血流感染金黄色葡萄球菌的耐药谱分析

Staphylococcus aureus Bloodstream Infections:Clinical Characteristics and Resistance Analysis

目的调查血流感染金黄色葡萄球菌的耐药谱,为临床治疗金黄色葡萄球菌血流感染提供指导。方法收集确诊金黄色葡萄球菌血流感染病例的临床资料,金黄色葡萄球菌分离自血液培养,利用全自动微生物分析仪对金黄色葡萄球菌进行菌种鉴定和药敏试验。结果共从87例血流感染的患者血液中分离出87株金黄色葡萄球菌,均无非重复株;有66例存在严重基础疾病;87株金黄色葡萄球菌中,36株为耐甲氧西林金黄色葡萄球菌(MRSA),占41.4%;金黄色葡萄球菌对多种抗菌药物呈普遍耐药,对青霉素和氨苄西林的耐药率已>95.0%,对磺胺甲噁唑/甲氧苄啶和利福平的耐药率<20.0%,对万古霉素、利奈唑胺、替考拉宁及喹奴普汀/达福普汀均100.0%敏感;MRSA的耐药率显著高于甲氧西林敏感金黄色葡萄球菌(MSSA)(P<0.05)。结论金黄色葡萄球菌引起的血流感染易发生于有基础疾病的患者,MRSA呈多药耐药性,但对万古霉素、利奈唑胺、替考拉宁及喹奴普汀/达福普汀敏感仍保持较高敏感性。

OBJECTIVE To investigate the clinical characteristics and resistance of Staphylococcus aureus bloodstream infections so as to guide the treatment of S.aureus bloodstream infections.METHODS Clinical data of S.aureus bloodstream infections were collected and drug sensitivity of isolated strains to antibacterial agents was tested.RESULTS Among 87 cases with S.aureus bloodstream infections,severe underlying diseases existed in 66 cases.Eighty-seven strains of S.aureus were isolated,including 36 meticillin-resistant S.aureus（MRSA）（41.4%）,strains S.aureus showed general resistance to many kinds of antibiotic drugs.The resistant rates to penicillin and ampicillin/sulbactam were higher than 95.0%,while only the resistant rates to sulfamethoxazole/trimethoprim and rifampicin were lower than 20.0%.All isolates of S.aureus were 100.0% sensitive to vancomycin,linezolid,teicoplanin and quinupristin/dalfopristin.The resistant rates of MRSA to ampicillin/subactam,sulfamethoxazole/trimethoprim,erythromycin,clindamycin hydrochloride,rifampicin,gentamicin,tetracycline and levofloxacin were all significantly higher than those of MSSA.CONCLUSION S.aureus bloodstream infections usually occur in the patients with severe underlying diseases.MRSA shows multi-resistant characteristics,but still keeps highly sensitive to vancomycin,linezolid,teicoplanin and quinupristin/dalfopristin.