7例解鸟氨酸拉乌尔菌感染临床特征分析  

Clinical Characteristics of Raoultella Ornithinolytica Infection:An Analysis of Seven Cases

作　　者：李周平 饶芝国[1] 刘音[1] 贺小旭[1] 李苗苗[1] 薛晓艳[1] LI Zhou-ping;RAO Zhi-guo;LIU Yin;HE Xiao-xu;LI Miao-miao;XUE Xiao-yan(Department of Critical Care Medicine,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院重症医学科,北京100049

出　　处：《中国合理用药探索》2023年第6期11-19,共9页Chinese Journal of Rational Drug Use

摘　　要：目的:分析解鸟氨酸拉乌尔菌感染患者的临床特征和诊治方法,提高对该病的认识,为临床提供更多诊疗依据。方法:回顾性分析某院2018年1月~2022年12月细菌培养诊断的解鸟氨酸拉乌尔菌感染患者的临床资料,总结该病的临床特征及诊治要点。结果:7例患者中,男性5例,女性2例;年龄2~84岁。患者的科室分布包括重症加强护理病房(ICU)2例、外科病房2例、内科病房2例、儿科病房1例;标本来源分布包括痰标本(2例)、尿标本(2例)、血标本(1例)、胆管引流液标本(1例)、咽拭子标本(1例);感染类型为呼吸道感染(3例)、尿路感染(2例)、胆管感染(1例)、血液感染(1例)。4例行侵入性操作。6例以感染症状为主,且均为细菌或真菌混合感染,均接受抗菌药物治疗,其中1例血液耐药株感染患者死亡,其他5例菌株对大多数抗菌药物敏感,治疗效果理想;1例以胸闷症状为主,考虑定植菌未使用抗菌药物。药敏试验结果中,未发现对复方磺胺甲唑、替加环素、黏菌素耐药的标本。结论:解鸟氨酸拉乌尔菌感染通常表现为发热,耐药株预后差,应引起临床重视。建议对感染患者进行早期病原学检查及耐药性监测,尤其重视多重耐药菌的筛查,有条件的话建议进行耐药基因检测,防止耐药菌进一步传播。Objective:To analyze the clinical characteristics of Raoultella ornithinolytica infection in the patients,and improve the understanding of this disease,so as to provide more evidence for the clinical diagnosis and treatment of this disease.Methods:The clinical data of seven patients diagnosed with Raoultella ornithinolytica infection through bacterial culture in a certain hospital between January 2018 and December 2022 were retrospectively analyzed to summarize the clinical characteristics,as well as key points of diagnosis and treatment of this disease.Results:Of the seven patients,five were male and two were female,aged from 2 to 84 years.Analyzed by department,two patients were from the intensive care unit(ICU)ward,two patients from the surgical ward,two patients from the medical ward and one patient from pediatric ward;analyzed by the source of specimen tested,the clinical bacterial cultures were isolated from sputum(n=2),urine(n=2),blood(n=1),biliary drainage(n=1),and throat swabs(n=1),respectively;analyzed by the site of infection,the infected sites were respiratory system(n=3),urinary system(n=2),bile duct(n=1)and blood(n=1),respectively.Four patients received invasive procedures.Six patients presented with obvious symptoms of infection,all of whom were confirmed as mixed bacterial or fungal infections and treated with antibiotics.Of these patients,one infected with a drug-resistant strain from blood died,and the remaining five responded well to treatment because their strains were sensitive to most antibiotics.One patient presented with chest tightness and did not receive antibiotic treatment due to bacterial colonization.No resistance to sulfamethoxazole,tigacycline or colistin was observed in all strains.Conclusion:Patients infected with Raoultella ornithinolytica usually present with fever and have poor prognosis after development of drug resistance.Early laboratory tests for etiological agents and drug resistance monitoring are recommended for infected patients,in particular screening for multidrug-re

关 键 词：解鸟氨酸拉乌尔菌 耐药菌 感染监测 复方磺胺甲唑 替加环素 黏菌素 

分 类 号：R446.5[医药卫生—诊断学]