摘要
本文探讨了老年患者脑膜炎败血伊丽莎白菌(Elizabethkingia meningoseptica,EM)感染的危险因素、临床特征及耐药情况,为临床有效的治疗提供参考。分析2018年1月—2023年1月绍兴市人民医院27株分离自60岁以上老年EM感染患者的菌株,采用VITEK-2全自动微生物鉴定药敏分析仪进行菌种鉴定和药敏实验,并统计该菌的感染临床特征和耐药性。结果表明,EM主要感染住院时间长(住院天数≥4周)的患者,占66.7%,存在严重基础疾病,其中呼吸系统疾病占44.4%,恶性肿瘤占22.2%,以及长期应用广谱抗菌药物及接受过有创操作的老年患者。标本类型以痰液标本为主(85.2%),其次为尿液(11.1%);患者主要来自重症医学科(74.1%),其次是放疗科(7.4%);EM对多种广谱抗菌药物表现为高度耐药,但对多西环素100%敏感,对头孢哌酮/他唑巴坦、哌拉西林/他唑巴坦、复方新诺明、左氧氟沙星的耐药性均<30%。由此可知,存在严重基础疾病并长时间住院、联合使用广谱抗菌药物以及接受多种侵入性诊疗是老年患者感染EM的危险因素,且EM多重耐药现象严重。因此合理使用抗菌药,积极治疗原发病,尽量减少有创操作,缩短住院时间,加强医疗环境管理,有利于EM的治疗和预防。
This study explored the risk factors,clinical characteristics,and drug resistance of Elizabethkingia meningoseptica(EM)infection in elderly patients to provide the reference for scientific and effective clinical treatment.Analysis of 27 strains isolated from EM infected patients aged over 60 years of Shaoxing People’s Hospital from January 2018 to January 2023 was carried out using VITEK-2 automatic microbial identification and drug sensitivity analyzer for bacterial identification and drug sensitivity tests,and analyzed the clinical characteristics and drug resistance of the bacteria.EM mainly infected the patients with long hospitalization stays(hospital days≥4 weeks),accounting for 66.7%;And patients with serious underlying diseases,including respiratory system diseases account for 44.4%,and malignant tumors 22.2%;Elderly patients who have used broad-spectrum antibacterial drugs for a long time and have undergone invasive procedures.The main type of specimen was sputum 85.2%,followed by urine of 11.1%.The patients mainly came from the department of critical care(74.1%),followed by the department of radiotherapy(7.4%).EM exhibited high resistance to a variety of broad-spectrum antibacterial drugs,but was 100%sensitive to doxycycline.Resistance to cefoperazone/tazobactam,piperacillin/tazobactam,compound sulfamethoxazole and levofloxacin was under 30%.The presence of serious underlying diseases and prolonged hospitalization,combined use of broad-spectrum antibiotics,and multiple invasive diagnoses and treatments are risk factors for elderly patients with EM infection.The phenomenon of multiple drug resistance in EM is serious.So,rational use of antibiotics,active treatment of primary diseases,minimizing invasive procedures,reducing hospital stay,and strengthening medical environmental management are conducive to the treatment and prevention of EM.
作者
张丹
孙桂芹
ZHANG Dan;SUN Guiqin(School of Medical Technology and Information Engineering,Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang Province,China;Shaoxing People’s Hospital,Shaoxing Hospital,Zhejiang University,Shaoxing 312000,Zhejiang Province,China)
出处
《微生物与感染》
CAS
2023年第5期278-283,共6页
Journal of Microbes and Infections
基金
复旦大学教育部/卫健委/医科院医学分子病毒学重点实验室开放课题(FDMV-2021003)。
关键词
脑膜炎败血伊丽莎白菌
危险因素
临床特征
耐药率
Elizabethkingia meningoseptica
Risk factor
Clinical features
Drug resistance rate
