重症监护病房患者洋葱伯克霍尔德菌感染临床特点及耐药性

Clinical characteristics and antimicrobial resistance of Burkholderia cepacia causing infection in intensive care unit patients

摘要:

目的了解重症监护病房（ICU）洋葱伯克霍尔德菌（BC）感染患者标本来源、临床特点及菌株耐药性，为指导临床合理用药提供依据。方法回顾性分析2011—2014年入住某院ICU发生BC感染患者的临床资料，并对菌株耐药性进行分析。结果共分离BC 267株，主要标本来源为痰（80.15%,214株），血（14.23%,38株），尿（3.37%,9株）。2011—2014年药敏试验结果显示，BC具有多重耐药性，对临床常用的多种抗菌药物因具有天然耐药性，如氨苄西林、头孢唑林、氨苄西林/舒巴坦、呋喃妥因、头孢呋辛耐药率均为100%；对头孢他啶、左氧氟沙星耐药率分别为4.12%，3.00%；对复方磺胺甲口恶唑耐药率呈升高趋势（χ2=5.885, P=0.015）。结论 ICU检出BC逐年增多，耐药情况严重，应加强医院感染防控管理与目标性监测，根据药敏试验结果合理选择抗菌药物,减低细菌耐药压力。

Abstract:

ObjectiveTo understand the specimen sources, clinical characteristics, and antimicrobial resistance of Burkholderia cepacia(B. cepacia) isolated from infected patients  in intensive care unit(ICU), so as to provide reference for guiding rational use of antimicrobial agents.MethodsClinical data of patients with B. cepacia infection in an ICU between 2011 and 2014 were analyzed retrospectively,  antimicrobial resistance of  strains was analyzed.ResultsA total of 267 B. cepacia strains were isolated, the major specimen sources  were sputum （80.15%,n=214）,  blood（14.23%,n=38）,and urine（3.37%,n=9）. Antimicrobial susceptibility testing results revealed that B. cepacia had multiple resistance, and was naturally resistant to multiple clinically used  antimicrobial agents, such as ampicillin, cefazolin, ampicillin/sulbactam, nitrofurantoin, and cefuroxime,resistant rates  were all 100%; resistant rates to ceftazidime  and levofloxacin were 4.12%  and 3.00% respectively；resistant rate to compound sulfamethoxazole had increased tendency（χ2=5.885, P=0.015）.ConclusionIsolation of B. cepacia in  ICU increased year by year, antimicrobial resistance is serious, management and targeted monitoring of prevention and control of healthcareassociated infection should be strengthened， antimicrobial agents should be chosen according to antimicrobial susceptibility testing results.