耐甲氧西林金黄色葡萄球菌临床分离株耐药性研究

Study on drug resistance of clinic separated methicillin-resistant staphylococcus aureus

目的探讨耐甲氧西林金黄色葡萄球菌（MRSA）临床分离株耐药性和致病性。方法选择2009年1月~2012年2月我院细菌室分离的金黄色葡萄球菌（SA）,采用全自动微生物分析仪VITEK-2 Compact进行鉴定;采用纸片扩散法（Kirby-Bauer）进行药敏试验。统计分析MRSA的分布和药敏试验结果。结果我院2009年1月~2012年2月细菌室分离SA 100株,其中,痰液79株,分泌物8株,血液7株,脓液4株,胸腹水2株。呼吸内科分离SA 37株（37%）,远高于其他科室;除了万古霉素、利奈唑胺、复方磺胺甲嗯唑、利福平、呋喃妥因外,MRSA对其他抗菌药物,如β-内酰胺类、氨基糖苷类、喹诺酮类、大环内酯类及四环素类耐药率均高于甲氧西林敏感金黄色葡萄球菌（MSSA）,且差异有统计学意义（P〈0.01）。结论 MRSA对大部分抗菌药物仍维持较高的耐药率,应定期监测临床标本中分离的MRSA耐药率,合理使用抗菌药,延缓SA临床株耐药性的增长,控制医院感染的发生及爆发流行。

Objective To investigate the drug resistance and pathogenicity of clinic isolated methicillin-resistant staphylococcus aureus（MRSA）.Methods The staphylococcus aureus（SA） which was separated by bacteriology room in our hospital from January 2009 to February 2012 was selected and identified by the automatic microorganism analyzer VITEK-2 Compact.The drug susceptivity test was performed by paper diffusion method（Kirby-Bauer）.The MRSA distribution and drug susceptivity test results were analyzed.Results There were 100 strains of SA separated by bacteriology room from January 2009 to February 2012,among which 79 samples were separated from sputums,8 samples were separated from secretions,7 samples were separated from blood,4 samples were separated from pyogenic fluids and 2 samples were separated from pleuroperitoneal fluids.37 strains of SA（37%） were separated from respiratory medicine department,its separation rate was far higher than other departments.Basides Vancomycin,Linezolid,Compound Sulfamethoxazole,Rifampicin,Nitrofurantoin,the drug resistance rates of MRSA to antibiotics of lactam,aminoglycosides,quinolones,macrolide and tetracyclines were remarkably higher than those of MSSA,the differences were statistically significant（P〈0.01）.Conclusion MRSA maitains higher drug resistance rate to most antimicrobial drugs.The drug resistance of MRSA separated from clinical specimens should be regularly monitored,antibacterial should be reasonably used,in order to delay the growth of clinical strains resistant of SA and control the incidence of nosocomial infection,outbreak and prevalence.