Department of Neonatology, Karadeniz Technical University, Trabzon, Turkey.
J Microbiol Immunol Infect. 2011 Dec;44(6):467-72. doi: 10.1016/j.jmii.2011.04.014. Epub 2011 May 24.
The aim of this study was to review the risk factors and clinical, bacteriological, and epidemiological characteristics of Stenotrophomonas maltophilia infections in our neonatal intensive care unit.
A retrospective matched case-control study was performed by comparing 23 cases of S maltophilia with 45 controls to identify the potential risk factors. To identify the case patients, the admission and medical records of patients in the neonatal intensive care unit and records from the Microbiology Department were reviewed between 2003 and 2008.
Sepsis in two neonates (9%), conjunctivitis in two neonates (9%), and ventilator-associated pneumonia in 19 (82%) neonates were determined. Invasive-procedures, exposure to aminoglycoside and carbapenem, total parenteral nutrition, histamine 2 blockers, exposure to steroids, cholestasis, and duration of hospitalization were significantly associated with S maltophilia infections (p<0.05). On multivariate analysis, invasive procedures (odds ratio, 18.81) and duration of hospitalization (odds ratio, 1.06) were determined to be the risk factors for S maltophilia infection. The most active antimicrobial agent was trimethoprim/sulfamethoxazole (87%) for S maltophilia infection, and the mortality rate was 17%.
Neonatologists should avoid from unnecessary invasive procedures and broad-spectrum antibiotics to reduce S maltophilia infections. Invasive procedures should be finished in the shortest time possible. Agent/factor-specific antibacterial treatment should be administered. Patients being discharged as early as possible will also reduce infection frequency. Stenotrophomonas maltophilia should be considered in patients with high Stenotrophomonas infection risk factors.
本研究旨在回顾我们新生儿重症监护病房（NICU）中嗜麦芽寡养单胞菌感染的危险因素、临床、细菌学和流行病学特征。
通过比较 23 例嗜麦芽寡养单胞菌感染患者与 45 例对照患者，采用回顾性匹配病例对照研究来确定潜在的危险因素。为了确定病例患者，我们回顾了 2003 年至 2008 年间新生儿重症监护病房的入院和病历以及微生物科的记录。
两名新生儿（9%）发生败血症，两名新生儿（9%）患有结膜炎，19 名新生儿（82%）患有呼吸机相关性肺炎。侵袭性操作、氨基糖苷类和碳青霉烯类药物暴露、全胃肠外营养、组胺 2 受体阻滞剂、皮质类固醇暴露、胆汁淤积和住院时间与嗜麦芽寡养单胞菌感染显著相关（p<0.05）。多变量分析确定，侵袭性操作（优势比，18.81）和住院时间（优势比，1.06）是嗜麦芽寡养单胞菌感染的危险因素。针对嗜麦芽寡养单胞菌感染最有效的抗菌药物是复方磺胺甲噁唑（87%），死亡率为 17%。
新生儿科医生应避免不必要的侵袭性操作和广谱抗生素，以减少嗜麦芽寡养单胞菌感染。应尽可能缩短侵袭性操作的时间。应根据具体的病原体/危险因素进行针对性的抗菌治疗。尽早出院的患者也会降低感染频率。对于具有高嗜麦芽寡养单胞菌感染风险因素的患者，应考虑嗜麦芽寡养单胞菌感染。
