2010-2011我院MRSA菌株的监测及耐药性分析

Detection of MRSA strains during 2010 to 2011 and an analysis on drug resistance of these strains

目的探讨分析2010-2011年我院MRSA（金黄色葡萄球菌）菌株的监测及耐药性情况。方法回顾性分析2010年3月至2011年3月我院住院及门诊患者资料，对标本培养出MRSA菌株进行监测及耐药性分析。结果经过分析统计，所有产生MRSA的标本中，痰液占215株（77．90％）、伤口分泌物占21株（7．61％）、尿液占17株（6．16％）、血液占13株（4．71％）、引流液占6株（72．17％）、其它5株为（1．81％）。在临床科室及门诊中，MRSA菌株分布情况是：呼吸内科156株（56．52％）、重症医学科50株（18．12％）、儿科21株（7．61％）、骨科18株（6．52％）、保健科9株（3．26％）、其他2例（0．72％）。经过耐药性分析，MRSA对万古霉素、替考拉宁及氯霉素等存在较低耐药性；MRSA对1、2代头孢菌素类、B-内酰胺类以及含酶抑制剂的B-内酰胺类存在耐药性；对氨基糖甙类、喹诺酮类及大环内酯类存在高度耐药性。结论MRSA菌株的监测标本以痰为主，临床分布以呼吸内科、重症医学科、儿科为主。MRSA是院内感染的最主要病原菌，而且具有多重耐药，临床应密切关注并控制MRSA院内感染的发生。

Objective To explore detection and drug resistance of MRSA strains during 2010 to 2011 in our hospital. Methods The data on the patients who had been hospitalized or had visited clinics during March 2010 to March 2011 were retrospectively analyzed. The cultured MRSA strains were identified and their drug re- sistance was determined. Results Of all the MRSA stains found in the samples, 215 （77.90%） stains were in sputum, 21 （7.61%） in wound secretion, 17 （6.16%） in urine, 13 （4.71%） in blood, 6 （72.17%） in drainage fluid , and 5 （1.81%） in other specimens. The distribution of MRSA strains in the clinical departments showed 156 （56.52%） in the department of respiratory medicine, 50 （18.12%） in the department of critical care medicine, 21 （7.61% ） in the department of pediatrics, 18 （6.52%） in department of orthopedics, 9 （3.26%） in the health care division, and 2 （0.72%） in other departments. MRSA stains had lower resistance to vancomycin, teicoplanin, and chloramphenicol, and were resistant to first and second-generation cephalosporins, B-lactam class, and B-lactam containing enzyme inhihitors, and highly resistant to aminoglycosides, quinolones and macrolides. Conclusions Sputum is main specimen in which MRSA strains are found. The stains distribute mainly in the departments of respiratory medicine, critical care medicine, and paediatrics.MRSA is the major pathogen for nosocomial infection and has multiple drug resistance. We should pay attention to and control the in- cidence of MRSA infection.