耐甲氧西林金黄色葡萄球菌医院感染及社区感染的流行特点

Epidemiology of nosocomial and community-onset infections caused by methicillin-resistant staphylococcus aureus

目的了解住院患者中耐甲氧西林金黄色葡萄球菌(MRSA)医院感染及社区感染的流行特点,为积极预防和控制MRSA的感染与传播提供科学依据。方法 2008年7月1日-2010年12月31日,由专职人员每天根据细菌培养结果按照统一的方法到病房对患者进行前瞻性调查,2005年1月1日-2008年6月30日对金黄色葡萄球菌培养阳性住院患者进行回顾性调查。结果 MRSA医院感染率为0.10‰,入院患者中MRSA社区发病的感染率为1.40‰;医院感染中MRSA感染率为70.40%,显著高于社区感染感染率为46.04%(P<0.001);MRSA感染主要发生在重症监护病房(ICU)、内科及干部病房,呼吸系统的感染;MRSA感染率最高的是ICU和干部病房,>80.0%,呼吸系统和泌尿系统的感染。结论金黄色葡萄球菌耐药状况在医院内形势依然严峻,预防与控制MRSA感染重点在ICU、内科及干部病房,主要发生在呼吸系统的感染。

OBJECTIVE To understand the epidemiology of methicillin-resistant staphylococcus aureus（MRSA） in nosocomial and community-acquired infections among inpatients,to provide scientific basis for the prevention and control of MRSA infection and transmission.METHODS From Jul 1,2008 to Dec 31,2010,a prospective survey was conducted by full-time staff,who went to wards investigate the patients everyday according to the results of bacterial culture.From Jan 1,2005 to Jun 30,2008,the inpatients with S.aureus culture-positive were investigated retrospectively.RESULTS MRSA incidence of nosocomial infection was 0.10‰,MRSA prevalence of community infection among admissions was 1.40‰;MRSA proportion in nosocomial infections（70.40%） was significantly higher than that in community-onset infections（46.04%）（P0.001）;MRSA infections,mainly respiratory infections,mostly occurred in intensive care unit（ICU）,internal medicine and cadres wards;The highest MRSA proportion were mainly respiratory and urinary infections,mostly occurred in ICU and cadres wards（80.0%）.CONCLUSION The drug resistance status of S.aureus is still severe.For the prevention and control of MRSA infections,we should focus on ICU,internal medicine and cadres wards,and respiratory infections.