儿童嗜麦芽窄食单胞菌临床分离株耐药性多中心研究  

Multicenter study on the antibiotic resistance of Stenotrophomonas maltophilia strains isolated from children

作　　者：邓慧玲[1,3] 张玉凤[1] 蔡慧君[2] 俞蕙[4] 王传清[4] 许红梅 景春梅 林爱伟[6] 李娜 陈英虎[7] 陈静[7] 曹清 黄卫春 张婷[9] 肖芳菲 陈益平[10] 温正旺[10] 杨锦红[10] 邓继岿[11] 施君 黄园园[12] 冀旭峰[12] 郝建华 张聪慧 DENG Huiling;ZHANG Yufeng;CAI Huijun;YU Hui;WANG Chuanqing;XU Hongmei;JING Chunmei;LIN Aiwei;LI Na;CHEN Yinghu;CHEN Jing;CAO Qing;HUANG Weichun;ZHANG Ting;XIAO Fangfei;CHEN Yiping;WEN Zhengwang;YANG Jinhong;DENG Jikui;SHI Jun;HUANG Yuanyuan;JI Xufeng;HAO Jianhua;ZHANG Conghui(Department of Infectious Diseases,Xi'an Children’s Hospital,Xi’an,710003,China)

机构地区：[1]西安市儿童医院感染二科,西安710003 [2]西安市儿童医院检验科,西安710003 [3]西安市中心医院儿科 [4]复旦大学附属儿科医院 [5]重庆医科大学附属儿童医院 [6]山东省济南市儿童医院 [7]浙江大学医学院附属儿童医院 [8]上海交通大学医学院附属上海儿童医学中心 [9]上海市儿童医院 [10]温州医科大学附属育英儿童医院 [11]深圳市儿童医院 [12]吉林大学第一医院 [13]开封市儿童医院

出　　处：《中国感染与化疗杂志》2021年第4期456-460,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解儿童嗜麦芽窄食单胞菌耐药现状和临床特点,为临床预防和治疗嗜麦芽窄食单胞菌感染提供依据。方法嗜麦芽窄食单胞菌资料来源于 2019年1月1日—12月31日全国11所三级甲等儿童医院。细菌鉴定采用全自动快速生物质谱检测系统;抗菌药物敏感性试验采用全自动微生物鉴定分析仪或 K-B纸片法,结果判断采用美国临床和实验室标准化协会(CLSI)-M100判断标准,对嗜麦芽窄食单胞菌耐药性进行分析;回顾性分析249 例嗜麦芽窄食单胞菌患儿的临床特点。结果共检出嗜麦芽窄食单胞菌1 453株,分离株主要来源于痰液标本,占48.5%,其次是血液和肺泡灌洗液,分别占25.1%和5.9%。该菌对甲氧苄啶-磺胺甲噁唑、左氧氟沙星、米诺环素敏感率较高,达90%以上;对头孢哌酮-舒巴坦敏感率达70.4%;对β内酰胺类抗菌药物耐药率较高,对哌拉西林-他唑巴坦的敏感率仅为44.4%。嗜麦芽窄食单胞菌感染主要见于2岁以下婴幼儿,临床表现多样,主要引起肺炎、脓毒血症等,多发生于有基础疾病、侵袭性操作、长期使用抗菌药物等高危患儿。结论儿童分离的嗜麦芽窄食单胞菌耐药率高,仅对甲氧苄啶-磺胺甲噁唑、左氧氟沙星、米诺环素较敏感,临床应根据药敏结果选用抗菌药物,防止菌株产生耐药和流行。同时,临床医师应尽量减少不必要的侵袭性操作,加强抗菌药物的合理、规范使用。Objective To investigate the antibiotic resistance profile and clinical characteristics of Stenotrophomonas maltophilia in children for better prevention and treatment of S.maltophilia infections.Methods S.maltophilia isolates were collected from 11 children’s hospitals in China from January 1 to December 31,2019.The bacteria were identified by automatic rapid biological mass spectrometry system,and the antimicrobial susceptibility test was performed by automatic microbial identification analyzer or KB disk method.The susceptibility results of S.maltophilia were interpreted in accordance with CLSI M100 breakpoints.The clinical characteristics of S.maltophilia infections in 249 children were analyzed retrospectively.Results A total of 1453 strains of S.maltophilia were identified.The strains were mainly isolated from sputum(48.5%),followed by blood(25.1%),and bronchoalveolar lavage fluid(BALF)(5.9%).More than 90%of these strains were susceptible to trimethoprim-sulfamethoxazole,levofloxacin,and minocycline.About 70.4%of these strains were susceptible to cefoperazone-sulbactam.Higher percentage of the strains were resistant toβ-lactam antibiotics.Only 44.4%of the strains were susceptible to piperacillin-tazobactam.S.maltophilia infection was mainly found in infants under 2 years old,with diverse clinical manifestations,such as pneumonia and sepsis.Underlying diseases,invasive procedures,and long-term use of antibiotics were risk factors for S.maltophilia infection in children.Conclusions The S.maltophilia isolates from children are highly resistant to a number of antimicrobial agents,but relatively susceptible to trimethoprim-sulfamethoxazole,levofloxacin,and minocycline.Antibacterial therapy should be prescribed cautiously according to the results of antimicrobial susceptibility testing for the purpose to prevent the emergence and spread of resistant strains.Clinicians should try to reduce unnecessary invasive procedures and strengthen the rational and standardized use of antimicrobial agents.

关 键 词：嗜麦芽窄食单胞菌 耐药性 临床特点 抗菌药物 

分 类 号：R446.5[医药卫生—诊断学]