宝安地区耐甲氧西林金黄色葡萄球菌(MRSA)前瞻性监测及相关研究

Prospective Surveillance and Relative Study of MRSA Infection in Baoan District

目的通过为期一年的前瞻性监测及时准确地了解宝安地区医院耐甲氧西林金黄色葡萄球菌(MRSA)感染的状况,为适时监控,预防与控制MRSA医院感染的传播与流行提供科学依据。方法对本地区三家医院同时进行MRSA感染的监测,筛选MRSA菌株并进行敏感性试验,及时获得MRSA感染者的临床数据。结果MRSA感染55例次,MRSA在金黄色葡萄球菌中的检出率34.81%,医院感染占90.91%,社区感染占9.09%,经χ2检验(P<0.05),感染主要分布在烧伤科、外科系统及呼吸内科,年龄以31～45岁为高发病阶段。长期使用广谱抗生素,气管插管使用呼吸机,烧伤、皮肤创面感染是感染MRSA的主要危险因素。药敏试验显示:对万古霉素、奎奴普丁/达福普丁100%敏感,复方SMZ/利奈唑烷97%敏感。结论前瞻性监测能及时了解掌握MRSA感染的动态。重点科室的监控,合理使用抗生素对于预防与控制外科尤其是烧伤创面感染至关重要。严格执行无菌技术,采取有效的消毒隔离措施,正确的洗手是预防院内交叉感染的重要环节。

Objective To timely and exactly investigate the infection status of methicillin resistant Staphylococcus aureus （MRSA） in Baoan District through practising one- year prospective surveillance program, and to provide the scientific evidence for timely monitoring, prevention and control of nosocomial MRSA infection. Results Three hospitals of Baoan District were simultaneously monitored with MRSA infection, MRSA strain was screened to conduct sensitivity test, and the clinical data of patients with MRSA infection were obtained in time. Results Fifty - five patients were infected with MRSA. The detection rate of MRSA from Staphylococcus aureus was 34.81%, with the nosocomial infection of 90.91% and community infection of 9.09 %, which were significantly different between each other （P〈 0.05）. MRSA infection mainly distributed in burn department, surgery department, and respiratory department, which occurred mainly in the age group of 31--45 years. Long - term use of broad - spectrum antibiotics, tracheal intubation with ventilator, burn, injured tissue infection were the main risk factors of MRSA infection. The result of drug sensitivity test showed that the sensitive rates of MRSA to vancomycin, quinupristin/dalfopristin were all 100%, and to Co- SMZ/linezolid 97%. Conclusions Prospective study can timely know the dynamics of MRSA infection. Monitor of the key medical departments and rational use of antibiotics play the very important roles in prevention and control of surgical infection, especially the burn wound infection. Strict implementation of aseptic technique, adoption of the effective disinfection and isolation measures, and hand - washing in a correct way are the important links to prevent cross infection.