232株金黄色葡萄球菌的临床分布特征及耐药性分析

Infectious distribution and drug-resistance analysis of Staphylococcus aureus isolates

目的了解金黄色葡萄球菌（金葡菌）临床分离株的感染分布特点及耐药现状,以便为临床感染治疗及预防提供帮助。方法收集南昌大学第二附属医院2007年1月至2009年12月临床分离的非重复金葡菌232株。常规方法进行菌株分离,血浆凝固酶、金葡菌单克隆抗体及Vitek-32型仪进行菌株鉴定,纸片扩散法测定菌株对抗菌药物的敏感性,头孢西丁法检测耐甲氧西林金葡菌（MRSA）,WHONET5.5软件分析数据。结果下呼吸道标本中分离的金葡菌最多,占44.0%,其次是脓液（20.3%）和血液（18.1%）。232株金葡菌中共检测到MRSA 131株（56.6%）,金葡菌对青霉素的耐药率最高（〉90.0%）,对庆大霉素、左氧氟沙星、克林霉素、红霉素和四环素的耐药率均〉50.0%;耐药率在10.0%50.0%的有阿米卡星、复方磺胺甲噁唑和夫西地酸;对替考拉宁耐药率非常低（1.3%）;未出现耐万古霉素的菌株。结论下呼吸道及皮肤软组织是金葡菌的主要感染部位;金葡菌对临床常用抗菌药物的耐药率近3年来趋于稳定,糖肽类抗菌药物对其仍有非常强的抗菌活性。

Objective To understand the infectious distribution and drug resistance of Staphylococcus aureus from nosocomial cases,and provide help for the treatment and prevention.Method A total of 232 nonduplicate strains of Staphylococcus aureus were collected in the Second Affiliated Hospital of Nanchang University from 2007 to 2009.The strains of Staphylococcus aureus were isolated from clinical specimens by routine method.The identification of Staphylococci was determined by plasma coagulase test,Staphylococci monoclonal antibody and VITEK-32 fully automated microbiology analyzer.All of the isolates were tested by Kirby-Bauer susceptibility.The antimicrobial susceptibility data was analyzed by WHONET 5.5 software.Result The rate of Staphylococcus aureus isolates from the lower respiratory tract specimens was 44.0%;20.3% in fester 18.1% in blood and 14.6% in secretions.The drug resistance rate was above 90.0% to penicillin,above 50.0% to oxacillin,gentamycin,levofloxacin,erythromycin and tetracycline,between of 10.0% and 50.0% to amikacin,sulfamethoxazole and fusidic acid,and 1.3% to teicoplanin.The drug resistance rate to vancomycin was not yet detected.Conclusion The lower respiratory tract,skin and soft tissue are the main infection site.The drug resistence rates of Staphylococcus aurens to the commonly used clinical antimicrobials are steady in the last 3 years.Staphylococcus aureus is still highly sensitive to glycopeptide antibiotics.