社区获得性和医院获得性MRSA感染的差异

Difference between community-and healthcare-associated MRSA infection

目的了解某医院社区获得性和医院获得性耐甲氧西林金黄色葡萄球菌(MRSA)感染的特点及耐药性,为MRSA感染的预防控制与治疗提供依据。方法采用前瞻性调查方法,对2010年1—6月该院MRSA感染者资料进行调查和统计分析。结果社区获得性MRSA(CA-MRSA)感染部位以皮肤软组织为主,占58.82%。MRSA呼吸道感染在社区和医院感染中的比例均较高,分别为29.41%和29.63%。CA-MRSA与医院获得性MRSA(HA-MRSA)感染者在年龄、住院天数、是否住重症监护室、是否手术、侵入性操作等方面存在明显差异(P<0.05)。HA-MRSA对利福平、庆大霉素、莫西沙星、环丙沙星的耐药率(74.19%～93.33%)显著高于CA-MRSA(37.50%～52.94%)(P<0.05)。结论 CA-MRSA与HA-MRSA感染特点及耐药性存在差异,应加强监测和防控,根据药敏试验结果合理使用抗菌药物。

ObjectiveTo realize the characteristics and drug resistance of community-associated（CA） and healthcareassociated（HA） methicillin-resistant Staphylococcus aureus（MRSA）infection, and provide reference for the prevention and control of MRSA-infection.MethodsData of MRSA-infected patients who were hospitalized between January and June 2010 were reviewed and analyzed retrospectively. ResultsThe major CA-MRSA infection site was skin and soft tissue （58.82%）. The rate of CA-MRSA respiratory tract infection and HA-MRSA respiratory tract infection was 29.41% and 29.63% respectively. There was significant difference in age, length of hospital stay, ICU stay, surgical operation and invasive operation between CA-MRSA and HA-MRSA infected patients（P〈0.05）. The resistant rate of HA-MRSA to rifampicin, gentamicin,moxifloxacin, and ciprofloxacin were all higher than those of CA-MRSA （74.19%-93.33% vs 37.50%-52.94%, P〈0.05）.ConclusionCA-MRSA infection varies from HA-MRSA infection in infection characteristics and drug resistance, prevention and control measures should be strengthened, and antimicrobial agents should be used according to antimicrobial susceptibility testing result.