皮氏罗尔斯顿菌感染患者42例临床特征及菌株药物敏感性

Clinical characteristics and bacterial antimicrobial susceptibility of 42 patients infected with Ralstonia pickettii

摘要:

目的研究临床分离获得的皮氏罗尔斯顿菌感染患者的临床特征及菌株药敏试验结果,为临床合理使用抗菌药物提供依据。方法回顾性分析2014年1月—2023年12月于天津市第一中心医院就诊的皮氏罗尔斯顿菌感染住院患者,分析皮氏罗尔斯顿菌的临床特征及药敏试验数据。结果 10年内共分离出罗尔斯顿菌属80株,其中非重复皮氏罗尔斯顿菌42株(52.5%)。42株皮氏罗尔斯顿菌中,64.3%分离自男性患者;分离自痰、导管、血、咽拭子、引流液标本的菌株分别占38.1%、28.6%、19.0%、4.8%、2.4%;临床来源科室分布以重症监护科病房(ICU)占比最高(52.4%);感染患者例数随年份先升后降,之后呈小幅波动,各科室感染患者例数随年份变化差异不具有统计学意义(P＞0.05)。皮氏罗尔斯顿菌对多西环素、左氧氟沙星、环丙沙星、米诺环素等药物具有较高的敏感率,敏感率为78.3%~90.9%;而对复方磺胺甲口恶唑、头孢唑林则完全(100%)耐药,对氨曲南、黏菌素、头孢替坦、妥布霉素、阿米卡星、头孢他啶、庆大霉素同样具有较高的耐药率(80.0%~97.4%)。对21种抗菌药物在不同年份间的耐药率变化比较,差异均无统计学意义(均P＞0.05)。结论皮氏罗尔斯顿菌主要来自ICU,感染人群以成年男性居多,从痰和导管标本中分离出的菌株最多;菌株呈现多重耐药,应注意对常用抗菌药物的耐药率变迁,加强细菌耐药动态监控,指导临床合理选择抗菌药物,实施早期有效治疗以改善患者预后。

Abstract:

Objective To study the clinical characteristics and bacterial antimicrobial susceptibility testing results of patients with clinically isolated Ralstonia pickettii (R. pickettii), and provide basis for the rational use of antimicrobial agents. Methods Inpatients with R. pickettii infection who were treated at the Tianjin First Central Hospital from January 2014 to December 2023 were analyzed retrospectively. Clinical characteristics and antimicrobial susceptibility testing results were analyzed. Results A total of 80 strains of Ralstonia spp. were isolated over 10-year period, including 42 (52.5%) non-repetitive strains of R. pickettii. Among 42 R. pickettii strains, 64.3% were isolated from male patients. The strains isolated from sputum, catheter, blood, throat swabs, and drainage fluid specimens accounted for 38.1%, 28.6 %, 19.0%, 4.8%, and 2.4%, respectively. The clinical distribution of R. pickettii was highest in the intensive care unit (ICU), with a proportion of 52.4%. The number of infected patients first increased and then decreased with the years, followed by a slight fluctuation. There was no statistically significant difference in the number of infected patients in each department over the years (P>0.05). R. pickettii had higher susceptibility rates to doxycycline, levofloxacin, ciprofloxacin, and minocycline, susceptibility rates were 78.3%-90.9%, but was completely resistant to compound sulfamethoxazole and cefazolin (100%), it also had higher resistance rates to aztreonam, colistin, cefotetan, tobramycin, amikacin, ceftazidime, and gentamicin (80.0%-97.4%). There was no statistically significant difference in the resistance rates to 21 antimicrobial agents among different years (all P>0.05). Conclusion R. pickettii is mainly from ICU, and the majority of the infected population are adult males. Most strains are isolated from sputum and catheter. R. pickettii presents multidrug resistance. Attention should be paid to the changes in the resistance rates of antimicrobial agents, strengthen the dynamic monitoring of bacterial resistance and guide the rational selection of antimicrobial agents in clinic, implement early and effective treatment to improve the prognosis of the patients.