皮肤科创面MRSA感染的临床诊断及危险因素分析

Clinical Diagnosis and Risk Factors Analysis of the Methicillin-Resistant Staphylococcus Aureus(MRSA) Infection of Skin and Soft Tissue

目的探讨皮肤软组织分泌物培养出耐甲氧西林金黄色葡萄球菌(MRSA)的相关疾病诊断及导致MRSA感染可能的危险因素,为皮肤科提前防控MRSA感染提供病种预警和危险因素的防治。方法回顾性分析2015年1月~2021年9月我院皮肤性病科皮肤软组织糜烂面分离培养出的MRSA。采用法国生物梅里埃公司的全自动微生物分析鉴定仪(VITEK-2 Compact)鉴定菌种。通过定义入院48小时内或48小时后获得的MRSA阳性培养,将感染分为社区获得性MRSA(CA-MRSA)或医院获得性MRSA(HA-MRSA)。结果(1)皮肤软组织MRSA感染平均占皮肤科多重耐药菌的83.19%,是主要多重耐药菌;(2)皮肤科MRSA感染主要以CA-MRSA感染为主,占71.11%(192/270)。与CA-MRSA感染相关的皮肤病依次为:天疱疮占比最高为28.12%,其次为葡萄球菌性烫伤样皮肤综合征(SSSS)16.67%和药物性皮炎6.77%(其中重症药疹2.08%)等。HA-MRSA感染最常见的也是天疱疮26.92%,其次为药物性皮炎12.82%(其中重症药疹11.54%)和脓疱性银屑病6.41%等;SSSS的CA-MRSA感染率要明显高于HA-MRSA感染(P=0.002);(3)HA-MRSA感染患者使用抗生素的比例明显高于CA-MRSA患者(P=0.001),但在糖皮质激素及免疫抑制剂系统使用上两种MRSA感染没有显著差异。结论皮肤科MRSA感染主要是社区获得性MRSA,MRSA感染最主要的疾病为天疱疮及SSSS,抗生素使用可增加院内感染MRSA的风险。

Objective To investigate the diagnosis and possible risk factors of skin and soft tissue infections caused by methicillin-resistent Staphylococcus aureus(MRSA),including community-associated(CA)and healthcare-associated(HA)isolates.Methods Through retrospective analysis,patients(n=899)with culture-proven S.aureus skin and soft tissue infections seen between January 1,2015,and September 31,2021,in dermatology department.The isolated bacteria were identified by VITEK Conpact 2 automatic bacteria analyzer.Results(1)The skin and soft tissue MRSA infection accounted for 83.19%of the multidrug resistant bacteria in dermatology,and was the main multidrug resistant bacteria;(2)MRSA infection in dermatology was mainly CA-MRSA infection,accounting for 71.11%(192/270).The skin diseases related to CA-MRSA infection were as follows:pemphigus accounted for 28.12%,followed by staphylococcal scald like skin syndrome(SSSS)16.67%and drug dermatitis 6.77%(including severe drug eruption 2.08%).The most common HA-MRSA infection was pemphigus(26.92%),followed by drug dermatitis(12.82%)(11.54%of severe drug eruption)and pustular psoriasis(6.41%);The infection rate of CA-MRSA in SSSS was significantly higher than that of HA-MRSA(P=0.002);(3)The proportion of patients with HA-MRSA infection using antibiotics was significantly higher than that of patients with CA-MRSA infection(P=0.001),but there was no significant difference in the use of glucocorticoid and immunosuppressive system between the two MRSA infections..Conclusion Dermatological MRSA infection is mainly community-acquired MRSA,and the main diseases of MRSA infection are pemphigus and SSSS.Antibiotic use can increase the risk of nosocomial MRSA infection.