、皮质激素、细胞毒药物和近期手术患者,感染部位主要为呼吸机相关性肺炎和下呼吸道;标本来源以呼吸道为主(84.0%),感染患者主要来自中心ICU(43.2%);EM产ESBLs和MBL率分别为100.0%和70.4%,对多种抗菌药物表现为高度耐药,对磺胺甲噁唑/甲氧苄啶、利福平及含酶抑制剂等复合抗菌药物有较高的体外抗菌活性,耐药率均低于25.0%。结论高龄、存在严重的基础疾病、使用广谱抗菌药物和多种侵入性诊疗是EM感染的主要临床病因,EM多药耐药现象严重,ESBLs和MBL检出率高,治疗EM感染首选磺胺甲噁唑/甲氧苄啶、利福平和含酶抑制剂类药物。OBJECTIVE To explore the clinical characteristics of nosocomial infection caused by Elizabethkingia meningospetica（EM）,analyze the drug resistance and detect extended-spectrumβ-lactamases（ESBLs）and metallo-beta-lactamase（MBL）produced by the strains so as to provide scientific basis for clinical treatment.METHODS A total of 81 patients with EM-induced nosocomial infection who were treated in the hospital from Jan2015 to Apr 2017 were retrospectively analyzed.The clinical data and results of in vitro drug susceptibility testing,detection of ESBLs and MBL were observed.RESULTS The patients with no less than 60 years of age,length of hospital stay no less than 28 days,severe underlying diseases,disease risk rating score no less than 4 points,invasive procedures,use of broad-spectrum antibiotics,glucocorticoids,cytotoxicity drugs and history of recent surgery were dominant among the patients with EM infection.The patients with ventilatory-associated pneumonia and lower respiratory tract infection were dominant among the patients with the infection.84.0% of the specimens were obtained from respiratory tract.43.2% of the patients with infection were from ICU.The isolation rates of ESBLs-and MBL-producing EM strains were 100.0%and 70.4%,respectively.The strains were highly resistant to a variety of antibiotics and showed high in vitro antibacterial activity against,sulfamethoxazole-trimethoprim,rifampicin and enzyme-containing inhibitors,and the drug resistance rates were less than 25.0%.CONCLUSION The advanced age,severe underlying diseases,use of broad-spectrum antibiotics and multiple invasive procedures are the leading factors for the EM infection,the EM strains are highly drug-resistant,the isolation rates of the ESBLs-and MBL-producing strains are high.sulfamethoxazole-trimethoprim,rifampicin and enzyme-containing inhibitors are the preferred antibiotics for the treatment of the EM infection.

关 键 词：脑膜败血伊丽莎白菌 医院感染 临床特点 耐药性 

分 类 号：R378[医药卫生—病原生物学]