74例金黄色葡萄球菌乳腺炎的耐药性分析

Antibiotics resistance in 74 strains of Staphylococcus aureus from acute mastitis

目的分析哺乳期乳房脓肿患者的金黄色葡萄球菌的耐药情况,指导临床合理使用抗菌药物。方法将厦门市妇幼保健院乳腺门诊及病房2009年2月至2011年1月抽取的128例哺乳期乳房脓肿患者的乳腺脓液接种于哥伦比亚血平板,置35℃培养箱,过夜孵育1824 h。革兰阳性球菌,触酶阳性,血浆凝固酶试验（＋）,必要时采用ATB-Expression细菌鉴定系统确认。用K-B纸片法检测其对苯唑西林等10种抗菌药物的敏感度。结果 128例检出细菌86例,阳性率67.2%,其中检出74株金黄色葡萄球菌（86.0%）,其对青霉素、红霉素和克林霉素有较强的耐药性,耐药率分别为94.6%、64.9%和59.5%;耐苯唑西林19株（25.7%）,对复方新诺明、磷霉素和庆大霉素较为敏感,对万古霉素、替考拉宁和左旋氧氟沙星100%敏感。结论哺乳期乳房脓肿致病菌主要为金黄色葡萄球菌,耐甲氧西林金黄色葡萄球菌（MRSA）占25.7%,其耐药情况不容忽视,青霉素类、大环内酯类等耐药率较高不能作为经验用药。建议临床使用抗菌药物前及时送检乳腺脓液细菌培养,以药敏结果指导临床合理经济用药。

Objective To analyze the antibiotics resistance in breastfeeding patients with acute mastitis to provide reference for rational use of drugs.Methods All pathogens isolated from 128 breastfeeding patients with acute mastitis from February 2009 to January 2011 were identified with ATB expression microbial identification system.Their sensitivity to ten kinds of antibiotics like Oxacillin was tested by Kirby-Bauer.Results A total of 86 strains were isolated（67.2%）.There were 74 strains of Staphylococcus aureus（86.0%）.The antibiotics resistance to penicillin,erythromycin and clindamycin stood at 94.6%,64.9% and 59.5%,respectively.MRSA occurrence rate was 25.7%.The antibiotics resistance to vancomycin,levofloxacin and teicoplanin were zero.Conclusion The major pathogen of acute mastitis in breastfeeding period is Staphylococcus aureus.Due to high resistance to penicillin and erythromycin,the clinical use of penicillin and erythromycin etc.should be minimized.It is recommended to perform drug sensitivity test before using any antibiotic durgs.