Cheng L, Gong Y L, Luo X Q, Zhang C, Liu M X, Peng Y Z
State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China.
Zhonghua Shao Shang Za Zhi. 2018 Feb 20;34(2):78-82. doi: 10.3760/cma.j.issn.1009-2587.2018.02.004.
To investigate the clinical characteristics of burn patients infected with (SM) and antibiotic resistance of the strains. 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. (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 and 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. 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.
探讨烧伤患者感染嗜麦芽窄食单胞菌（SM）的临床特点及菌株的耐药情况。回顾性分析2011年7月至2017年7月收治于我科、检测出SM的烧伤患者的临床资料。采用API 20NE细菌鉴定板或全自动微生物鉴定仪鉴定病原菌。采用微量肉汤稀释法对左氧氟沙星、复方磺胺甲恶唑、米诺环素、头孢哌酮/舒巴坦进行药敏试验。分析SM的年度检出情况、感染SM患者的临床特点及预后、SM的标本来源及检出时间、检出SM前患者的病原菌及抗生素应用情况以及SM对上述4种抗生素的耐药情况。药敏试验结果采用WHONET 5.5软件进行分析。（1）共119例患者检测出SM，2011年至2017年分别为11例、12例、21例、22例、28例、13例和12例。（2）感染SM的患者中，男性86例（72.3%），女性33例（27.7%）。年龄≥65岁的患者占11.8%（14/119）。年龄≥18岁且＜65岁的患者占76.5%（91/119）。年龄＜18岁的患者占11.8%（14/119）。烫伤患者最为常见（共72例，占60.5%），烧伤总面积≤10%体表面积的患者也最为常见（共35例，占29.4%）。有基础疾病史的患者比例为16.8%（20/119），行气管切开术的患者占46.2%（55/119），行深静脉置管的患者占47.9%（57/119），有重症监护病房（ICU）住院史的患者占61.3%（73/119）。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）从患者伤口渗出液中检出的SM占比最高（58.0%，69/119），其次为痰液标本（17.6%，21/119）、血液（14.3%，17/119）、伤口组织（4.2%，5/119）、导管（4.2%，5/119）和尿液（1.7%，2/119）。SM的检出时间为入院后10小时至71天，平均时间为共35例，占29.4%）。有基础疾病史的患者比例为16.8%（20/119），行气管切开术占46.2%（55/119），行深静脉置管占47.9%（57/119），有重症监护病房（ICU）住院史占61.3%（73/119）。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）从患者伤口渗出液中检出的SM占比最高（58.0%，69/119），其次为痰液标本（17.6%，21/119）、血液（14.3%，17/119）、伤口组织（4.2%，5/119）、导管（4.2%，5/119）和尿液（1.7%，2/119）。SM的检出时间为入院后10小时至71天，平均时间为12.7天。（4）检出SM前已检出病原菌的患者比例为66.4%（79/119），其中 和 在菌株中占较高比例。（5）检出SM前使用抗生素的患者比例为91.6%（109/119），44.0%（48/109）的患者使用3种及以上抗生素。抗生素共应用271次。最常用的抗生素是糖肽类抗生素（63次），其次是碳青霉烯类抗生素（61次）。（6）7年中SM对左氧氟沙星和米诺环素的总敏感率较高（分别为91.6%和99.4%）。SM对头孢哌酮/舒巴坦的总敏感率较低（52.5%）。SM对复方磺胺甲恶唑的总敏感率较高（77.6%），近3年的年度敏感率均高于90.0%。烧伤患者感染SM后气管切开和深静脉置管率较高，多数患者入住ICU并使用广谱抗生素。SM对左氧氟沙星、米诺环素和复方磺胺甲恶唑敏感性较高。
