烧伤病区甲氧西林耐药葡萄球菌耐药性及相关分析

Drug resistance of methicillin resistant Staphylococcus strains in burn ward and relative analysis

目的 了解烧伤病房住院患者各类标本中甲氧西林耐药葡萄球菌的分布及耐药状况,为临床治疗提供参考. 方法 2008年1月-2010年12月,采用常规方法从笔者单位烧伤科患者创面、血液、痰液、肺泡灌洗液等标本中分离、鉴定细菌.通过K-B纸片扩散法检测菌株对万古霉素等15种抗生素的耐药率,数据采用WHONET 5.5软件统计分析.利用脉冲场凝胶电泳（PFGE）技术对40株甲氧西林耐药金黄色葡萄球菌（MRSA）进行同源性分析. 结果 总共分离出葡萄球菌386株,包括金黄色葡萄球菌196株,血浆凝固酶阴性葡萄球菌190株,其中MRSA和甲氧西林耐药血浆凝固酶阴性葡萄球菌（MRCoNS）的年平均分离率分别为73.00％（143株/196株）和74.20％（141株/190株）.各年度MRSA、MRCoNS对青霉素、苯唑西林、头孢唑林、头孢呋辛等β内酰胺类抗生素耐药率均为100.00％；未见对万古霉素、替考拉宁和利奈唑胺耐药菌株.PFGE将40株MRSA分为A、B、C3型,其中A型33株,包括A1亚型30株、A2亚型3株；B型6株,包括B1亚型3株、B2亚型3株；C型1株. 结论 2008年1月-2010年12月笔者单位MRSA和MRCoNS分离率高,耐药严重,呈多药耐药性.PFGE A型为MRSA主要流行株.

Objective To study the distribution and drug resistance of methicillin resistant Staphylococcus strains in various specimens of inpatients in burn wards,and to provide reference for clinical treatment.Methods Bacteria were isolated from specimens of wound exudate,blood,sputum,and bronchoalveolar lavage fluid etc.,which were collected from patients hospitalized in our burn wards from January 2008 to December 2010.The bacteria were routinely cuhured and identified.Drug resistance of the Staphylococci to 15 antibiotics commonly used in clinic was identified by K-B disk diffusion method.Data were processed with statistical software WHONET 5.5.The homology of 40 strains of methicillin resistant Staphylococcus aureus （MRSA） was analyzed by pulsed-field gel electrophoresis （PFGE）.Results Altogether 386 strains of Staphylococcus were isolated,including 196 strains of Staphylococcus aureus and 190strains of coagulase negative Staphylococcus.The mean annual isolation rates of MRSA and methicillin resistant coagulase negative Staphylococcus （MRCoNS） were respectively 73.00％ （143/196） and 74.20％（141/190）.The resistance rates of MRSA and MRCoNS to β-lactams drugs,such as penicillin,oxacillin,cefazolin,and cefuroxime were 100.00％ in every year.No Staphylococcus strains resistant to vancomycin,teicoplanin,or linezolid were found.Three different PFGE patterns A,B,and C were identified among 40 MRSA strains,including 33 strains of type A （30 strains in sub-type A1 and 3 strains in sub-type A2）,6strains of type B （respectively 3 strains in sub-types B1 and B2）,and 1 strain of type C.Conclusions The isolation rates of MRSA and MRCoNS were high in our burn wards from January 2008 to December 2010.All of them showed strong drug resistance property,and they were multidrug resistant.The most prevalent strain was PFGE type A.