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目的探讨新生儿重症监护病房(NICU)嗜麦芽窄食单胞菌(SMA)感染的临床特点、耐药情况及治疗。方法对2008年1月至2012年12月我院NICU收治的SMA感染患儿进行回顾性分析,对其临床特征、细菌耐药性及治疗情况进行总结。结果本院NICU近5年共收治新生儿20463例,其中SMA感染54例,发生率2.63‰,2008—2012年发生率分别为4.17‰、2.80‰、3.05‰、2.50‰、0.94‰。其中新生儿败血症36例,新生儿肺炎18例;早产儿与足月儿发生率差异无统计学意义(2.61‰比2.65‰,P>0.05)。临床主要表现为气促(27例)、黄疸(22例)、青紫(17例)、消化道出血(7例)、腹胀(8例)、呕吐(7例)等,常见并发症有呼吸衰竭(18例)、心力衰竭(13例)、坏死性小肠结肠炎(6例)、弥散性血管内凝血(4例)、休克(3例)等;13例(24.1%)考虑为医院感染,早产儿及气管插管机械通气患儿医院感染发生率分别高于足月儿及鼻塞无创辅助通气患儿(1.63‰比0.2‰,7.21‰比0.75‰,P均<0.01)。SMA对头孢哌酮/舒巴坦、替卡西林/克拉维酸钾敏感度较高,均>70%,对哌拉西林/他唑巴坦、头孢他啶耐药率在30%~40%。结论SMA是新生儿医院感染的重要病原菌,新生儿SMA感染主要表现为新生儿败血症和新生儿肺炎,耐药率高,早产儿医院感染SMA发生率高于足月儿。
Objective To investigate the clinical features, drug resistance and treatment of neonatal intensive care unit (NICU) Stenotrophomonas maltophilia (SMA) infection. Methods From January 2008 to December 2012 in our hospital NICU admitted SMA infection in children were retrospectively analyzed, its clinical features, bacterial resistance and treatment were summarized. Results The NICU of our hospital treated 20,463 newborns in the recent 5 years, of which 54 cases were SMA infection, the incidence was 2.63 ‰. The incidence rates in 2008-2012 were 4.17 ‰, 2.80 ‰, 3.05 ‰, 2.50 ‰ and 0.94 ‰, respectively. There were 36 cases of neonatal sepsis and 18 cases of neonatal pneumonia. There was no significant difference in the incidence of premature infants and full-term infants (2.61 ‰ vs 2.65 ‰, P> 0.05). Clinical manifestations include shortness of breath (27 cases), jaundice (22 cases), bruising (17 cases), gastrointestinal bleeding (7 cases), abdominal distension (8 cases) and vomiting (7 cases). Common complications include respiratory failure (18 cases), heart failure (13 cases), necrotizing enterocolitis (6 cases), disseminated intravascular coagulation (4 cases) and shock (3 cases). Thirteen patients (24.1% The prevalence of nosocomial infection in preterm infants and children with mechanical ventilation of tracheal intubation was higher than that of full-term infants and nasal non-invasive ventilation (1.63 ‰ vs 0.2 ‰, 7.21 ‰ vs 0.75 ‰, P <0.01, respectively). The sensitivity of SMA to cefoperazone / sulbactam and ticarcillin / clavulanate was higher than 70%, and the resistance rates to piperacillin / tazobactam and ceftazidime were between 30% and 40%. Conclusion SMA is an important pathogen of neonatal nosocomial infection. The neonatal SMA infection is mainly neonatal sepsis and neonatal pneumonia. The drug resistance rate is high, and the incidence of SMA in preterm infants with hospital infection is higher than that of full-term infants.