147株金黄色葡萄球菌临床分离及耐药分析

Isolation of 147 clinical strains of staphylococcus aureus and analysis of their drug resistance

目的监测本地区儿童感染耐甲氧西林金黄色葡萄球菌(MRSA)情况,掌握儿童感染金黄色葡萄球菌(SAU)耐药情况,指导临床合理应用抗生素,为提高治疗效果提供依据。方法对各类感染标本分离的147株金黄色葡萄球菌应用VITEK-32微生物全自动分析系统进行鉴定,采用K-B纸片扩散法进行药敏试验;采用头孢西丁纸片扩散法筛选MRSA菌株,同时进行D-试验研究红霉素诱导克林霉素耐药情况。使用WHONET5.4软件对原始数据进行分析和统计学处理。结果小儿金黄色葡萄球菌感染标本主要来自于痰液,共分离到金黄色葡萄球菌121株,占阳性菌株的82.3%(121/147),其中耐甲氧西林金黄色葡萄球菌(MRSA)42株。头孢西丁纸片扩散法结果显示147株金黄色葡萄球菌检出MRSA 47株(31.9%)。药物敏感试验结果显示147株金黄色葡萄球菌对青霉素全部耐药,而对万古霉素全部敏感,对苯唑西林、头孢唑啉、红霉素、克林霉素敏感率分别为64.6%、98.0%、44.2%、52.4%。药敏结果显示SAU存在多重耐药情况,有10株对红霉素和克林霉素同时耐药;D-试验结果显示诱导试验阳性率为54.5%。结论本文多数分离出金黄色葡萄球菌(SAU)菌株标本取自于呼吸道感染的痰液。通过药敏分析发现SAU对青霉素耐药率为100%,提示该种药物已不适合应用本地区SAU感染患儿的治疗。147株金黄色葡萄球菌中存在多重耐药情况并检出MRSA 47株(31.9%),提示本地区儿童感染SAU,特别是MRSA耐药形势不容乐观,仍需加强对MRSA的日常监测工作。

Objective To detect the situation of infected children＇s methicillin resistant staphylococcus aureus（MRSA） as well as methicillin resistant staphylococcus aureus（SAU） so as to guide rational application of antibiotics in the clinical context,and to improve the effect of treatment.Methods Totally 147 strains of isolated staphylococcus aureus from all kinds of infectious specimens were identified by microbial automatic analysis system of VITEK-32,Kirby-bauer method of drug sensitive test,Cefoxitin disk diffusion method of screening MRSA strains as well as D-test to research that erythromycin induced the drug resistance of clindamycin simultaneously.Moreover,WHONET5.4 software was used in the analysis and processing of original data statistically.Results The infectious specimens of pediatric staphylococcus aureus were mainly from sputum.121 strains of staphylococcus aureus accounting for 82.3% of the 147 positive strains were isolated.Among the 121 strains,there were 42 MRSA strains.The result of cefoxitin disk diffusion method showed that 47（31.9%） of the 147 strains were MRSA.Drug sensitive test showed that all the 147 strains of staphylococcus aureus were resistant to penicillin,but sensitive to vancomycin.The sensitivity ratio of oxacillin,cefazolin,erythromycin and clindamycin were 64.6%,98.0%,44.2% and 52.4% respectively.Drug sensitive test result showed SAU had multiple drug resistance.Ten strains were resistant to both erythromycin and clindamycin.D-test result showed that the positive inducement rate was 54.5%.Conclusions In this paper,the most strain specimens of the isolated staphylococcus aureus（SAU） were taken from sputum of respiratory infections.Through the analysis of drug sensitive test,it was found that 100% of SAU were resistant to penicillin.This result indicated that the drug is not suitable for treatment of infected children again.Forty-seven（31.9%） of 147 strains with multiple drug resistance were MRSA.This indicated that the situation that the children in this region were infected by SAU,especially by MRSA,which is not optimistic.Therefore it still needs to strengthen the daily work of monitoring MRSA.