摘要
目的探讨山东地区医院获得性嗜麦芽寡养单胞菌(stenotrophomonas maltophilia,SMA)耐药性及相关危险因素分析。方法收集2015年10月1日~2016年9月30日期间山东省118家医院的送检标本进行细菌培养,分离鉴定得到4 808株SMA菌株,对其分布、耐药性进行分析。共获得2 000例资料完整的SMA感染患者作为观察组;选取2 000例同科室、年龄±3岁且未发生SMA感染的患者作为对照组,并采用logistic多元回归分析分析SMA感染的相关危险因素。结果 SMA的标本来源中62.65%为痰液,17.55%为肺泡灌洗液,56.47%来自ICU,26.87%来自呼吸内科。SMA对左旋氧氟沙星、复方新诺明、米诺环素和环丙沙星有较低的耐药性(<10%);对氨苄西林、头孢唑林、庆大霉素、亚胺培南和美罗培南的耐药率为60.02%~90.01%;对头孢他啶、头孢呋辛、头孢噻肟、四环素、阿莫西林/克拉维酸和哌拉西林/他唑巴坦的耐药率在37.51%~45.00%之间。单因素分析和Logistic多因素分析表明SMA感染的独立危险因素为:ICU入住(P=0.026)、慢性肺部疾病(P=0.042)、入侵性操作(P=0.005)、使用三种以上抗生素(P=0.003)、免疫抑制剂(P=0.014)。结论 ICU和呼吸内科应特别加强对SMA菌群的监控力度,减少不必要的有创诊疗操作,避免广谱抗生素和免疫抑制剂滥用,预防医源性感染的发生,减少交叉感染,降低医院获得性SMA感染率。
Objective To analyze the drug resistance and risk factors of nosocomial infection of Stenotrophomonas maltophilia （SMA） in Shandong. Methods The samples of 118 hospitals in Shandong province were collected from October lth,2015 to September 30th, 2016, and 4 808 strains of SMA were isolated and identified, then the distribution and drug resistance were analyzed. 2 000 patients with SMA infection and with integrity data as the observation group, 2 000 patients from the same department, age± 3 years old and no SMA infection were selected as control group, the related risk factors of SMA infection were analyzed by Logistic multiple regression. Results 62.65% of SMA samples were sputum,17.55% were bronchoalveo- lar lavage fluid,56.47% came from ICU, 26.87 % from respiratory medicine. SMA had a relatively low resistance to levo- floxacin, cotrimoxazole, ciprofloxacin and minocycline （ 〈 10 % ）. Resistant to ampicillin, cefazolin, gentamicin, imipenem and meropenem were between 60.02 % ~ 90.01%. Resistance rate to ceftazidime, cefuroxime, cefotaxime, tetracycline, amoxicil- lin/clavulanic acid, piperacillin/resistance tazobactam were between 37.51% ~ 45.00%. Single factor analysis and Logistic multivariate analysis showed that the independent risk factors of SMA infection were ICU admission, chronic pulmonary dis- ease,invasive operation, using more than three kinds of antibacterial agents and the using of immunosuppressants. Conclusion The ICU and respiratory medicine should strengthen the monitoring of SMA flora,reduce unnecessary invasive diagnosis and treatment, avoid the abuse of broad-spectrum antibiotics and immunosuppressive agents, prevent the occurrence of iatro- genic infection,reduce cross infection,and reduce hospital acquired SMA infection rate.
作者
吕刚飞
刘海洋
赵乔妹
LU Gang-fei;LIU Hai-yang;ZHAO Qiao-mei(Department of Clinical Laboratory;Department of Pharmacy ,Zaozhuang Mining Group Center Hospital, Shandong Zaozhuang 277800, China;Department of Clinical Laboratory the First Affiliated Hospital of PLA General Hospital ,Beijing 100048,China)
出处
《现代检验医学杂志》
CAS
2018年第3期136-140,共5页
Journal of Modern Laboratory Medicine
关键词
医院获得性
嗜麦芽寡养单胞菌
耐药性
危险因素
山东
hospital acquired
stenotrophornonas maltophilia
drug resistance
risk factors
Shandong province
