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目的探讨嗜麦芽窄食单胞菌血流感染的临床特点、治疗方案和预后。方法对浙江大学医学院附属第一医院2012年1月至2015年8月诊断为嗜麦芽窄食单胞菌血流感染的住院患者的临床资料进行回顾性分析。结果 54例嗜麦芽窄食单胞菌血流感染患者平均年龄50.5岁,检出前平均住院16天。17例(31.4%)合并有其他细菌感染,43例(79.6%)合并其他系统感染,其中合并肺部感染最常见(32例,占59.3%)。嗜麦芽窄食单胞菌血流感染多发生于恶性实体肿瘤、血液病患者(各占29.6%),最常见于肝胆外科(25.9%)等科室。54例患者好转32例(59.2%),死亡22例(40.7%);好转组APACHEII评分14.13±4.54、死亡组APACHEII评分27.59±8.17,两组比较有统计学差异(P<0.05)。合并其他部位感染、高APACHEII评分组死亡率更高(P<0.05),而使用敏感抗生素组死亡率更低(P<0.05)。结论嗜麦芽窄食单胞菌血流感染多见于免疫力低下的危重患者,多发生在院内外科手术操作的科室,并容易合并其他部位感染。规范使用敏感抗菌药物,积极治疗合并感染,可有助于改善嗜麦芽窄食单胞菌血流感染患者预后。
Objective To investigate the clinical characteristics, treatment and prognosis of Stenotrophomonas maltophilia bloodstream infection. Methods The clinical data of hospitalized patients diagnosed as Stenotrophomonas maltophilia by the First Affiliated Hospital of Zhejiang University School of Medicine from January 2012 to August 2015 were analyzed retrospectively. Results The average age of 54 patients with Stenotrophomonas maltophilia infection was 50.5 years and the average hospital stay before the test was 16 days. Of the 17 patients (31.4%) who had other bacterial infections, 43 (79.6%) had other bacterial infections, of which the most common were pulmonary infections (32, 59.3%). Stenotrophomonas maltophilia bloodstream infections occur in malignant solid tumors, blood disease patients (29.6% each), the most common in hepatobiliary surgery (25.9%) and other departments. 54 cases were improved in 32 cases (59.2%), and 22 cases died (40.7%). The APACHEII score was 14.13 ± 4.54 in the improvement group and 27.59 ± 8.17 in the death group. There was significant difference between the two groups (P <0.05). Combined with other parts of the infection, the higher the APACHEII score mortality was higher (P <0.05), while the use of sensitive antibiotics mortality was lower (P <0.05). Conclusion Stenotrophomonas maltophilia bloodstream infections are more common in critically ill patients with immunocompromised patients, occur in departments of surgical operations in the hospital, and easily merge with other parts of the infection. Standardize the use of sensitive antimicrobial agents, active treatment of co-infection can help to improve the prognosis of Stenotrophomonas maltophilia bloodstream infection.