Nosocomial Infections Caused By Stenotrophomonas Maltophilia:Associated Risk Factors And Antibiotic Resistance

Objective Stenotrophomonas maltophilia(S.m)is a new multidrug resistant opportunistic pathogen in recent years.,especially for immunocompromised or immunodeficiency patients,it has gradually become an important pathogen in hospital and community infection.In recent years,the infection of Stenotrophomonas maltophilia is lack of specific clinical manifestations,or there are other bacterial infections.Because it almost has a certain resistance to all antibiotics,including sulfonamides,beta lactam,quinolone and aminoglycoside and the resistance mechanism is rather complex,attracting wide attention of clinicians.At present,there are only some clinical retrospective studies and case reports based on Stenotrophomonas maltophilia infection treatment,there are no scholars put forward the treatment to promote unity.At home and abroad,we have consistently advocated the selection of antibacterials according to the drug sensitivity results,so that the clinical treatment has encountered severe challenges.This article will make a retrospective analysis of all cases of Stenotrophomonas maltophilia infection in our hospital in recent 4 years to investigate the associated risk factors and antibiotic resistance of nosocomial infections caused by Stenotrophomonas maltophilia,and provide the basis for the clinical prevention and treatment of the rational drug use of Stenotrophomonas maltophilia infection.Methods We retrospectively analyzed the general situation,basic disease,antibiotic use and antibiotic resistance in 90 patients with Stenotrophomonas maltophilia infection from January 2014 to October 2017 in our hospital.30 patients with no Stenotrophomonas maltophilia infection in the same period were selected as control group.149 strains of Stenotrophomonas maltophilia were isolated from sputum,urine and blood samples from infected patients,excluding repeated separation strains in the same part of the same case.All of the data were input EXCEL database,13 risk factors that may affect Stenotrophomonas maltophilia infection,such as age,duration of hospitalization,whether patients with cardiovascular disease,lung disease,diabetes and cancer,whether had tracheotomy,mechanical ventilation,vein catheterization and other surgery,ever use of corticosteroids,carbapenems and the use of more than three kinds of antibiotics were analyzed one by one into SPSS20.0 statistical software.Multivariate logistic regression analysis screened out the risk factors of Stenotrophomonas maltophilia infection.Results The elderly patients aged 70 and above were the main separation population of Stenotrophomonas maltophilia,accounting for 55%.In our hospital,the isolation rate of sputum is the highest in all clinical specimens isolated from Stenotrophomonas maltophilia,accounting for 72.5%.Multivariate logistic regression results showed that duration of hospitalization(OR 1.061,P?0.05)and the use of more than three kinds of antibiotics(OR 7.085,P?0.05)were positively correlated with Stenotrophomonas maltophilia infection.Stenotrophomonas maltophilia has a certain resistance to most antibiotics.Antimicrobial susceptibility showed the lowest resistance rate to minocycline,followed by cefoperazone/ sulbactam and sulfamethoxazole,the drug resistance rate to levofloxacin was 33.6%,and the resistance to imipenem cilastatin was natural.Conclusion Stenotrophomonas maltophilia is one of the most common pathogenic bacteria in nature and clinic.For the Stenotrophomonas maltophilia isolated from various clinical specimens,the presence of a certain proportion of colonized bacteria should be considered before the selection of antimicrobial agents.The difference between colonization and infected bacteria should be distinguished from the general condition of the patient,the outcome of the disease and the related auxiliary examination.By analyzing the source and distribution of the strains,the respiratory tract is the main site of the infection of Stenotrophomonas maltophilia.Duration of hospitalization and the use of more than three kinds of antibiotics may be independent risk factors of Stenotrophomonas maltophilia infection.Stenotrophomonas maltophilia is resistant to a variety of antibiotics and is natural resistant to imipenem cilastatin,and the mechanism of drug resistance is quite complex,which brings some difficulties to the clinical treatment of Stenotrophomonas maltophilia infection.Therefore,regular monitoring and analyzing the drug resistance of Stenotrophomonas maltophilia,adjusting the use of antibiotics correct and rational according to the drug sensitivity results is conducive to control the Stenotrophomonas maltophilia infection.We should strengthen the clinical disinfection and sterilization of medical environment,medical equipment and medical personnel hands.Strict implementation of aseptic operation procedures,as far as possible to reduce unnecessary invasive treatment operation and to reduce the high frequency of infection factors.Actively strengthen symptomatic treatment,and improve patient body condition and patient resistance.The use of sensitive narrow spectrum antibiotics to shorten the patient's time of hospitalization and ultimately reduce the incidence and mortality of the Stenotrophomonas maltophilia infection.