耐甲氧西林与甲氧西林敏感金黄色葡萄球菌对复方新诺明耐药性的对比分析

Resistance of methicillin resistant staphylococcus aureus and methicillin sensitive staphylococcus aureus on cotrhnoxazole

目的对比分析耐甲氧西林金黄色葡萄球菌（MRSA）与甲氧西林敏感金黄色葡萄球菌（MSSA）对复方新诺明（SXT）的耐药性。方法对2009年1月至2012年9月临床分离的522株金黄色葡萄球菌进行分析，细菌鉴定和药敏试验采用VITEK2Compact全自动细菌培养鉴定仪。根据金黄色葡萄球菌对SXT耐药或敏感，分为SXT耐药（SXT—R）组和SXT敏感（SXT—S）组，比较2组MRSA和MSSA对各抗菌药物的耐药性。结果MRSA与MSSA对万古霉素、替考拉宁、奎奴普丁／达福普汀、利奈唑胺、替加环素和呋喃妥因的耐药率均〈1．5％，且二者之间差异无统计学意义（均P〉0．05）；MSSA对亚胺培南、氨苄西林／舒巴坦、利福平、莫西沙星、左旋氧氟沙星和环丙沙星的耐药率均〈9．1％，但MRSA的耐药率高达84．6％～100．0％，MSSA与MRSA比较差异有统计学意义（均P〈0．05）。MRSA对SXT的耐药率[41．2％（127／308）]低于MSSA[57．9％（114／197）]，差异有统计学意义（P〈0．05）。SXT—R组和SXT—S组中MRSA分离率分别为52．7％和68．6％。SXT—R组MSSA对氨苄西林／舒巴坦、亚胺培南、左旋氧氟沙星、环丙沙星、莫西沙星的耐药性低于SXT—S组[0（0．0）比25．0％（1／4），0（0．0）比25．0％（1／4），1．6％（1／63）比5．1％（4／79），6．1％（7／114）比10．8％（9／83），6．2％（7／113）比10．8％（9／83）]，差异均有统计学意义（均P〈0．05）。结论MRSA对SXT的耐药率低于MSSA，SXT可作为治疗MRSA的可选药物之一。

Objective To compare and analyze the resistance of methicillin resistant staphylococcus anreus （MRSA） and methicillin sensitive staphylococcus aureus（MSSA） on cotrimoxazole（SXT）. Methods On the Janu- ary 2009 to September 2012, 522 clinical isolates staphylococcus aureus were analyzed. The bacteria identification and drug sensitivity test were performed by VITEK 2 Compact automatic bacteria identification instrument. According to resistance or sensitive of staphylococcus aureus on SXT, 505 staphylococcus aureus were divided into SXT-R group and SXT-S group. Results The antibacterial activity of MRSA and MSSA on vancomycin, teicoplanin, quinupristin/ Dafoe Putin, linezolid, tigecycline and nitrofurantoin were better and the resistance rates were 〈 1.5% ; there were no significant differences（ all P 〉 0.05 ）. The resistance rates of MSSA on imipenem, ampicillin/ sulbactam, rifampicin, moxifloxacin, levofloxacin and ciprofloxac were 〈 9.1%, but resistance rates of MRSA were 84.6%-100.0% ; the difference was statistically significant （P 〈0.05）. The MRSA isolating rates in SXT-R group and SXT-S group were 52.7% （127/241） and 68.6% （181/264）. The resistance rates of MSSA on ampicillin / sul- bactam, imipenem, levofloxacin and ciprofloxac, moxifloxacin in SXT-R group were lower than those in SXT-S group [0（0.0） vs 25.0% （1/4）, 0（0.0） vs 25.0% （1/4）, 1.6% （1/63）vs 5.1% （4/79）, 6.1% （7/l14）vs 10.8% （9/ 83 ）, 6.2% （7/113） vs 10.8% （9/83） ; all P 〈 0.05 ]. Conclusion The resistance rate of MRSA on cotrimoxazole is lower than MSSA; cotrimoxazole can be used as one of alternative therapeutic agents in the treatment of MRSA.