Julve R, Rovira E, Belda A, Prat J, Escoms R, Albert A, Gonzalvo F
Servicio Medicina Interna, Hospital de Sagunto, Valencia.
An Med Interna. 1998 Sep;15(9):476-80.
Stenotrophomonas maltophilia (SM) is a gram-negative bacillus whose incidence like nosocomial pathogen has been incremented in the last years, especially in immunocompromised patients, subjected to invasive procedures and those receiving broad-spectrum antimicrobial therapy.
We report 15 isolations of SM between 1994-1996.
The criteria for SM infection were fulfilled by 9 patients (60%), and 6 patients (40%) were colonized. The mean age of the patient was 60 +/- 12 years. Major predisposing factors in infections included venous catheterization (100%), prior surgery (86%), residence in ICU (80%), prior antibiotic therapy (80%) and intubation (66%). The most common underlying disease were heart disease (60%), treatment with immunosuppressors and/or steroids (46%) and chronic lung disease (46%). Ten cases (66%) had polymicrobial culture. The mortality rate was 40%. Risk factors associated with fatal outcome included the following: chronic lung disease (p = 0.043), nasogastric catheterization (p = 0.01), urinary tract catheterization (p = 0.02), intubation (p = 0.04) and the presence of pneumonia or sepsis by SM (p = 0.02). The most active agents were colistina (100%), cotrimoxazol (71%) and ceftazidima (53%). The isolates were highly resistant to first and second-generation cephalosporins (100%) tetracyclines (86%), aztreonam (91%) and imipenem (71%).
SM cause a wide range of clinical syndromes and is more likely to cause infection or colonization in patients who have underlying disease. Due to its inherent multiple-antimicrobial resistance, it would appear its potential as a nosocomial pathogen will continue to increase. Therapy of patients should include cotrimoxazole.
嗜麦芽窄食单胞菌（SM）是一种革兰氏阴性杆菌，近年来其作为医院病原体的发病率有所上升，尤其是在免疫功能低下、接受侵入性操作以及接受广谱抗菌治疗的患者中。
我们报告了1994年至1996年间15例SM分离株。
9例患者（60%）符合SM感染标准，6例患者（40%）为定植。患者的平均年龄为60±12岁。感染的主要易感因素包括静脉置管（100%）、既往手术（86%）、入住重症监护病房（80%）、既往抗生素治疗（80%）和插管（66%）。最常见的基础疾病是心脏病（60%）、使用免疫抑制剂和/或类固醇治疗（46%）以及慢性肺病（46%）。10例（66%）有多种微生物培养。死亡率为40%。与致命结局相关的危险因素包括：慢性肺病（p = 0.043）、鼻胃管插管（p = 0.01）、尿道插管（p = 0.02）、插管（p = 0.04）以及存在SM引起的肺炎或败血症（p = 0.02）。最有效的药物是黏菌素（100%）、复方新诺明（71%）和头孢他啶（53%）。分离株对第一代和第二代头孢菌素（100%）、四环素（86%）、氨曲南（91%）和亚胺培南（71%）高度耐药。
SM可引起广泛的临床综合征，更有可能在有基础疾病的患者中引起感染或定植。由于其固有的多重抗菌耐药性，其作为医院病原体的潜力似乎将继续增加。患者的治疗应包括复方新诺明。
