重症患者继发脑膜败血伊丽莎白菌感染的临床病因与耐药性
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摘要
目的分析重症监护病房患者继发脑膜败血伊丽莎白菌感染的临床病因和耐药特点,为临床治疗和预防脑膜败血伊丽莎白菌感染提供依据。方法收集2011年1月至2014年12月重症监护病房患者临床标本,常规分离培养细菌,K-B纸片法进行药敏试验,利用WHONET 5.6软件分析处理试验数据。结果造成脑膜败血伊丽莎白菌主要危险因素有中央静脉插管、应用广谱抗生素、严重的基础疾病、使用免疫抑制剂、入住ICU时间等;检出的71例阳性标本以下呼吸道为主,占87.3%,其次为血液和尿液,分别占5.6%和2.8%;药敏试验表明脑膜败血伊丽莎白菌对万古霉素、磺胺甲唑/甲氧苄啶、利福平和米诺环素的耐药率最低,分别为0.0%、15.5%、16.9%和18.3%,对三种含酶抑制剂的耐药率均<30.0%,其余抗菌药物除环丙沙星、左氧氟沙星外,均>85.0%。结论脑膜败血伊丽莎白菌引发的医院感染已日益严重,该菌对临床常用的头孢类、碳青霉烯类、氨基糖苷类及多种β-内酰胺类抗生素呈高度耐药,临床应加强耐药性监测,防止医院感染,治疗脑膜败血伊丽莎白菌感染首选万古霉素、磺胺甲唑/甲氧苄啶、米诺环素、利福平和含酶抑制剂。
Objective To analyze the risk factors and drug resistance of the pathogens in ICU patients with secondary bacterial infection of Flavobacterium meningosepticum and provide the basis for clinical treatment and prevention of the infection.Methods Clinical specimens of ICU patients from January 2011 to December2014were collected to isolate the pathogens;K-B disk diffusion method was used to determine the drug susceptibility;WHONET 5.6software was used to process data.Results The main risk factors for sepsis caused by Flavobacterium meningosepticum were central venous catheter,use of broad-spectrum antibiotics,severe underlying diseases,use of immune inhibitors,ICU stay length and so on.The 71 cases of positive samples were of lower respiratory tract(87.3%),blood(5.6%)and urine(2.8%).The resistance rates of Flavobacterium meningosepticum to Vancomycin,Sulfamethoxazole/trimethoprim,Rifampin and Minocycline were 0.0%,15.5%,16.9%and 18.3%respectively;the resistance rates to three enzyme inhibitors were lower than 30.0%,while those to the other antimicrobial agents(except to Ciprofloxacin and Levofloxacin)were higher than >85.0%.Conclusion Nosocomial infection caused by Flavobacterium meningosepticum has become increasingly serious.Clinicians should strengthen the monitoring of the drug resistance.Vancomycin,Sulfamethoxazole/trimethoprim,Rifampin,Minocycline and enzyme inhibitors are the first choice drugs for the treatment.
Objective To analyze the risk factors and drug resistance of the pathogens in ICU patients with secondary bacterial infection of Flavobacterium meningosepticum and provide the basis for clinical treatment and prevention of the infection.Methods Clinical specimens of ICU patients from January 2011 to December2014were collected to isolate the pathogens;K-B disk diffusion method was used to determine the drug susceptibility;WHONET 5.6software was used to process data.Results The main risk factors for sepsis caused by Flavobacterium meningosepticum were central venous catheter,use of broad-spectrum antibiotics,severe underlying diseases,use of immune inhibitors,ICU stay length and so on.The 71 cases of positive samples were of lower respiratory tract(87.3%),blood(5.6%)and urine(2.8%).The resistance rates of Flavobacterium meningosepticum to Vancomycin,Sulfamethoxazole/trimethoprim,Rifampin and Minocycline were 0.0%,15.5%,16.9%and 18.3%respectively;the resistance rates to three enzyme inhibitors were lower than 30.0%,while those to the other antimicrobial agents(except to Ciprofloxacin and Levofloxacin)were higher than >85.0%.Conclusion Nosocomial infection caused by Flavobacterium meningosepticum has become increasingly serious.Clinicians should strengthen the monitoring of the drug resistance.Vancomycin,Sulfamethoxazole/trimethoprim,Rifampin,Minocycline and enzyme inhibitors are the first choice drugs for the treatment.
引文
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[11] QIN Fang,SHEN Han,ZHANG Zhi-feng.37 Flavobacterium meningospticum clinical distribution and drug analysis[J].Chin J Lab Diagn,2010,14(8):1301-1302.(in Chinese)秦芳,沈瀚,张之烽.37株脑膜脓毒金黄杆菌临床分布及耐药性分析[J].中国实验诊断学,2010,14(8):1301-1302.
[12] YU Tao,MA Yun,JIANG Xiao-bing.Analyusis of drug resistance and homology of Elizabethkingia meningosepticum isolated from hospital environment[J].Chin J Health Lab Technol,2014,24(19):2821-2823.(in Chinese)于涛,马芸,姜晓冰.医院环境分离脑膜败血伊丽莎白菌耐药性及同源性分析[J].中国卫生检验杂志,2014,24(19):2821-2823.
[13] FAN Hong-wei,LV Wei,WU Dong,et al translation.Sanford guide to antimicrobial therapy[S].41th ed.Beijing:Chinese Peking Union Medical College Publishing House?,2011:63-65.(in Chinese)范洪伟,吕玮,吴东,等译.桑福德抗微生物治疗指南[S].41版.北京:中国协和医科大学出版社,2011:63-65.
[14] SUN Gui-qin,LI Meng,WANG Lei,et al.Clinical distribution and drug resistance of Elizabethkingia meningosepticum infection[J].Chin J Microecol,2014,26(5):540-543.(in Chinese)孙桂芹,李蒙,王蕾,等.脑膜炎败血伊丽莎白金菌感染的临床分布及耐药性分析[J].中国微生态学杂志,2014,26(5):540-543.
[2]People′s Republic of China Medical department.Hospital infection diagnostic criteria(trial)[J].Natl Med J China,2001,81(5):314-316.(in Chinese)中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-316.
[3]YE Ying-wu,WANG Yu-san,SHEN Zi-yu.National clinical laboratory procedures[M].3rd ed.NanJing:Southeast University Publishing House,2011:827-836.(in Chinese)叶应妩,王毓三,申子瑜.全国临床检验操作规程[M].3版.南京:东南大学出版社,2011:827-836.
[4]Clinical and Laboratory Standard Institute.M07-A8 Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically;approved standard-eighth edition[S].2012.
[5]CHEN Dong-ke,SUN Chang-gui.Practical clinical?microbiology examination?and Atlas[M].Beijing:People′s Medical Publishing House,2011:465-466.(in Chinese)陈东科,孙长贵.实用临床微生物学检验与图谱[M].北京:人民卫生出版社,2011:465-466.
[6]WU Qing,LU Hong,LIU Mei-na,et al.Clinical distribution and antibiotic resistance analysis of Flavobacterium meningospticum[J].Pract J Med,2008,24(10):1815-1816.(in Chinese)吴庆,陆红,刘媚娜,等.脑膜炎败血黄杆菌的临床分布及耐药性分析[J].实用医学杂志,2008,24(10):1815-1816.
[7]SHI Qing-feng,GAO Ling.ICUFlavobacterium meningosepticum caused by hospital-acquired infections and antimicrobial resistance of clinical features[J].Int J Lab Med,2013,34(1):27-31.(in Chinese)石青峰,高玲.ICU脑膜炎败血黄杆菌所致医院获得性感染的临床特征及耐药性分析[J].国际检验医学杂志,2013,34(1):27-31.
[8]LU Mei-hua,HONG Yong-fu.Clinical analysis of malignant tumors in patients with lower respiratory tract infection caused by Flavobacterium meningosepticum[J].Chin J Microecol,2014,26(8):935-937.(in Chinese)鲁梅华,洪永富.脑膜炎败血黄杆菌致恶性肿瘤患者下呼吸道感染的临床分析[J].中国微生态学杂志,2014,26(8):935-937.
[9]HUANG Qing-ning,LIU Ding,CHEN Ping,et al.Risk factors for lower respiratory tract infections caused by Elizabethkingia meningospeticain adult patients and analysis of drug resistance[J].Chin J Nosocomiol,2012,22(14):3028-3030.(in Chinese)黄庆宁,刘丁,陈萍,等.脑膜败血伊丽莎白金菌引发成年患者下呼吸道感染的危险因素及耐药性分析[J].中华医院感染学杂志,2012,22(14):3028-3030.
[10] CHEN Xing-chun,NONG Sheng-zhou,ZHAO Li,et al.Analysis of clinical features and drug resistance of Eliz abethkingia meningosepticum[J].Chin J Nosocomiol,2014,24(20):4961-4962.(in Chinese)陈杏春,农生洲,赵丽,等.脑膜败血伊丽莎白菌感染特征及耐药性分析[J].中华医院感染学杂志,2014,24(20):4961-4962.
[11] QIN Fang,SHEN Han,ZHANG Zhi-feng.37 Flavobacterium meningospticum clinical distribution and drug analysis[J].Chin J Lab Diagn,2010,14(8):1301-1302.(in Chinese)秦芳,沈瀚,张之烽.37株脑膜脓毒金黄杆菌临床分布及耐药性分析[J].中国实验诊断学,2010,14(8):1301-1302.
[12] YU Tao,MA Yun,JIANG Xiao-bing.Analyusis of drug resistance and homology of Elizabethkingia meningosepticum isolated from hospital environment[J].Chin J Health Lab Technol,2014,24(19):2821-2823.(in Chinese)于涛,马芸,姜晓冰.医院环境分离脑膜败血伊丽莎白菌耐药性及同源性分析[J].中国卫生检验杂志,2014,24(19):2821-2823.
[13] FAN Hong-wei,LV Wei,WU Dong,et al translation.Sanford guide to antimicrobial therapy[S].41th ed.Beijing:Chinese Peking Union Medical College Publishing House?,2011:63-65.(in Chinese)范洪伟,吕玮,吴东,等译.桑福德抗微生物治疗指南[S].41版.北京:中国协和医科大学出版社,2011:63-65.
[14] SUN Gui-qin,LI Meng,WANG Lei,et al.Clinical distribution and drug resistance of Elizabethkingia meningosepticum infection[J].Chin J Microecol,2014,26(5):540-543.(in Chinese)孙桂芹,李蒙,王蕾,等.脑膜炎败血伊丽莎白金菌感染的临床分布及耐药性分析[J].中国微生态学杂志,2014,26(5):540-543.