Gopalakrishnan R, Hawley H B, Czachor J S, Markert R J, Bernstein J M
Wright State University School of Medicine, Dayton, Ohio, USA.
Heart Lung. 1999 Mar-Apr;28(2):134-41. doi: 10.1053/hl.1999.v28.a96418.
To study the epidemiology of Stenotrophomonas maltophilia infections in the intensive care units (ICUs) of community general hospitals.
Retrospective chart review of 143 patients with cultures positive for S. maltophilia over a 2-year period.
Intensive care units of 2 community general hospitals.
Patients with S. maltophilia infection or colonization were elderly (mean age 62.4 years), intubated for a mean of 11.8 days, and had a mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 16.6. A tracheostomy was present in 22.4%, and underlying chronic respiratory disease and malignancy were found in 25.9% and 15.4%, respectively. Only 2 patients (1.4%) were neutropenic. Most isolates (89.5%) were from the respiratory tract and were part of a polymicrobial culture in 52. 5% of patients. Only a slightly higher APACHE II score (mean = 18.0, SD 7.8 vs mean = 15.6, SD 6.2, P = 0.052) differentiated patients with infection from those with colonization. All but 2 patients were exposed to antibiotics before their positive culture. Crude mortality rate was 41.3% overall and was significantly higher in those with an APACHE II score of 15 or more (48.8% vs 30.5%, P = 0. 028).
S. maltophilia is emerging as an important cause of nosocomial infection, especially pneumonia, in ICUs of community general hospitals. Patients tend to be elderly, intubated for a mean of about 12 days, have high APACHE II scores, and frequently have a tracheostomy or underlying chronic respiratory disease. In contrast to earlier reports, neutropenia and underlying malignancy are uncommon in our ICU population. We found prior antibiotic exposure was almost universal and similar to previous reports, but use of imipenem was much less common in our community hospital patients. Patients with a high APACHE II score should be considered infected rather than colonized, but differentiation of infection from colonization remains problematic. Isolation of S. maltophilia from a patient carries a crude mortality rate of 41.3%, and patients with an APACHE II score of 15 or more have a significantly higher mortality rate than those with lesser scores, approaching 50%. Trimethoprim-sulfamethoxazole (TMP-SMX) remains the drug of choice for infections caused by S. maltophilia.
研究社区综合医院重症监护病房（ICU）中嗜麦芽窄食单胞菌感染的流行病学情况。
对143例在两年期间嗜麦芽窄食单胞菌培养呈阳性的患者进行回顾性病历审查。
两家社区综合医院的重症监护病房。
嗜麦芽窄食单胞菌感染或定植的患者年龄较大（平均年龄62.4岁），平均插管11.8天，急性生理与慢性健康状况评分系统II（APACHE II）平均得分为16.6。22.4%的患者行气管切开术，25.9%和15.4%的患者分别存在潜在慢性呼吸道疾病和恶性肿瘤。仅有2例患者（1.4%）为中性粒细胞减少症患者。大多数分离株（89.5%）来自呼吸道，52.5%的患者的分离株是多微生物培养的一部分。仅有感染患者的APACHE II评分略高（平均=18.0，标准差7.8，而定植患者平均=15.6，标准差6.2，P = 0.052）。除2例患者外，所有患者在培养结果呈阳性之前均接受过抗生素治疗。总体粗死亡率为41.3%，APACHE II评分为15分或更高的患者的粗死亡率显著更高（48.8%对30.5%，P = 0.028）。
嗜麦芽窄食单胞菌正成为社区综合医院ICU医院感染尤其是肺炎的重要原因。患者往往年龄较大，平均插管约12天，APACHE II评分高，且经常行气管切开术或患有潜在慢性呼吸道疾病。与早期报告不同，中性粒细胞减少症和潜在恶性肿瘤在我们的ICU患者中并不常见。我们发现既往抗生素暴露几乎普遍存在，与先前报告相似，但亚胺培南在我们社区医院患者中的使用要少得多。APACHE II评分高的患者应被视为感染而非定植，但区分感染和定植仍然存在问题。从患者中分离出嗜麦芽窄食单胞菌的粗死亡率为41.3%，APACHE II评分为15分或更高的患者的死亡率明显高于评分较低的患者，接近50%。复方磺胺甲恶唑（TMP-SMX）仍然是嗜麦芽窄食单胞菌所致感染的首选药物。
