社区获得性MRSA感染的临床特征和耐药性分析

Analysis of clinical characteristics and antibiotics resistance of community-acquired MRSA

目的 研究社区获得性甲氧西林耐药金黄色葡萄球菌 (MRSA)感染的临床特征及分离菌的耐药情况 ,指导临床合理用药。方法 以同期分离的引起医院获得性感染的MRSA菌株作为对照 ,分析杭州地区两所医院近年来临床各类标本中分离的引起社区获得性感染的MRSA菌株的临床特征和对非 β 内酰胺类抗生素耐药状况。结果 社区获得性MRSA感染患者的平均年龄为 30 .89±13.3岁 ,较院内感染患者的平均年龄 (5 6 .0± 11.8岁 )为轻 (P <0 .0 1) ,且绝大多数没有基础疾病。体外药敏示 :两组细菌对万古霉素的体外敏感率为 10 0 % ;对利福平、磷霉素和甲氧苄啶 磺胺甲唑 ,社区感染菌株的体外敏感率分别为 86 .8%、81.6 %和 5 2 .6 % ,院内感染菌株的体外敏感率分别为88.1%、82 .9%和 6 1.9% ,各组间差异均无显著性 (P >0 .0 5 ) ;但社区感染菌株对奈替米星、克林霉素、红霉素和四环素的敏感率分别为 73.7%、6 0 .5 %、2 8.9%和 81.6 % ,院内感染菌株的体外敏感率分别为 5 0 .5 %、4 5 .7%、11.4 %和 5 8.6 % ,社区感染菌株敏感率高于院内感染菌株 (P <0 .0 1;P <0 .0 5 ;P <0 .0 1;P <0 .0 1) ;社区感染分离株中多重耐药株的发生率较院内感染低 (31.6 %vs 81.0 % ,P <0 .0 1)。

Objective To investigate the clinical characteristics and antibiotics resistance of community-acquired MRSA and to guide antibiotics chemotherapy in clinics. Methods All isolates were collected from patients in two hospitals of Hangzhou in recent years. Results The mean age of patients with community-acquired infection was lower than that of patients with hospital-acquired infection(30.89±13.3 vs 56.0±11.8 years,P<0.01). Most patients of community-acquired infection did not have underlying diseases. All isolates were sensitive to vancomycin and have the same sensitivity to rifampicin,fosfomycin and SMZ/TMP(86.8% vs 88.1%,P> 0.05 ;81.6% vs 82.9%,P>0.05 and 52.6% vs 61.9%,P>0.05);Comparing to hospital strains,community-acquired MRSA were more sensitive to netimycin,clindamycin,erythromycin and minocycline (73.7% vs 50.5%,P<0.01;60.5% vs 45.7%,P<0.05;28.9% vs 11.4%,P<0.01 and 81.6% vs 58.6%,P<0.01);The incidence of multiresistant strains in community infection is lower than that of hospital infection( 31.6% vs 81.0%,P<0.01). Conclusion Community-acquired MRSA was different from hospital-acquired MRSA and the experimental use of antibiotics should be dealed with differently to treat community and hospital infection.