医院与社区获得性耐甲氧西林金黄色葡萄球菌感染的临床特点和耐药性的对比分析

Clinical Features and Antimicrobial Resistance of Hospital-and Community-acquired MRSA Infection

目的对比分析医院和社区获得性耐甲氧西林金黄色葡萄球菌(MRSA)感染的临床特点及耐药性,为临床合理应用抗菌药物提供依据。方法回顾性分析我院2010年5月—2011年4月所有MRSA感染的病例。结果共发现MRSA感染183例,其中医院感染MRSA(HA-MRSA)152例(占83.1%),社区获得性MRSA(CA-MRSA)31例(占16.9%)。HA-MRSA中60岁以上者103例(占67.8%),而CA-MRSA中60岁以上者6例(占19.4%),二者差异有统计学意义(χ2=25.05,P<0.001)。HA-MRSA主要来自神经内科(17.8%,27/152)、ICU(15.8%,24/152)等;CA-MRSA主要来自皮肤科(19.4%,6/31)、急诊科(19.4%,6/31)等。HA-MRSA对莫西沙星、左氧氟沙星、庆大霉素、利福平、四环素的耐药率均高于CA-MRSA,差异有统计学意义(P<0.05)。结论 HA-MRSA患者年龄较大,大多患有严重基础疾病,以脑血管意外最常见,主要来源于神经内、外科和ICU,标本以痰液和血液为主;而CA-MRSA多见于既往体健的青壮年,主要来源于皮肤科、急诊科和呼吸科,主要表现为皮肤感染和重症肺炎。实验室一旦检出MRSA,可根据临床特点初步判断是HA-MRSA还是CA-MRSA,临床医师可进一步根据药敏结果合理选用抗菌药物。

Objective To investigate the clinical features and antimicrobial resistance of hospital-and community-acquired MRSA infections. Methods The MRSA infection cases in our hospital between May 2010 and April 2011were retrospectively analyzed. Results Of 183 MRSA infections,152（83.1%） were hospital-acquired MRSA（HA-MRSA） infections and 31（16.9%）were community-acquired MRSA（CA-MRSA） infections.The proportion of patients aged 60 years old and above accounted for 67.8%（103） of the patients with HA-MRSA,higher than that（19.4%,6） of the patients with CA-MRSA（χ2=25.05,P0.001）.Patients with HA-MRSA mainly came from Department of Neurology（17.8%,27/152） and ICU（15.8%,24/152）,while patients with CA-MRSA mainly came from Department of Dermatology（19.4%,6/31） and Emergency（19.4%,6/31）.HA-MRSA infections had higher resistance rate to moxifloxacin,levofloxacin,gentamicin,rifampicin,and tetracycline than CA-MRSA infections（P0.05）. Conclusion HA-MRSA infections were common in elderly patients most of whom had serious co-morbidities.Among these co-morbidities,cerebral vascular diseases were most commonly seen.The cases of HA-MRSA infections mainly came from Departments of Neurology,Neural Surgery and ICU.The samples mainly consisted of sputum and blood.CA-MRSA infections were common in otherwise healthy young people from Departments of Dermatology,Emergency,and Respiratory Diseases.They often showed up as skin infection or severe pneumonia.Different clinical features of HA-MRSA and CA-MRSA infections can assist in the differentiation between the two once MRSA is detected from laboratory tests.Drug susceptibility test can further help the clinicians to choose appropriate antimicrobial drugs.