引起皮肤软组织及血流感染的金黄色葡萄球菌耐药特性分析

Drug resistance of Staphylococcus aureus causing skin and soft tissue or bloodstream infections

目的调查引起皮肤软组织和血流感染的金黄色葡萄球菌的耐药特征,为临床防治其感染提供帮助。方法采用血浆凝固酶、金黄色葡萄球菌单克隆抗体及VITEK-32型仪进行菌株鉴定,纸片琼脂扩散法(K-B法)进行药物敏感性试验,E-test条检测金黄色葡萄球菌对万古霉素的MIC,头孢西丁纸片法检测耐甲氧西林金黄色葡萄球菌,所有数据采用WHONET5.6软件分析。结果 2011年6月-2012年6月从患者皮肤软组织和血流感染标本中共分离获得118株金黄色葡萄球菌,其中检出MRSA 27株,检出率为22.8%,未检出万古霉素、替考拉宁、利奈唑胺耐药株,对磺胺甲恶唑/甲氧苄啶、阿米卡星、夫西地酸及左氧氟沙星,耐药率分别为4.20%、5.90%、6.70%及8.40%;耐药率最高的是青霉素为92.30%;MRSA与MSSA比较耐药率差异有统计学意义的分别为阿米卡星、磺胺甲噁唑/甲氧苄啶、左氧氟沙星、庆大霉素及红霉素。结论导致皮肤软组织和血流感染的金黄色葡萄球菌耐药性较严重,尤其是MRSA的多药耐药性更严重,临床应引起重视并加强对耐药菌的监测。

OBJECTIVE To investigate antimicrobial drug resistance characteristics of Staphylococcus aureus causing the skin and soft tissue infections and bloodstream infections so as to guide the clinical prevention and treatment. METHODS The identification of the strains was performed with the use of coagulase test, monoclonal antibody of S. aureus test ,and VITEK-32 automated microbial identification system, then the drug susceptibility testing was performed by using disc agar diffusion method （K-B method ）, the vancomycin MIC was determined by E-test, the methicillin-resistant S. aureus was detected by cefoxitin disk method, and all the data were processed through WttONET 5.6 software. RESULTS Totally 118 strains of S. aureus have been isolated from the clinical specimens obtained from the patients with skin and soft tissue infections and the bloodstream infections between Jun 2011 and Jun 2012, among which 27 strains of MRSA have been detected with the detection rate of 22.8 % ; no strains resistant to vancomycin, teicoplanin, or linezolid have been detected. The drug resistance rates of the S. aureus strains to sulfamethoxazole-trimethoprim , amikacin, fusidic acid, and levofloxacin were 4.20 %, 5.90%, 6.70M, and 8.40%, respectively; the drug resistance rate to penicillin was the highest （92.30%） ; the difference in the drug resistance rate to sulfamethoxazole-trimethoprim, levofloxacin, gentamicin or erythromycin between the MRSA and MSSA was significant. CONCLUSION The S. aureus strains causing the skin and soft tissue or bloodstream infections are highly drug resistant, and the multidrug-resistance in the MRSA is even more serious, it is necessary for the hospital to strengthen the monitoring of the drug resistant strains.