Objective: To investigate the clinical characteristics of burn patients infected with Stenotrophomonas maltophilia (SM) and antibiotic resistance of the strains. Methods: Clinical data of burn patients detected with SM, admitted to our unit from July 2011 to July 2017 were retrospectively analyzed. API 20NE bacteria identification panel or fully automated microbial identification instrument was used to identify pathogen. Minimal inhibitory concentration method was used in drug sensitivity test of levofloxacin, compound sulfamethoxazole, minocycline, and cefoperazone/sulbactam. Annual detection of SM, clinical characteristics and prognosis of patients infected with SM, sample source and detection time of SM, detection of the pathogens and antibiotics application of patients before their detection of SM, and drug resistance of SM to the above four antibiotics were analyzed. The results of drug sensitivity test were analyzed by software WHONET 5.5. Results: (1) There were totally 119 patients detected with SM, with 11, 12, 21, 22, 28, 13, and 12 cases from 2011 to 2017, respectively. (2) Among patients infected with SM, there were 86 (72.3%) males and 33 (27.7%) females. Patients aged more than or equal to 65 years accounted for 11.8% (14/119). Patients aged more than or equal to 18 years and less than 65 years accounted for 76.5% (91/119). Patients aged less than 18 years accounted for 11.8% (14/119). Patients with scald were the most common (totally 72 cases, accounted for 60.5%), and patients with total burn area less than or equal to 10% total body surface area were the most common (totally 35 cases, accounted for 29.4%), too. The proportion of patients with history of basic disease was 16.8% (20/119), with tracheotomy of 46.2% (55/119), with deep vein catheterization of 47.9% (57/119), with history of staying in intensive care unit (ICU) of 61.3% (73/119). Seventy-five (63.0%) patients were cured. Twenty-four (20.2%) patients were improved. Fourteen (11.8%) patients gave up treatment. Six (5.0%) patients died. (3) SM detected from wounds exudate of patients occupied the highest proportion (58.0%, 69/119), which was followed by samples of sputum (17.6%, 21/119), blood (14.3%, 17/119), wound tissue (4.2%, 5/119), catheter (4.2%, 5/119), and urine (1.7%, 2/119). The detection time of SM was 10 hours to 71 days post admission, with the average time of 12.7 days. (4) The proportion of patients detected with pathogens before detection of SM was 66.4% (79/119), and Acinetobacter baumannii and Staphylococcus aureus occupied high proportion among the strains. (5) The proportion of patients using antibiotics before detection of SM was 91.6% (109/119), and 44.0% (48/109) patients used 3 kinds of antibiotics or more. The antibiotics were applied for 271 times. The most frequently used antibiotics were glycopeptides antibiotics (63 times), followed by carbapenems antibiotics (61 times). (6) The total sensitivity rates of SM to levofloxacin and minocycline in 7 years were high (91.6% and 99.4%, respectively). The total sensitivity rate of SM to cefoperazone/sulbactam was low (52.5%). The total sensitivity rate of SM to compound sulfamethoxazole was high (77.6%), and the annual sensitivity rate was higher than 90.0% in recent 3 years. Conclusions: Burn patients infecting SM have high rates of tracheotomy and deep vein catheterization, and most of them stay in ICU and use broad-spectrum antibiotics. SM has high sensitivity to levofloxacin, minocycline, and compound sulfamethoxazole.
目的： 分析感染嗜麦芽窄食单胞菌烧伤患者的临床特征及该菌的耐药情况。 方法： 对2011年7月—2017年7月笔者单位收治检出嗜麦芽窄食单胞菌的烧伤患者的临床资料进行回顾性分析。采用API 20NE细菌鉴定板条或全自动微生物鉴定仪鉴定菌株，采用最低抑菌浓度法选取左氧氟沙星、复方磺胺甲 唑、米诺环素、头孢哌酮/舒巴坦进行药物敏感试验。统计各年度嗜麦芽窄食单胞菌检出情况、感染嗜麦芽窄食单胞菌患者临床特征及预后、嗜麦芽窄食单胞菌样本来源及检出时间、检出嗜麦芽窄食单胞菌前患者病原菌检出情况及抗生素使用情况、嗜麦芽窄食单胞菌对前述4种抗生素的耐药情况。药物敏感试验结果采用WHONET 5.5软件进行统计。 结果： (1)共119例患者检出嗜麦芽窄食单胞菌，2011—2017年依次为11、12、21、22、28、13、12例。(2)感染嗜麦芽窄食单胞菌的患者中，男86例(72.3%)、女33例(27.7%)；年龄≥65岁者占11.8%(14/119)，年龄≥18岁且<65岁者占76.5%(91/119)，年龄<18岁者占11.8%(14/119)；烫伤患者最多，共72例(60.5%)；烧伤总面积≤10%体表总面积的患者最多，共35例(29.4%)；16.8%(20/119)的患者有基础病史，46.2%(55/119)的患者行气管切开，47.9%(57/119)的患者行深静脉置管，61.3%(73/119)的患者入住重症监护病房(ICU)；75例(63.0%)患者治愈，24例(20.2%)患者好转，14例(11.8%)患者放弃治疗，6例(5.0%)患者死亡。(3)患者创面分泌物检出嗜麦芽窄食单胞菌的比例最大，为58.0%(69/119)；其次是痰液、血液、创面组织、导管、尿液，分别占17.6%(21/119)、14.3%(17/119)、4.2%(5/119)、4.2%(5/119)、1.7%(2/119)。嗜麦芽窄食单胞菌的检出时间为入院后10 h～71 d，平均12.7 d。(4)66.4%(79/119)的患者在检出嗜麦芽窄食单胞菌之前检出了病原菌，菌株中鲍氏不动杆菌和金黄色葡萄球菌所占比例较大。(5)91.6%(109/119)的患者在检出嗜麦芽窄食单胞菌之前使用过抗生素，且有44.0%(48/109)的患者使用过3类及以上的抗生素。共使用抗生素271次，其中碳青霉烯类和糖肽类抗生素使用次数较多，分别为61、63次。(6)7年间，嗜麦芽窄食单胞菌对左氧氟沙星和米诺环素的总体敏感率高，分别为91.6%、99.4%；对头孢哌酮/舒巴坦的总体敏感率较低，为52.5%；对复方磺胺甲 唑的总体敏感率较高，为77.6%，且年敏感率在近3年高于90.0%。 结论： 感染嗜麦芽窄食单胞菌的烧伤患者气管切开、深静脉置管率较高，大部分患者入住ICU、使用广谱抗生素。嗜麦芽窄食单胞菌对左氧氟沙星、米诺环素和复方磺胺甲 唑敏感率高。.
Keywords: Burns; Drug resistance; Infection; Stenotrophomonas maltophilia.