分析我院嗜麦芽窄食单胞菌的耐药性及呼吸道感染该菌的临床特点
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摘要
目的了解我院嗜麦芽窄食单胞菌(Stenotrophomonas maltophilia, SMA)的耐药性及其呼吸道感染的危险因素、临床意义,分析影响呼吸道感染SMA患者转归的因素。
方法测定2009年5月-2010年3月分离到的65株SMA对4种抗菌药物米诺环素、复方新诺明、左氧氟沙星、亚胺培南的敏感性,进行耐药性分析。收集其中33例呼吸道感染SMA患者的性别、年龄、基础疾病、住院天数、分离出SMA前的住院时间、留置导管种类和数目、混合感染情况以及抗菌药物使用情况,及患者入院、其他细菌(除SMA外)培养阳性、SMA培养阳性第一天的体温、血压、呼吸频率、脉搏、血常规、肝功能、血气分析,进行APACHEⅡ评分(急性生理学及慢性健康状况评分Ⅱ,acute physiology and chronic health evaluationⅡ)。采用t检验和Spearman相关分析了解SMA感染的临床意义及转归的影响因素。
结果33例呼吸道感染SMA患者中,男25例,女8例；平均住院日为40.41±27.88天,培养出SMA前的平均住院日是24.41±15.51天。平均年龄为65.24±18.81岁,≥60岁者26例(78.78%)。基础疾病中血液系统疾病占10例(30.30%)；恶性肿瘤8例(24.24%)；慢性疾病9例(27.27%),三者共达81.81%。所有的患者都有深静脉留置针,导管种类多样包括13例(39.39%)患者留有胃管,11例(33.33%)留有尿管,10例(30.30%)行中心静脉置管,9例(27.27%)行气管插管辅助通气。33例患者合并真菌感染19例(57.58%),鲍曼不动杆菌18例(54.55%),铜绿假单胞菌16例(48.48%),阴沟杆菌12例(36.36%),耐甲氧西林凝固酶阴性葡萄球菌8例(24.24%)。感染SMA之前,27例患者(81.82%)使用了加酶抑制剂抗菌素,24例(72.73%)使用了碳氢酶希类抗菌素,20例(60.61%)进行了抗真菌治疗,10例(30.30%)使用了利奈唑胺,喹诺酮类的使用为9例(27.27%)。转归：痊愈3例(9.09%),显效11例(33.33%),进步1例(3.03%),无效18例(54.55%)。患者入院、其他细菌(除SMA外)培养阳性、SMA培养阳性第一天的APACHEⅡ评分分别为16.34±5.07、18.96±5.36、19.8±6.62*,两两间进t检验,仅入院第一天与SMA培养阳性第一天的APACHEⅡ评分存在统计学差异(P<0.05)。患者入院第一天APACHEⅡ评分≥15分者22例,其中无效12例(71.43%)。入院第一天APACHEⅡ评分与转归两者存在相关性,相关系数为0.382*(P<0.05)。65株SMA药敏结果为：米诺环素、复方新诺明、左氧氟沙星、亚胺培南的耐药率分别为10.77%、13.85%、32.31%、100%.
结论①住院时间长；年龄大；危重的基础疾病；导管的留置；存在混合感染,大量高档抗生素的使用；APACHEⅡ评分>15分可能为呼吸道感染SMA的危险因素。②APACHEⅡ评分分值越高,呼吸道感染SMA死亡率越高。③呼吸道SMA培养阳性可能提示患者病情加重。④我院临床治疗嗜麦芽窄食单胞菌感染可首选米诺环素、复方新诺明进行经验治疗。
Objective:Aimed to analyze resistance of S. maltophilia, identify predictors and clinical sense of positive cultures of S. maltophilia isolated from respiratory tract, and the effective factors of the outcomes.
Methods:Analyzing the resistance of 65 strains of S.maltophilia to Minocycline, Trimethoprim+Sulfamethoxazole, Levofloxacin and Imipenem, from the Second hospital of shanxi medical university between May 2009 and March 2010. Patients'sexuality, age, severity of illness, length of hospitalization, number/types of indwelling catheters, concomitant infections and prior antibiotic exposure of 33 patients with positive cultures of S. maltophilia isolated from respiratory tract, were collected as a retrospective cohort study. Temperature, pressure, breathing rate, pulse, blood routine, hepatic function, blood gas analysis of the first day of admission, positive culture of S. maltophilia and others microbes (except S. maltophilia) were collected to assesse severities of illness by the APACHE II (acute physiology and chronic health evaluation II) score. T test and Spearman correlation analysis were used to determine the clinical significance of positive cultures of S. maltophilia isolated from respiratory tract and the effective factors of the outcomes.
Results:Twenty-five males and eight females were studied. The mean (SD) length of hospitalization and it prior to positive cultures of S. maltophilia were 40.41±27.88,24.41±15.51, respectively. The mean(SD) age was 65.24+18.81.≥60 year was 78.78%. Presence of underlying illness included hematological system disease 10 (30.30%), malignant tumor 8 (24.24%) chronic disease9(27.27%). The sum was up to 81.81%. All patients had intravenous lines. Types of indwelling catheters were various, including gastric tube 13 (39.39%), urinary catheters 11 (33.33%), central venous catheters10(30.30%), tracheal intubation 9(27.27%). Polymicrobial cultures (concurrent with S. maltophilia) were common and including fungus 19 (57.58%) Acinetobacter baumannii 18 (54.55%), Pseudomonas aeruginosa 16 (48.48%), Bacterium cloacae12 (36.36%), methicillin-resistant Staphylococcus aureus 8 (24.24%). All patients had recept the treatment with kinds of broad-spectrum antibiotics, prior to positive culture of S. maltophilia, including penicillins withβ-lactamase inhibitors 81.82%, carbapenems 72.73%, antifungal agents 60.61%, linezolid 30.30%, quinolones 27.27%.3 in 33 patients recovered themselves, while relieved 33.33%, improved 3.03%, mortality 54.55%. The ApacheⅡ(acute physiology and chronic health evaluationⅡ) score on the first day of admission, positive culture of S. maltophilia and others microbes (except S. maltophilia) were 16.34±5.07、18.96±5.36、19.8±6.62*, respectively. T test were performed separately for each variable. The ApacheⅡscores on the first day of admission and positive culture of S. maltophilia with P values of<0.05 were considered statistically significant. The number of patients with APACHEⅡscores on the first day of admission≥15 was 22, in which 12 (71.43%) patients with positive cultures isolated from respiratory tract were dead. The outcome was associated with APACHEⅡscores on admission, with spearman coefficient correlation 0.382* (P<0.05). The resistant rate of S. maltophilia to Minocycline, Trimethoprim+Sulfamethoxazole, Levofloxacin and Imipenem were 17.39%、21.74%、33.82%、100%, respectively.
Conclusion:①prolonged hospitalisation, older age, presence of severious underlying illness, presence of types of indwelling catheters, Polymicrobial cultures, previous therapy with broad spectrum antibiotics, APACHEⅡscores≥15 may be the risk factors for S. maltophilia infection.②Regarding to patients with Positive culture of S. maltophilia isolated from respiratory tract, The higher of the APACHEⅡscores are, the higher the mortality rate become.③Positive culture of S. maltophilia isolated from respiratory tract could suggest that severity of illness has got worse.④Minocycline and Trimethoprim+sulfamethoxazole are the optimal antibiotics of choice for the treatment of S. maltophilia infections in our hospital.
方法测定2009年5月-2010年3月分离到的65株SMA对4种抗菌药物米诺环素、复方新诺明、左氧氟沙星、亚胺培南的敏感性,进行耐药性分析。收集其中33例呼吸道感染SMA患者的性别、年龄、基础疾病、住院天数、分离出SMA前的住院时间、留置导管种类和数目、混合感染情况以及抗菌药物使用情况,及患者入院、其他细菌(除SMA外)培养阳性、SMA培养阳性第一天的体温、血压、呼吸频率、脉搏、血常规、肝功能、血气分析,进行APACHEⅡ评分(急性生理学及慢性健康状况评分Ⅱ,acute physiology and chronic health evaluationⅡ)。采用t检验和Spearman相关分析了解SMA感染的临床意义及转归的影响因素。
结果33例呼吸道感染SMA患者中,男25例,女8例；平均住院日为40.41±27.88天,培养出SMA前的平均住院日是24.41±15.51天。平均年龄为65.24±18.81岁,≥60岁者26例(78.78%)。基础疾病中血液系统疾病占10例(30.30%)；恶性肿瘤8例(24.24%)；慢性疾病9例(27.27%),三者共达81.81%。所有的患者都有深静脉留置针,导管种类多样包括13例(39.39%)患者留有胃管,11例(33.33%)留有尿管,10例(30.30%)行中心静脉置管,9例(27.27%)行气管插管辅助通气。33例患者合并真菌感染19例(57.58%),鲍曼不动杆菌18例(54.55%),铜绿假单胞菌16例(48.48%),阴沟杆菌12例(36.36%),耐甲氧西林凝固酶阴性葡萄球菌8例(24.24%)。感染SMA之前,27例患者(81.82%)使用了加酶抑制剂抗菌素,24例(72.73%)使用了碳氢酶希类抗菌素,20例(60.61%)进行了抗真菌治疗,10例(30.30%)使用了利奈唑胺,喹诺酮类的使用为9例(27.27%)。转归：痊愈3例(9.09%),显效11例(33.33%),进步1例(3.03%),无效18例(54.55%)。患者入院、其他细菌(除SMA外)培养阳性、SMA培养阳性第一天的APACHEⅡ评分分别为16.34±5.07、18.96±5.36、19.8±6.62*,两两间进t检验,仅入院第一天与SMA培养阳性第一天的APACHEⅡ评分存在统计学差异(P<0.05)。患者入院第一天APACHEⅡ评分≥15分者22例,其中无效12例(71.43%)。入院第一天APACHEⅡ评分与转归两者存在相关性,相关系数为0.382*(P<0.05)。65株SMA药敏结果为：米诺环素、复方新诺明、左氧氟沙星、亚胺培南的耐药率分别为10.77%、13.85%、32.31%、100%.
结论①住院时间长；年龄大；危重的基础疾病；导管的留置；存在混合感染,大量高档抗生素的使用；APACHEⅡ评分>15分可能为呼吸道感染SMA的危险因素。②APACHEⅡ评分分值越高,呼吸道感染SMA死亡率越高。③呼吸道SMA培养阳性可能提示患者病情加重。④我院临床治疗嗜麦芽窄食单胞菌感染可首选米诺环素、复方新诺明进行经验治疗。
Objective:Aimed to analyze resistance of S. maltophilia, identify predictors and clinical sense of positive cultures of S. maltophilia isolated from respiratory tract, and the effective factors of the outcomes.
Methods:Analyzing the resistance of 65 strains of S.maltophilia to Minocycline, Trimethoprim+Sulfamethoxazole, Levofloxacin and Imipenem, from the Second hospital of shanxi medical university between May 2009 and March 2010. Patients'sexuality, age, severity of illness, length of hospitalization, number/types of indwelling catheters, concomitant infections and prior antibiotic exposure of 33 patients with positive cultures of S. maltophilia isolated from respiratory tract, were collected as a retrospective cohort study. Temperature, pressure, breathing rate, pulse, blood routine, hepatic function, blood gas analysis of the first day of admission, positive culture of S. maltophilia and others microbes (except S. maltophilia) were collected to assesse severities of illness by the APACHE II (acute physiology and chronic health evaluation II) score. T test and Spearman correlation analysis were used to determine the clinical significance of positive cultures of S. maltophilia isolated from respiratory tract and the effective factors of the outcomes.
Results:Twenty-five males and eight females were studied. The mean (SD) length of hospitalization and it prior to positive cultures of S. maltophilia were 40.41±27.88,24.41±15.51, respectively. The mean(SD) age was 65.24+18.81.≥60 year was 78.78%. Presence of underlying illness included hematological system disease 10 (30.30%), malignant tumor 8 (24.24%) chronic disease9(27.27%). The sum was up to 81.81%. All patients had intravenous lines. Types of indwelling catheters were various, including gastric tube 13 (39.39%), urinary catheters 11 (33.33%), central venous catheters10(30.30%), tracheal intubation 9(27.27%). Polymicrobial cultures (concurrent with S. maltophilia) were common and including fungus 19 (57.58%) Acinetobacter baumannii 18 (54.55%), Pseudomonas aeruginosa 16 (48.48%), Bacterium cloacae12 (36.36%), methicillin-resistant Staphylococcus aureus 8 (24.24%). All patients had recept the treatment with kinds of broad-spectrum antibiotics, prior to positive culture of S. maltophilia, including penicillins withβ-lactamase inhibitors 81.82%, carbapenems 72.73%, antifungal agents 60.61%, linezolid 30.30%, quinolones 27.27%.3 in 33 patients recovered themselves, while relieved 33.33%, improved 3.03%, mortality 54.55%. The ApacheⅡ(acute physiology and chronic health evaluationⅡ) score on the first day of admission, positive culture of S. maltophilia and others microbes (except S. maltophilia) were 16.34±5.07、18.96±5.36、19.8±6.62*, respectively. T test were performed separately for each variable. The ApacheⅡscores on the first day of admission and positive culture of S. maltophilia with P values of<0.05 were considered statistically significant. The number of patients with APACHEⅡscores on the first day of admission≥15 was 22, in which 12 (71.43%) patients with positive cultures isolated from respiratory tract were dead. The outcome was associated with APACHEⅡscores on admission, with spearman coefficient correlation 0.382* (P<0.05). The resistant rate of S. maltophilia to Minocycline, Trimethoprim+Sulfamethoxazole, Levofloxacin and Imipenem were 17.39%、21.74%、33.82%、100%, respectively.
Conclusion:①prolonged hospitalisation, older age, presence of severious underlying illness, presence of types of indwelling catheters, Polymicrobial cultures, previous therapy with broad spectrum antibiotics, APACHEⅡscores≥15 may be the risk factors for S. maltophilia infection.②Regarding to patients with Positive culture of S. maltophilia isolated from respiratory tract, The higher of the APACHEⅡscores are, the higher the mortality rate become.③Positive culture of S. maltophilia isolated from respiratory tract could suggest that severity of illness has got worse.④Minocycline and Trimethoprim+sulfamethoxazole are the optimal antibiotics of choice for the treatment of S. maltophilia infections in our hospital.
引文
[1]李双玲,王东信,吴新民,等.外科重症监护病房医院感染和相关死亡危险因素.中华医院感染学杂志.2006年,16卷(05期)：503-507
[2]段金菊,刘卓拉,张润梅,等.2001-2005年某院抗生素使用情况及革兰阴性细菌耐药性分析.中国药物与临床.2007年2月,7卷(2期).98-102.
[3]Andrea LH Kwa, Jenny GH Low, Tze-Peng Lim. Independent Predictors for Mortality in Patients with Positive Stenotrophomonas maltophilia Cultures. Annals Academy of Medicine. October 2008,37(10)
[4]Paez JI, Tengan FM, Barone AA, et al. Factors associated with mortality in patients with bloodstream infection and pneumonia due to Stenotrophomonas maltophilia. Eur J Clin Microbiol Infect Dis.2008 Oct;27(10):901-6.
[5]Clinical and Laboratory Standards Institute Performance standards for antimicrobial susceptibility testing:Fifteenth Information Supplement 2005, M100-S15.
[6]Knaus W A, Draper E A, Wanger D P, et al. APACHE Ⅱ:a severity of classification system. Crit Care Med,1985,13(40):818-829.
[7]Torres A, Fabregas N, Ewig S, et al.Sampling methods for ventilator-associated pneumonia: validation using different histological and microbiological references. Crit Care Med,2000, 28(8):2799-2804.
[8]Guidelines for the management of adults with hospital-acquired, ventilator-associated,and healthcare-associated pneumonia[J]. Am J Respir Crit Care Med,2005,171:388-416.
[9]蔡福良,刘励军.机械通气患者气道内嗜麦芽窄食单胞菌的临床特征及其对抗感染治疗反应的初步研究,[苏州大学硕士学位论文].苏州,2008年.
[10]Evans HL, Smith PW, Pruett TL, et al. Differences in Early-and Late-Onset Ventilator-Associated Pneumonia Between Surgical and Trauma Patients in a Combined Surgical or Trauma Intensive Care Unit. J Trauma:injur,infect, Crit Care,2008,64 (3):714-720.
[11]Mendoza DL,Darin M,Waterer GW,et al.Update on Stenotrophomonas maltophilia Infection in the ICU.Clinical Pulmonary Med,2007,14 (1):17-22.
[12]Kollef MH, Silver P, Murphy DM, Trovillion E. The effect of late-onsetventilator-associated pneumonia in determining patient mortality. Chest1995;108:1655-62.
[13]Rello J, Diaz E. Concise definitive reviews in critical care pneumonia in the ICU:ventilator-associated pneumonia.Crit Care Med,2003,31:2544-2551.
[14]Soo H, Wen YE, Nguyen TV, et al. Impact of clinical guidelines in the management of severe hospital-acquired pneumonia.Chest,2005,128:2778-2787.
[15]Beardsley JR, Williamson JC, Johnson JW, et al. Using local microbiologic data to develop institutional-specific guidelines for the treatment of hospital-acquired pneumonia.chest,2006, 130:787-793.
[16]DELTMD, JESUBRB, MARTA H, et al. Clinical Epidemiology of StenotroPhomonas maltoPhilia Colonization and Infection:A Multicenter Study 2002 Lippineott. Williams & Wilkins Volume,2002,81(3):228.
[17]徐晓,徐卫东.鲍曼不动杆菌下呼吸道感染的临床和药敏分析[J].中国现代医药杂志.2007年10月,9卷(10期)：1027-29.
[18]昊宁钱,晓明,刘玉亭.38例高龄铜绿假单胞菌肺部感染的临床分析[J].中华保健医学杂志.2009年,11卷(3期)：202-204.
[19]陈木林.387假单胞菌的分离鉴定和临床药敏分析[J].中国实用医药.2009年8月,4卷(24期)： 17-18.
[20]喻华,兰红.阴沟肠杆菌感染及耐药性研究.四川医学[J].2000年11月,21卷(第11期)：974
[21]邵长周,瞿介明,何礼贤.APACHEⅡ评分在ICU铜绿假单胞菌下呼吸道感染患者中的应用[J].中国危重病急救医学.2003年11月,15卷(11期).652-655.
[22]江利东,张川,蒋辉.APACHE评分在ICU的临床应用[J].四川医学,2004,25(11)：1218-1219.
[23]王小兵,夏业军,潘怀富,等.APACHE评分对219例重症急性肾衰竭病情及预后分析[J].中国中西医结合肾病杂志,2005,6(2)：95.
[24]张志功,朱化刚,孟翔凌,等.APACHEⅡ、 RANSON评分在重症急性胰腺炎中的应用价值[J].肝胆外科杂志,2005,13(2)：32-35.
[25]Paez JI, Costa SF.Risk factors associated with mortality of infections caused by Stenotrophomonas maltophilia:a systematic review. J Hosp Infect.2008 Oct;70(2):101-8.
[26]Wong T H, Tan B H, Ling M L, et al. Multi resistant acinetobacter baumannii on a burns unit clinical risk factors and prognosis.Burns,2002,28(4):349357.
[27]Pathmanathan A, Waterer GW. Significance of positive Stenotrophomonas maltophilia culture in acute respiratory tract infection. Eur Respir J,2005,25:911-914.
[28]彭伶丽,王红红.APACHE评分及其在护理领域的应用进展.护理学杂志2008年11月,23卷21期78-80.
[29]JACOBS S, ZULEIKA Mm, MPHANSA T.The MultipleOrgan Dysfunction Score as a descriptor of patient outcome in septic shock compared with two other scoring systems.Crit Care Med,1999,27(4):741-744.
[30]Di Bonaventura G, Pompilio A, Zappacosta R, et al.Excessive inflammatory response of DBA/2 mice to Stenotrophomonas maltophilia lung infection:implications in cystic fibrosis.Infect Immun.2010 Mar 22.
[31]王悦,张鲁涛,史利克,等.2004-2007年嗜麦芽窄食单胞菌临床分布和耐药性分析.中国微生态学杂志.2009年8月,21卷(8期)：754-757.
[32]孟峻,郭素芳,张永梅,等.60株嗜麦芽寡养单胞菌的临床分布与耐药性分析.中华医院感染学杂志.2009年,19卷(23期)：3265-3271.
[33]孙二琳,宋诗铎,祁伟,等.嗜麦芽寡养单胞菌临床株外排泵SmeDEF诱导表达的研究.中国抗生素杂志,2007年12月,32卷(12期)：736-739.
[34]胡族琼,陈清,周文,等.氨基糖苷类抗生素诱导嗜麦芽窄食单胞菌适应性耐药发生及其初步机制.实用医学杂志,2009年,25卷(16期)：2614-2616.
[1]石燕,陈拥军,邓为之.44株嗜麦芽窄食单胞菌的耐药分析.临床肺科杂志,2008年2月,13(2)：235-236.[2] Johnson E H, Busaidy R, Hameed M S. An outbreak of lymphadenitis associated with Stenotrophomonas (Xanthomonas) maltophilia in Omani goats. Journal of Veterinary Medicine Series B,2003,50(2):102-104.
[3]张浩吉,谢明权,张健騑,等.猪源嗜麦芽窄食单胞菌16SrRNA基因的克隆和序列分析.中国兽医科技,2004,34(6)：3-5.
[4]Harris N B, Rogers D G. Septicemia associated with Stenotrophomonas maltophilia in a West African dwarf crocodile(Osteolaemus tetraspissubsp.tetraspis). Journal of Veterinary Diagnostic Investigation,2001,13(3):255-258.
[5]Geng Y, Wang K Y,Chen D F,et al.Isolation,identification and phylogenetic analysis of one pathogenic bacterium associated from channel catfish.Acta Microbiologica Sinica,2006,46(4)：28-31[耿毅,汪开毓,陈德芳,等.斑点叉尾鮰一株致病菌的分离、鉴定与系统发育分析.微生物学报,2006,46(4)：28-31]
[6]骆雪萍,施善阳,黄巍.重症加强治疗病房内嗜麦芽窄食单胞菌呼吸机相关性肺炎临床特征调查.中国呼吸与危重监护杂志,2008年11月,7(6)：421-423.
[7]王冬,戴媛媛.嗜麦芽窄食单胞菌感染的临床分布及耐药性分析.实用临床医学.2009年,10(4)：6-8.
[8]宫奇林,赵青,石晓红,等.嗜麦芽窄食单胞菌122株耐药性及基因分型.中国医药.2009年10月,4(10)：786-787.
[9]胡族琼,杨银梅,柯雪梅,等.嗜麦芽窄食单胞菌临床分离株的耐药特征研究.南方医科大学学报.2009年,29(5)：852-855.
[10]时东彦,李仲兴,赵建宏, 嗜麦芽窄食单胞菌Ⅰ类整合子的分布及耐药谱型.中国感染控制杂志.2009年1月,8(1)：33-35.
[11]Qamruddin AO, Alkawash MA.Soothill JS.Antibiotic susceptiBility of Stenotrophomonas maltophilia in the presence of laetoferrin[J].Antimierob Agents Chemother,2005, 49(10):4425-4426.
[12]孙二琳,宋诗铎,祁伟,等.嗜麦芽寡养单胞菌临床株多重耐药外排泵SmeDEF调控基因smeT的序列分析.中华医院感染学杂志,2006年,16(2)：121-125.
[13]孙二琳,宋诗铎,祁伟,等.嗜麦芽寡养单胞菌临床株外排泵SmeDEF诱导表达的研究.中国抗生素杂志[J],2007年12月,32(12)：736-739.
[14]陈愉,周秀珍,张智洁.泵抑制剂对嗜麦芽寡养单胞菌氟喹诺酮主动外排表型特征的影响.中国医科大学学报,2007年6月,36(3).288-290.
[15]Zhang L, Li XZ, Poole K. SmeDEF multidrug efflux pump contributes to intrinsic multidrug resistance in Stenotrophomonas maltophilia. Antimicrob Agents Chemother,2001,45 (12): 3497-3503.
[16]方小龙,陈群.嗜麦芽窄食单胞菌的耐药机制研究.国际检验医学杂志,2007年1月,28(1)：49-51.
[17]LiXZ,Zhang L, Poole K.SmeC, an outer membrane multidrug efflux protein of Stenotrophomonas maltophilia. Antimierob Agents Chemother,2002,46(2):333-343.
[18]Crossman LC, Gould VC, Dow JM, et al. The complete genome, comparative and functional analysis of Stenotrophomonas maltophilia reveals an organism heavily shielded by drug resistance determinants. Genome Biol,2008,9(4):74.
[19]Avison MB, Higgins CS, Ford PJ, et al. Dieffrential regulation of L1 and L2 beta-laetamase expression in Stenotrophomonas maltophilia. Antimicrob Chemother.2002,49(2):387-389.
[20]李艳,刘长庭,邓笑伟.常用抗菌药物对L1、L2酶的诱导及两种酶的调控关系.解放军医学杂志,2008年4月,33(4)：465-467.
[21]明德松,庄建良,苏智军,等.从全耐嗜麦芽寡养单胞菌检出一种氨基糖苷类修饰酶aac(6’)-Ⅰ b基因的新变型基因.中华医院感染学杂志.2008年,18(11)：1519-1521.
[22]Okazaki A, Avison MB. Aph(3')-llc, an Aminoglycoside resistance determinant from Stenotrophomonas maltophilia. Antimicrob Agents Chemother,2007,51(1):359-360.
[23]胡族琼,陈清,周文,等.氨基糖苷类抗生素诱导嗜麦芽窄食单胞菌适应性耐药发生及其初步机制.实用医学杂志,2009年,25(16)：2614-2616.
[24]Mckay G A, Woods D E, Maccdonald K L,et al.Role of phosphoglucomutase of Stenotrophomonasmaltophilia in lipopolysaccharide biosynthesis, virulence and antibiotic resistance. Infect Immun,2003,71(6):3068-3075.
[25]Ribera A, Domenech SA, Ruiz J, et al. Mutation in gyrA and parC QRDRs are not relavant for quinolone resistance in epidemiological unrelated Stenotrophomonas maltophilia clinical isolates[J]. Microb-Drug Resist,2002,8(4):245-251.
[26]Shimizu K, Kikuchi K, Sasaki T. Smqnr, a New Chromosome-Carried Quinolone Resistance Gene in Stenotrophomonas maltophilia.Antimicrob Agents Chemother,2008,52(10):3823-3825.
[27]邓笑伟,张丹梅,刘长庭,等.嗜麦芽寡养单胞菌氨基糖苷类修饰酶与Ⅰ类整合酶基因的研究.中华医院感染学杂志2009,19(17)：2233-2235.
[28]Diaz MA, Cooper RK, Cloeckaert A. Plasmid-mediated high-level gentamicin resistance among enterobacteria isolated from Petturtles in Louisiana. Appl Environ Microbiol,2006,72(1):306-312.
[29]邓笑伟,刘长庭,李艳,等.嗜麦芽窄食单胞菌整合子与耐药性关系的研究[J].中华检验医学杂志,2008,31(11)：1265-1267.
[30]邓笑伟,刘长庭.复方磺胺甲嗯唑与替卡西林/克拉维酸、头孢哌酮/舒巴坦联用对嗜麦芽寡养单胞菌体外抗菌活性的研究.中国抗生素杂志.2007年3月,32(3)：178-180.
[2]段金菊,刘卓拉,张润梅,等.2001-2005年某院抗生素使用情况及革兰阴性细菌耐药性分析.中国药物与临床.2007年2月,7卷(2期).98-102.
[3]Andrea LH Kwa, Jenny GH Low, Tze-Peng Lim. Independent Predictors for Mortality in Patients with Positive Stenotrophomonas maltophilia Cultures. Annals Academy of Medicine. October 2008,37(10)
[4]Paez JI, Tengan FM, Barone AA, et al. Factors associated with mortality in patients with bloodstream infection and pneumonia due to Stenotrophomonas maltophilia. Eur J Clin Microbiol Infect Dis.2008 Oct;27(10):901-6.
[5]Clinical and Laboratory Standards Institute Performance standards for antimicrobial susceptibility testing:Fifteenth Information Supplement 2005, M100-S15.
[6]Knaus W A, Draper E A, Wanger D P, et al. APACHE Ⅱ:a severity of classification system. Crit Care Med,1985,13(40):818-829.
[7]Torres A, Fabregas N, Ewig S, et al.Sampling methods for ventilator-associated pneumonia: validation using different histological and microbiological references. Crit Care Med,2000, 28(8):2799-2804.
[8]Guidelines for the management of adults with hospital-acquired, ventilator-associated,and healthcare-associated pneumonia[J]. Am J Respir Crit Care Med,2005,171:388-416.
[9]蔡福良,刘励军.机械通气患者气道内嗜麦芽窄食单胞菌的临床特征及其对抗感染治疗反应的初步研究,[苏州大学硕士学位论文].苏州,2008年.
[10]Evans HL, Smith PW, Pruett TL, et al. Differences in Early-and Late-Onset Ventilator-Associated Pneumonia Between Surgical and Trauma Patients in a Combined Surgical or Trauma Intensive Care Unit. J Trauma:injur,infect, Crit Care,2008,64 (3):714-720.
[11]Mendoza DL,Darin M,Waterer GW,et al.Update on Stenotrophomonas maltophilia Infection in the ICU.Clinical Pulmonary Med,2007,14 (1):17-22.
[12]Kollef MH, Silver P, Murphy DM, Trovillion E. The effect of late-onsetventilator-associated pneumonia in determining patient mortality. Chest1995;108:1655-62.
[13]Rello J, Diaz E. Concise definitive reviews in critical care pneumonia in the ICU:ventilator-associated pneumonia.Crit Care Med,2003,31:2544-2551.
[14]Soo H, Wen YE, Nguyen TV, et al. Impact of clinical guidelines in the management of severe hospital-acquired pneumonia.Chest,2005,128:2778-2787.
[15]Beardsley JR, Williamson JC, Johnson JW, et al. Using local microbiologic data to develop institutional-specific guidelines for the treatment of hospital-acquired pneumonia.chest,2006, 130:787-793.
[16]DELTMD, JESUBRB, MARTA H, et al. Clinical Epidemiology of StenotroPhomonas maltoPhilia Colonization and Infection:A Multicenter Study 2002 Lippineott. Williams & Wilkins Volume,2002,81(3):228.
[17]徐晓,徐卫东.鲍曼不动杆菌下呼吸道感染的临床和药敏分析[J].中国现代医药杂志.2007年10月,9卷(10期)：1027-29.
[18]昊宁钱,晓明,刘玉亭.38例高龄铜绿假单胞菌肺部感染的临床分析[J].中华保健医学杂志.2009年,11卷(3期)：202-204.
[19]陈木林.387假单胞菌的分离鉴定和临床药敏分析[J].中国实用医药.2009年8月,4卷(24期)： 17-18.
[20]喻华,兰红.阴沟肠杆菌感染及耐药性研究.四川医学[J].2000年11月,21卷(第11期)：974
[21]邵长周,瞿介明,何礼贤.APACHEⅡ评分在ICU铜绿假单胞菌下呼吸道感染患者中的应用[J].中国危重病急救医学.2003年11月,15卷(11期).652-655.
[22]江利东,张川,蒋辉.APACHE评分在ICU的临床应用[J].四川医学,2004,25(11)：1218-1219.
[23]王小兵,夏业军,潘怀富,等.APACHE评分对219例重症急性肾衰竭病情及预后分析[J].中国中西医结合肾病杂志,2005,6(2)：95.
[24]张志功,朱化刚,孟翔凌,等.APACHEⅡ、 RANSON评分在重症急性胰腺炎中的应用价值[J].肝胆外科杂志,2005,13(2)：32-35.
[25]Paez JI, Costa SF.Risk factors associated with mortality of infections caused by Stenotrophomonas maltophilia:a systematic review. J Hosp Infect.2008 Oct;70(2):101-8.
[26]Wong T H, Tan B H, Ling M L, et al. Multi resistant acinetobacter baumannii on a burns unit clinical risk factors and prognosis.Burns,2002,28(4):349357.
[27]Pathmanathan A, Waterer GW. Significance of positive Stenotrophomonas maltophilia culture in acute respiratory tract infection. Eur Respir J,2005,25:911-914.
[28]彭伶丽,王红红.APACHE评分及其在护理领域的应用进展.护理学杂志2008年11月,23卷21期78-80.
[29]JACOBS S, ZULEIKA Mm, MPHANSA T.The MultipleOrgan Dysfunction Score as a descriptor of patient outcome in septic shock compared with two other scoring systems.Crit Care Med,1999,27(4):741-744.
[30]Di Bonaventura G, Pompilio A, Zappacosta R, et al.Excessive inflammatory response of DBA/2 mice to Stenotrophomonas maltophilia lung infection:implications in cystic fibrosis.Infect Immun.2010 Mar 22.
[31]王悦,张鲁涛,史利克,等.2004-2007年嗜麦芽窄食单胞菌临床分布和耐药性分析.中国微生态学杂志.2009年8月,21卷(8期)：754-757.
[32]孟峻,郭素芳,张永梅,等.60株嗜麦芽寡养单胞菌的临床分布与耐药性分析.中华医院感染学杂志.2009年,19卷(23期)：3265-3271.
[33]孙二琳,宋诗铎,祁伟,等.嗜麦芽寡养单胞菌临床株外排泵SmeDEF诱导表达的研究.中国抗生素杂志,2007年12月,32卷(12期)：736-739.
[34]胡族琼,陈清,周文,等.氨基糖苷类抗生素诱导嗜麦芽窄食单胞菌适应性耐药发生及其初步机制.实用医学杂志,2009年,25卷(16期)：2614-2616.
[1]石燕,陈拥军,邓为之.44株嗜麦芽窄食单胞菌的耐药分析.临床肺科杂志,2008年2月,13(2)：235-236.[2] Johnson E H, Busaidy R, Hameed M S. An outbreak of lymphadenitis associated with Stenotrophomonas (Xanthomonas) maltophilia in Omani goats. Journal of Veterinary Medicine Series B,2003,50(2):102-104.
[3]张浩吉,谢明权,张健騑,等.猪源嗜麦芽窄食单胞菌16SrRNA基因的克隆和序列分析.中国兽医科技,2004,34(6)：3-5.
[4]Harris N B, Rogers D G. Septicemia associated with Stenotrophomonas maltophilia in a West African dwarf crocodile(Osteolaemus tetraspissubsp.tetraspis). Journal of Veterinary Diagnostic Investigation,2001,13(3):255-258.
[5]Geng Y, Wang K Y,Chen D F,et al.Isolation,identification and phylogenetic analysis of one pathogenic bacterium associated from channel catfish.Acta Microbiologica Sinica,2006,46(4)：28-31[耿毅,汪开毓,陈德芳,等.斑点叉尾鮰一株致病菌的分离、鉴定与系统发育分析.微生物学报,2006,46(4)：28-31]
[6]骆雪萍,施善阳,黄巍.重症加强治疗病房内嗜麦芽窄食单胞菌呼吸机相关性肺炎临床特征调查.中国呼吸与危重监护杂志,2008年11月,7(6)：421-423.
[7]王冬,戴媛媛.嗜麦芽窄食单胞菌感染的临床分布及耐药性分析.实用临床医学.2009年,10(4)：6-8.
[8]宫奇林,赵青,石晓红,等.嗜麦芽窄食单胞菌122株耐药性及基因分型.中国医药.2009年10月,4(10)：786-787.
[9]胡族琼,杨银梅,柯雪梅,等.嗜麦芽窄食单胞菌临床分离株的耐药特征研究.南方医科大学学报.2009年,29(5)：852-855.
[10]时东彦,李仲兴,赵建宏, 嗜麦芽窄食单胞菌Ⅰ类整合子的分布及耐药谱型.中国感染控制杂志.2009年1月,8(1)：33-35.
[11]Qamruddin AO, Alkawash MA.Soothill JS.Antibiotic susceptiBility of Stenotrophomonas maltophilia in the presence of laetoferrin[J].Antimierob Agents Chemother,2005, 49(10):4425-4426.
[12]孙二琳,宋诗铎,祁伟,等.嗜麦芽寡养单胞菌临床株多重耐药外排泵SmeDEF调控基因smeT的序列分析.中华医院感染学杂志,2006年,16(2)：121-125.
[13]孙二琳,宋诗铎,祁伟,等.嗜麦芽寡养单胞菌临床株外排泵SmeDEF诱导表达的研究.中国抗生素杂志[J],2007年12月,32(12)：736-739.
[14]陈愉,周秀珍,张智洁.泵抑制剂对嗜麦芽寡养单胞菌氟喹诺酮主动外排表型特征的影响.中国医科大学学报,2007年6月,36(3).288-290.
[15]Zhang L, Li XZ, Poole K. SmeDEF multidrug efflux pump contributes to intrinsic multidrug resistance in Stenotrophomonas maltophilia. Antimicrob Agents Chemother,2001,45 (12): 3497-3503.
[16]方小龙,陈群.嗜麦芽窄食单胞菌的耐药机制研究.国际检验医学杂志,2007年1月,28(1)：49-51.
[17]LiXZ,Zhang L, Poole K.SmeC, an outer membrane multidrug efflux protein of Stenotrophomonas maltophilia. Antimierob Agents Chemother,2002,46(2):333-343.
[18]Crossman LC, Gould VC, Dow JM, et al. The complete genome, comparative and functional analysis of Stenotrophomonas maltophilia reveals an organism heavily shielded by drug resistance determinants. Genome Biol,2008,9(4):74.
[19]Avison MB, Higgins CS, Ford PJ, et al. Dieffrential regulation of L1 and L2 beta-laetamase expression in Stenotrophomonas maltophilia. Antimicrob Chemother.2002,49(2):387-389.
[20]李艳,刘长庭,邓笑伟.常用抗菌药物对L1、L2酶的诱导及两种酶的调控关系.解放军医学杂志,2008年4月,33(4)：465-467.
[21]明德松,庄建良,苏智军,等.从全耐嗜麦芽寡养单胞菌检出一种氨基糖苷类修饰酶aac(6’)-Ⅰ b基因的新变型基因.中华医院感染学杂志.2008年,18(11)：1519-1521.
[22]Okazaki A, Avison MB. Aph(3')-llc, an Aminoglycoside resistance determinant from Stenotrophomonas maltophilia. Antimicrob Agents Chemother,2007,51(1):359-360.
[23]胡族琼,陈清,周文,等.氨基糖苷类抗生素诱导嗜麦芽窄食单胞菌适应性耐药发生及其初步机制.实用医学杂志,2009年,25(16)：2614-2616.
[24]Mckay G A, Woods D E, Maccdonald K L,et al.Role of phosphoglucomutase of Stenotrophomonasmaltophilia in lipopolysaccharide biosynthesis, virulence and antibiotic resistance. Infect Immun,2003,71(6):3068-3075.
[25]Ribera A, Domenech SA, Ruiz J, et al. Mutation in gyrA and parC QRDRs are not relavant for quinolone resistance in epidemiological unrelated Stenotrophomonas maltophilia clinical isolates[J]. Microb-Drug Resist,2002,8(4):245-251.
[26]Shimizu K, Kikuchi K, Sasaki T. Smqnr, a New Chromosome-Carried Quinolone Resistance Gene in Stenotrophomonas maltophilia.Antimicrob Agents Chemother,2008,52(10):3823-3825.
[27]邓笑伟,张丹梅,刘长庭,等.嗜麦芽寡养单胞菌氨基糖苷类修饰酶与Ⅰ类整合酶基因的研究.中华医院感染学杂志2009,19(17)：2233-2235.
[28]Diaz MA, Cooper RK, Cloeckaert A. Plasmid-mediated high-level gentamicin resistance among enterobacteria isolated from Petturtles in Louisiana. Appl Environ Microbiol,2006,72(1):306-312.
[29]邓笑伟,刘长庭,李艳,等.嗜麦芽窄食单胞菌整合子与耐药性关系的研究[J].中华检验医学杂志,2008,31(11)：1265-1267.
[30]邓笑伟,刘长庭.复方磺胺甲嗯唑与替卡西林/克拉维酸、头孢哌酮/舒巴坦联用对嗜麦芽寡养单胞菌体外抗菌活性的研究.中国抗生素杂志.2007年3月,32(3)：178-180.