Stenotrophomonas (Xianthomonas) maltophilia as an emerging opportunistic pathogen in association with HIV infection:: A 10-year surveillance study
Stenotrophomonas (Xianthomonas) maltophilia as an emerging opportunistic pathogen in association with HIV infection:: A 10-year surveillance study
复制标题
DOI：
10.1007/s15010-003-3113-6
复制
发表时间：
2003-06-01
期刊：
影响因子：
7.5
通讯作者：
Chiodo, F
中科院分区：
文献类型：
--
作者：
Calza, L;Manfredi, R;Chiodo, F
背景：嗜麦芽窄食单胞菌是一种医院内机会性致病菌，可导致免疫功能低下患者的严重感染并发症。目前，有关其在HIV感染中的临床意义的信息非常有限。患者和方法：对我所三级护理中心10年间(1991-2000年)1374例HIV感染者的临床和微生物记录进行了回顾性调查，以确定所有的嗜麦芽窄食单胞菌感染病例，并对流行病学、临床和实验室变量进行分析。对嗜麦芽窄食单胞菌菌血症与非伤寒沙门氏菌引起的菌血症进行比较。结果：59例HIV感染者共发生61例嗜麦芽窄食单胞菌感染，其中败血症/菌血症48例(78.7%)，下呼吸道感染5例，尿路感染4例，咽炎2例，淋巴结炎和肝脓肿各1例。61例嗜麦芽窄食单胞菌感染中有47例(77%)为医院内感染(即在住院第3天后确诊)，细菌分离株对多种β-内酰胺类化合物、氨曲南、亚胺培南和氨基糖苷类药物的耐药性增加。同时，38例非伤寒沙门氏菌引起的菌血症。结论：与非伤寒沙门氏菌比较，本组病例中13例为院内感染。菌血症与晚期免疫缺陷、白细胞减少-中性粒细胞减少、中心静脉置管、既往广谱抗菌治疗和/或皮质类固醇治疗有关，发生嗜麦芽窄食单胞菌播散性感染的风险显著更高。
Background: Stenotrophomonas (Xanthomonas) maltophilia has been increasingly reported as a nosocomial opportunistic pathogen, responsible for serious infectious complications in immunocompromised patients. At present very Limited information is available concerning its clinical significance in the setting of HIV infection.Patients and Methods: A retrospective survey of clinical and microbiological records of 1,374 HIV-infected patients referring to our tertiary care center during a 10-year period (1991-2000) was performed to identify all episodes of S. maltophilia infection and analyze epidemiological, clinical and Laboratory variables. The episodes of S. maltophilia bacteremia were compared with those caused by non-typhoid Salmonella spp. occurring in HIV-infected patients referring to our center during the same period, in order to evaluate eventual predisposing risk factors.Results: 61 episodes of S. maltophilia infection were observed in 59 HIV-infected patients: sepsis/bacteremia in 48 cases (78.7%), Lower airways infection in five, urinary tract infection in four, pharyngitis in two, Lymphadenitis and Liver abscess in one case each. 47 of 61 episodes (77%) of S. maltophilia infection occurred as nosocomial disease (i.e. were diagnosed after the 3rd day of hospitalization) and bacterial isolates showed an elevated resistance profile against many beta-lactam compounds, aztreonam, imipenem and aminoglycosides. At the same time, 38 episodes of bacteremia due to non-typhoid Salmonella spp. were diagnosed in our patients, 13 of which were nosocomial infections.Conclusion: When compared with non-typhoid Salmonella spp. bacteremia, a significantly higher risk of developing S. maltophilia disseminated infection was seen in association with advanced immunodeficiency, Leukopenia-neutropenia, central venous catheterization, prior broad-spectrum antimicrobial therapy and/or corticosteroid treatment.