凝固酶阴性葡萄球菌耐药性及D-试验研究分析

Research and Analysis of Coagulase-Negative Staphylococcus Resistant and D-test

目的观察临床标本中凝固酶阴性葡萄球菌（CNS）对各种抗菌药物的耐药性及诱导克林霉素耐药状况。方法收集2008年1月～2009年12月临床分离的196株CNS，将其分为甲氧西林耐药的CNS（MRCNS）组和甲氧西林敏感的CNS（MSCNS）组，根据美国临床和实验室标准协会（CLSI）的标准进行药敏试验及D-试验，采用WHONET5．4版软件统计分析数据。结果MRCNS占CNS的71．4％；除万古霉素、利奈唑胺、四环素外，MRCNS组对其余八种抗生素（青霉素、苯唑西林、氯霉素、庆大霉素、环丙沙星、复方新诺明、红霉素和克林霉素）的耐药率均高于MSCNS组，差异有统计学意义（P〈0．05），未发现对万古霉素、利奈唑胺的耐药菌株；对红霉素耐药而克林霉素敏感的CNS中，诱导克林霉素耐药率为67．4％，其中MSCNS组高于MRCNS组，但差异无统计学意义（P〉0．05）。结论临床分离CNS中MRCNS栓出率高并呈多重耐药，且CNS诱导克林霉素耐药率高，因此加强对CNS的常规耐药检测及D-试验有利于指导临床用药。

Objective To observate clinical specimens of coagulase-negative staphylococci （CNS） on a variety of antimicrobial drug resistance and the prevalence of inducible clindamycin resistance. Methods Clinical separation 196 strains of CNS were collected from January 2008 to December 2009,they were divided into methicillin-resistant CNS（MRCNS） group and methicillin-sensitive CNS （MSCNS） group. The antibiotics sensitivity tests and D-test were carried out according to CLSI standards. WHONET 5.4 statistic software was usesd to analyse the date. Results MRCNS accounted for 71.4% of the CNS. Except vancomycin, linezolid and tetracycline, resistance rates of MRCNS gruap to the remaining eight kinds of the antibiotic （ penicillin G, oxacillin, chloramphenicol, gentamicin, ciproflo xacin, trimethoprim/sulfamethoxazole, erythromycin and clindamycin） were higher than MSCNS group. There was statistically significant（P〈0.05）. The resistant strains to vancomycin, linezolid had not been found. CNS which got resistent to erythromycin and sensitive to elindamycin, the rate of inducible dindamycin resistance was 67.4% ,with MSCNS group higher than MRCNS group, but there was no statistically significant （P 〉0.05）. Conclusion Among clinical isolates of CNS,MRCNS detection rate was obviously high and showed multiple drug resistance. What＇s more, the rate of inducible clindamycin resistance was high in CNS,Therefore,enhancing the conventional resistance testing on CNS and D-test could help guiding clinical medication.