分泌物分离的凝固酶阴性葡萄球菌耐药性及预防对策

Drug resistance of coagulase-negative Staphylococciisolated from secretions and prevention countermeasures

目的监测与分析医院住院患者2008-2011年感染性分泌物分离的凝固酶阴性葡萄球菌(CNS)耐药性,探讨感染控制方案并制定相应的预防措施。方法细菌培养和鉴定按照《全国临床检验操作规程》(第3版),采用常规方法进行;药敏试验采用CLSI推荐的K-B法,药敏结果采用CLSI 2008-2011年折点进行判断;万古霉素采用E-test试条进行检测;耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检测采用头孢西丁法;采用WHONET5.4-5.5软件进行数据统计分析。结果 177株CNS中检出MRCNS 97株,检出率为54.8%;CNS对青霉素、红霉素、克林霉素的耐药率最高,均>80.0%;对磺胺甲噁唑/甲氧苄啶耐药率>60.0%;对氯霉素和利福平的耐药率较低,均≤4.0%;未发现对万古霉素、替考拉宁和利奈唑胺耐药菌株。结论医院应严格按照卫生部制定的《抗菌药物临床应用管理办法》对抗菌药物的使用进行分级管理,临床医师应根据病原学检测结果对感染性疾病有针对性地进行治疗,以遏制和降低细菌耐药现象的产生和扩散。

OBJECTIVE To monitor and analyze the antimicrobial resistance of coagulase-negative Staphylococci （CNS） isolated from infectious secretion specimens obtained from the hospitalized patients from 2008 to 2011 and to explore infection control program so as to develop appropriate prevention measures. METHODS Referring to National Guide to Clinical Laboratory Procedures （third edition）, the bacterial culture and identification were performed by the routine methods. The drug susceptibility testing was carried out by K-B methods recommended by CLSI. The results were assessed according to CLSI 2008--2011 breakpoints. The E-test was used to detect the susceptibility of vancomycin. Methicillin-resistant coagulase-negative Staphylococci （MRCNS） was detected by cefoxitin. WHONET 5.4-5.5 software was used for statistical analysis of data. RESULTS Of 177 strains of CNS, totally 97 （54.8%） strains of MRCNS were detected. The drug resistance rates to the commonly used antibiotics such as penicillin, erythromycin and clindamycin were the highest, all above 80.0%, the drug resistance rate to trimethoprim-sulfamethoxazole was higher than 60. 0%, the drug resistance rates to chloramphenicol and rifampicin lower than 4.0% no strains were found resistant to vancomycin, teicoplanin, or linezolid. CONCLUSION The hospital should carry out the classified management of use of antibiotics strictly in accordance with Management of the Clinical Use of Antibiotics by Ministry of Health. The clinician should perform the targeted treatment of infectious disease based on the etiological examination result so as to prevent the emergence and spread of the bacterial resistance.