下呼吸道感染嗜麦芽窄食单胞菌的危险因素与耐药性分析

摘要

目的探讨下呼吸道感染嗜麦芽窄食单胞菌的危险因素与耐药性.方法回顾性分析46例嗜麦芽窄食单胞菌下呼吸道感染患者的临床资料,采用琼脂二倍稀释法测定抗生素对临床分离株的最低抑菌浓度(MICs).结果严重基础疾病、入住ICU、反复应用广谱抗生素尤其是第三代头孢菌素和亚胺培南、接受激素或化疗药物治疗、建立人工气道和机械通气是下呼吸道感染嗜麦芽窄食单胞菌的危险因素.药敏结果显示左旋氧氟沙星敏感率最高91.3%,其次是加替沙星87.0%,再次是复方磺胺甲基异□唑71.7%;环丙沙星、头孢哌酮/舒巴坦、替卡西林/克拉维酸的敏感率均超过60.0%;新型广谱β内酰胺类抗生素耐药率从50.0%～95.7%.结论有严重基础疾病的患者应避免长期滥用广谱抗生素,存在危险因素时高度警惕该菌感染的发生,及时作细菌培养与药敏检查,感染后可选用左旋氧氟沙星、加替沙星、复方磺胺甲基异□唑治疗,或根据药敏结果选择其他敏感抗生素.%[Objective] To explore the risk factors and antimicrobial resistance of lower respiratory tract infection with Stenotrophomonas maltophilia. [Methods] Clinical data of 46 cases of lower respiratory tract infection with Stenotrophomonas maltophilia were analyzed retrospectively, the minimal inhibitory concentrations ( MICs ) for clinical isolates were determined by standard agar dilution method. [Results] Severe underlying disease, admittance to ICU, using broad-spectrum antibiotics especially the third-generation cephalosporins and imipenem repeatedly, using glucocorticoids or chemotherapy drugs, establishment of artifical airway and mechanical ventilation were risk factors of lower respiratory tract infection with Stenotrophomonas maltophilia. The sensitive rate of Stenotrophomonas maltophilia to levofloxacin was the highest about 91.3%, followed by gatifloxacin 87.0% and trimethoprim/ sulfamethoxazole 71.7% while ciprofloxacin, cefoperazone/sulbactam and ticarcillin/ clavulanic acid were more than 60%. The resistant rates to newer broad-spectrum β-lactams ranged from 50.0% to 95.7%. [Conclusions] The patients with severe underlying disease should be avoided to abuse broad-spectrum antibiotics for a long time and be on guard against infection with Stenotrophomonas maltophilia while risk factors mentioned above are existing, bacterial culture and anntibiotic susceptibility test must be carried out promptly. Levofloxacin, gatifloxacin and trimethoprim/sulfamethoxazole may be used to treat infection with Stenotrophomonas maltophilia, and other susceptibility antibiotics be chosen according to the results of the anntibiotic susceptibility test.