2006—2008年我院金黄色葡萄球菌耐药监测

Resistance surveillance of Staphylococcus aureus in our hospital from 2006 to 2008

目的了解我院2006年1月至2008年12月分离的金黄色葡萄球菌对常用抗菌药物的耐药性。方法采用K-B法进行药敏试验,以CLSI2008年判断标准分析临床分离株,分析采用WHONET5.4及SPSS13.0统计软件。结果分别从ICU和非ICU分离出金黄色葡萄球菌54株和145株。ICU内标本主要来自于痰液(85.2%),非ICU标本来主要自于痰液(38.6%)、分泌物(29.0%)及脓液标本(17.9%)。ICU内金黄色葡萄球菌对β内酰胺类、大环内酯类、克林霉素类、氟喹诺酮类、氨基糖苷类耐药率均高于非ICU。ICU内金黄色葡萄球菌对头孢菌素类耐药率高(>73.1%)。ICU和非ICU金黄色葡萄球菌对利福平均较为敏感(敏感率>50%)。近3年来,ICU内金黄色葡萄球菌的耐药率无显著变化(P>0.05)。ICU内耐甲氧西林金黄色葡萄球菌及甲氧西林敏感金黄色葡萄球菌耐药率均高于非ICU,差异具有统计学意义(P<0.05)。未发现对万古霉素、替考拉宁和利奈唑胺耐药的金黄色葡萄球菌株。结论通过分析金黄色葡萄球菌耐药率的变迁,有利于采取措施控制ICU内耐甲氧西林金黄色葡萄球菌的流行和指导临床用药。

Objective To investigate the resistance ofclinicial isolates of Staphylococcus aureus （SA） from Jan 2006 to Dec 2008. Methods Disk diffusion method was used to determine the antimicrobial susceptibility. Resluts were evaluated accoding to CLSI 2008. And WHONET 5.4 and SPSS13.0 softwares were used to analyze the data. Results 45 isolates of SA were collected in ICUs and 145 in non-ICUs. The majority of the specimens （85.2%） in ICUs were isolated from the sputum; while the non-ICUs samples were from the sputum（38.6%）, secretion （29.0%） and pus （17.9%）. S. aureus isolates from the ICU-patients were more resistance against the β-lactams, macrolides, clindamycin, fluoroquinolones and aminoglycosides than those isolates from non-ICUs. The resistance rate （〉73.1%） of SA to cephalosporins in ICUS was higher than those in non-ICUs, but both had more than 50% sensitibity against Rifampin. In recent 3 years, the resistance of S. aureus to the tested antimicrobials had no significant difference （P〉0.05）. The resistance of methicilin-resistant Staphylococcus aureus （MRSA） and methicilin-suseeptible Staphylococcus aureus （MSSA） in ICUs were higher than those in non-ICUs, and the differences were statistically significant （P〈0.05）. The SA isolates resistant to Vancomycin, Teicoplanin and Linezolid were not found. Conclusion Analyzing the resistance alteration of the S. aureus in ICU will help to control the outbreak in ICU and direct rational use of antimicrobials clinically.