综合重症监护病房皮氏罗尔斯顿菌感染的临床特征及其耐药性

Clinical characteristics and drug resistance of Ralstonia pickettii infection in general intensive care unit

    摘要
  • 摘要:
    目的 分析综合重症监护病房皮氏罗尔斯顿菌感染的临床特征和耐药性，为临床合理使用抗菌药物提供参考。
    方法 收集2021年1月－2024年12月柳州市人民医院综合ICU检出皮氏罗尔斯顿菌患者125例的临床资料，回顾性分析皮氏罗尔斯顿菌的药敏试验数据和患者的临床特征。
    结果 125例患者共检出皮氏罗尔斯顿菌217株，检出率为0.25%（217/86 882），检出率呈逐年升高趋势（χ2=147.283，P＜0.001）。标本主要来自支气管肺泡灌洗液（56.16%）和痰液标本（43.15%）。125例患者中，男性84例（67.20%），年龄69.00（57.00，80.00）岁，≥65岁的患者78例（62.40%），均合并其他疾病，其中合并高血压70例、肾功能不全41例、冠状动脉粥样硬化性心脏病38例、脑梗死36例、糖尿病27例、肿瘤11例、慢性阻塞性肺病10例。皮氏罗尔斯顿菌的检出时间主要为入院＞3~≤14 d（50.40%），其次为＞14~≤28 d（31.20%）。住院期间116例（92.80%）患者检出除皮氏罗尔斯顿菌以外的其他细菌。皮氏罗尔斯顿菌对临床常用抗菌药物的耐药率较高（＞75.00%）。18例患者在皮氏罗尔斯顿菌结果报告前死亡或自动出院，在107例的在院患者中，14例（13.08%）已在使用敏感抗菌药物，10例（71.43%）好转；77例（71.96%）更换了敏感抗菌药物，46例（59.74%）好转；16例（14.95%）未更换抗菌药物，8例（50.00%）好转。
    结论 在综合ICU中，皮氏罗尔斯顿菌感染患者通常合并多种基础疾病，感染部位主要为肺部感染，且常为混合性感染。需全面评估患者感染状况，制定个体化抗菌药物治疗方案。

     

    Abstract:
    OBJECTIVE  To analyze the clinical characteristics and drug resistance of Ralstonia pickettii infection in the general intensive care unit （ICU）, providing a reference for the rational use of antibacterial agents in clinical practice.
    METHODS  Clinical data were collected from 125 patients detected with R. pickettii in the general ICU of Liuzhou People's Hospital from Jan. 2021 to Dec. 2024. A retrospective analysis was conducted on the drug susceptibility test data of R. pickettii and the clinical characteristics of the patients.
    RESULTS  A total of 217 strains of R. pickettii were detected in 125 patients, with a detection rate of 0.25% （217/86 882）, showing an increasing trend year by year （χ2=147.283, P＜0.001）. The specimens were mainly from bronchoalveolar lavage fluid （56.16%） and sputum specimens （43.15%）. Among the 125 patients, there were 84 males （67.20%）, with an age of 69.00 （57.00, 80.00） years old. There were 78 patients （62.40%） aged ≥65 years, all of whom had comorbidities, including hypertension in 70 cases, renal insufficiency in 41 cases, coronary atherosclerotic heart disease in 38 cases, cerebral infarction in 36 cases, diabetes mellitus in 27 cases, tumors in 11 cases and chronic obstructive pulmonary disease in 10 cases. The detection time of R. pickettii was mainly within 3 to 14 days after admission （50.40%）, followed by 14 to 28 days （31.20%）. During hospitalization, other bacteria besides R. pickettii were detected in 116 patients （92.80%）. R. pickettii exhibited high resistance rates （＞75.00%） to commonly used clinical antibacterial agents. Eighteen patients died or were discharged automatically before the results of R. pickettii were reported. Among the 107 inpatients, 14 （13.08%） were already taking sensitive antibacterial agents, with 10 （71.43%） showing improvement; additionally, 77 （71.96%） changed sensitive antibacterial agents, with 46 （59.74%） showing improvement; and 16 （14.95%） did not change antibacterial agents, with 8 （50.00%） showing improvement.
    CONCLUSIONS  In the general ICU, patients infected with R. pickettii often have multiple underlying diseases, with the lungs being the primary site of infection, and mixed infections are common. It is necessary to comprehensively evaluate the patient's infection status and develop an individualized antibacterial agent treatment plan.

     

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