45株罗尔斯顿菌临床分离株的分布及药物敏感性  

Drug susceptibility and distribution of 45 clinical Ralstonia isolates

作　　者：袁红霞 房丽丽[2] 施惠宣 徐和平[2] 马晓波[2] YUAN Hong-xia;FANG Li-li;SHI Hui-xuan;XU He-ping;MA Xiao-bo(The Fifth People's Hospital of Chongqing,Chongqing 400062,China;不详)

机构地区：[1]重庆市第五人民医院检验科,重庆400062 [2]厦门大学附属第一医院检验科厦门市基因检测重点实验室,福建厦门361003 [3]厦门大学附属第一医院儿科,福建厦门361003

出　　处：《中华医院感染学杂志》2025年第1期127-131,共5页Chinese Journal of Nosocomiology

基　　金：福建省卫健委科技计划项目(2021QNB016)。

摘　　要：目的比较皮氏罗尔斯顿菌和解甘露醇罗尔斯顿菌的体外药敏,分析罗尔斯顿菌属感染患者临床特点,以期为临床相关感染的诊治提供实验依据。方法纳入厦门市某教学医院2017-2022年临床分离的23株解甘露醇罗尔斯顿菌、22株皮氏罗尔斯顿菌,用哥伦比亚血琼脂平板复苏菌株,以Vitek-MS MALDI-TOF方法复核鉴定,采用Vitek-2Compact全自动微生物分析仪进行药敏分析。回顾患者的临床资料,比较不同部位罗尔斯顿菌属感染的危险因素、抗菌药物选择及预后转归。结果患者以男性居多(30例,66.67%);年龄1月-90岁,>60岁者21例(46.67%);主要来自ICU(12例,26.67%)、血液科(6例,13.33%)、呼吸与危重症医学科(5例,11.11%)和普外科(5例,11.11%)等;标本分布以呼吸道(23株,51.11%)和血液(18株,40.00%)为主;两种罗尔斯顿菌对不同抗菌药物的体外药敏相似,对头孢曲松、头孢唑肟、替加环素、氟喹诺酮类、头孢噻肟、头孢吡肟、四环素和磺胺甲噁唑/甲氧苄啶的耐药率均低于5.00%,对美罗培南、妥布霉素和哌拉西林/他唑巴坦的耐药率高于70.00%;所有患者均接受了经验抗菌,37例患者换用了敏感的药物,分别有24例单药方案和13例联合方案,预后22例好转(59.46%),15例无改善(40.54%);血流感染患者中皮氏罗尔斯顿菌相关的预后好于解甘露醇罗尔斯顿菌(81.82%vs.57.14%),但呼吸道相关感染患者中解甘露醇罗尔斯顿菌预后好转的情况好于皮氏罗尔斯顿菌(50.00%vs.27.27%)。结论罗尔斯顿菌属为一种医院感染的机会病原体,威胁患者生命。准确的鉴定和药敏支持有助于临床的及时诊疗,第三、四代头孢菌素、氟喹诺酮类、四环素、磺胺甲噁唑/甲氧苄啶等可作为抗菌的选择。OBJECTIVE To compare the in vitro drug susceptibility between Ralstonia pickettii and Ralstonia mannitolilytica and analyze the clinical characteristics of Ralstonia spp so as to provide experimental data for clinical diagnosis and treatment of related infections.METHODS Totally 23 strains of R.mannitolilytica and 22 strains of R.picketti were isolated from a teaching hospital in Xiamen between 2017 and 2022.The strains were grown onto Columbia blood agar and re-identified by Vitek-MS MALDI-TOF,and the antimicrobial susceptibility testing was performed by using Vitek-2 Compact full-automatic microorganism analyzer.The clinical data of the patients were retrospectively analyzed,the risk factors for the different sites of Ralstonia infections,types of antibiotics and treatment outcomes were observed and compared.RESULTS The male patients(30 cases,66.67%)were dominant.There were 21 cases(46.67%)aged more than 60 years old among the patients aged between 1 month and 90 years old.There were 12(26.67%)cases from ICU,6(13.33%)cases from hematology department,5(11.11%)cases from respiratory and critical care medicine department and 5(11.11%)cases from general surgery department.As for the distribution of specimens,there were 23(51.11%)strains from respiratory tract specimens and 18(40.00%)strains from blood specimens.The two species of Ralstonia showed the similar in vitro drug susceptibility to different types of antibiotics;the drug resistance rates to ceftriaxone,ceftizoxime,tigecycline,fluoroquinolones,cefotaxime,cefepime,tetracycline and sulfamethoxazole-trimethoprim were less than 5.00%;the drug resistance rates to meropenem,tobramycin and piperacillin-tazobactam were greater than 70.00%.All of the patients received the empirical antimicrobial therapy,37 patients changed to sensitive antibiotics,24 of whom were treated with monotherapy,and 13 were treated with combined drug therapy.As for the treatment outcomes,22(59.46%)were improved,and 15(40.54%)were not improved.The prognosis of the patients with R.picketti-rel

关 键 词：皮氏罗尔斯顿菌 解甘露醇罗尔斯顿菌 感染 药物敏感性 

分 类 号：R378[医药卫生—病原生物学]