金黄色葡萄球菌207株药敏分析

Drug Sensitive Analysis of 207 Strains of Staphylococcus Aureus in Children

目的分析2003-2006年儿科住院患儿金黄色葡萄球菌(SAU)检出率及耐甲氧西林金黄色葡萄球菌(MRSA)发生率的变化和21种抗生素对SAU分离株的抗菌效应,为临床合理用药提供依据。方法2003年1月-2006年12月上海交通大学附属第六人民医院儿科住院患儿207例,入院48h内采集标本,其中咽拭子培养75株、痰培养57株、脐分泌物培养25株、脓液培养23株、血培养20株、胸腔穿刺液培养和中段水培养各3株、脑脊液培养1株。菌种鉴定采用SAU乳胶凝集试验,21种常用抗生素的药敏试验分析采用纸片扩散法(K-B法),其方法及结果判读按2006年美国临床实验室标准进行。MRSA菌株筛选用苯唑西林和(或)头孢西丁纸片法,用WHONET5软件分析结果;SAU的检出率和MRSA的发生率趋势变化检验采用Cochran-Mantel-Haenszel趋势检验分析。结果SAU207株中甲氧西林敏感金黄色葡萄球菌177例,占85.5%;MRSA30例,占14.5%。SAU对青霉素、苯唑西林、一代头孢(头孢唑啉)、二代头孢(头孢呋辛)、三代头孢(头孢噻肟、头孢曲松)、红霉素、克林霉素、甲氧苄啶-磺胺甲基异唑、环丙沙星、磷霉素和利福平的敏感率分别为4.8%、85.5%、84.9%、90.0%、88.3%、37.5%、46.3%、92.7%、74.2%、97.2%和94.0%。菌株均对糖肽类抗生素(如万古霉素和替考拉宁)和左氧氟沙星敏感。2003-2006年不同年份SAU的检出率与MRSA的发生率分别为9.6%、19.8%、25.0%、39.5%和5.0%、5.9%、12.7%、24.7%。结论SAU分离株对青霉素和红霉素的耐药率高,而对头孢菌素和苯唑西林相对有较高的敏感性,SAU检出率和MRSA发生率逐年上升,儿科应加强对SAU的监测。

Objective To analyze the changes of the frequency of staphylococcus aureus （SAU） and methicillin resistant staphylococcus aureus （MRSA） isolated from hospitalized children from 2003 to 2006, and investigate the 21 antimicrobial susceptibility against SAU strains for providing reference for clinical rational use of drug. Methods The SAU strains were isolated from 207 children who were hospitalized in department of pediatrics of the sixth people＇s hospital affiliated to Shanghai jiaotong university from Jan. 2003 to Dec. 2006 during the first 48 h of hospital stay. Strains were isolated from cotton - tipped swab of throat culture 75 strains, sputum culture 57 strains, secretion of bellybutton culture 25 strains,liquor pulis culture 23 strains, hemoculture 20 strains, tube thoracostomy culture 3 strains, middle piece urnary culture 3 strains, cerebrospinal fluid culture 1 strain. The strains were identified by latex agglutination test, the in vitro activities of the 21 antimicrobial agents against 207 SAU isolates was tested by disc diffusion test （ K - B method） according to the guidelines of the clinical and laboratory standards institute. MRSA was screened by oxacillin disc diffusion test. The data were analyzed by WHONET 5 software, Cochran - Mantel - Haenszel was used to analyze the tendency of SAU isolating rate and MRSA detectable rate. Results Of these SAU,30 strains （ 14.5 % ） isolates were MRSA and 177 strains （ 85.5 % ） were methicillin sensitive staphylococcus aureus. The sensitive rates of SAU to Penicifin, Oxacillin, Cefuroxime Sodium, Cefotaxime, Ceftriaxone, Erythromycin, Clindamycin, Trimethoprim/Sulfamethoxazole, Ciprofloxacin, Fosfomycin and Rifampin were 4.8% ,85.5% ,84.9% ,90.0% ,88.3% ,37.5% ,46.3% ,92.7% ,74.2% ,97.2% ,94.0% ,respectively. All the strains were sensitive to peptide antibiotic（ for instance, vacomycin and teicoplanin） and Levofloxacin. The SAU isolated rate and MRSA detectable rate were 9.6% ,19.8% ,25.0% ,39.5% and 5.0% ,5.9% ,12.7% ,24.7% in 2003 - 2006,respectively. Conclusions SAU has strong resistance to Penicilin and Erythromycin,but relative sensitive to Oxacillin and Cephalosporin. The SAU isolatating rate and MRSA resistant rate is increased in our area, pediatrics should to strengthen the monitoring of SAU is important in pediatrics.