ICU痰培养金黄色葡萄球菌耐药性变迁分析

Change of drug resistance of Staphylococcus aureus cultured from sputum in ICU

目的分析ICU患者痰培养中金黄色葡萄球菌对常用抗菌药物的耐药性变迁,以指导临床合理使用抗菌药物,降低细菌耐药性的产生。方法回顾性调查分析2008-2011年ICU痰培养中金黄色葡萄球菌耐药性的变迁。结果 2008-2011年ICU痰培养分离金黄色葡萄球菌112株,其检出率2008年居第3位,2009年居第2位,2010年居第4位,2011年居第2位;金黄色葡萄球菌对青霉素4年耐药率均为100.0%,对庆大霉素和四环素4年耐药率≥92.3%,对亚胺培南/西司他丁、氟喹诺酮类、头孢类、苯唑西林和阿莫西林4年耐药率≥84.6%,对克林霉素、红霉素和利福平4年耐药率≥65.5%,对磺胺甲噁唑/甲氧苄啶和氯霉素4年耐药率≤25.5%,对万古霉素敏感率均为100.0%;耐甲氧西林金黄色葡萄球菌(MRSA)2008年检出率为100.0%,2009年检出率为88.5%,2010年检出率为100.0%,2011年检出率为90.9%。结论目前ICU金黄色葡萄球菌及MRSA检出率越来越高,并且耐药情况严重,应采取必要措施,减少细菌耐药的发生。

OBJECTIVE To analyze the change of the drug resistance of Staphylococcus aureus cultured from the sputum in ICU so as to guide the reasonable clinical use of antibiotics and prevent the occurrence of the bacterial resistance. METHODS Retrospective investigation was carried out to analyze the change of drug resistance of S. aureus strains isolated from 2008 to 2011. RESULTS Totally 112 strains of S. aureus were isolated from the sputum specimens from 2008 to 2011 ,with the detection rate ranking the first place in 2008, the second place in 2009, the fourth place in 2010,and the second place in 2011. The drug resistance rates of the S. aureus strains to penicillin were 100.0% during the four years, the resistance rates to gentamicin and tetracycline were higher than 92.3%, the resistance rates to imipenem/ cilastatin, fluoroquinolones, cephalosporins, oxacillin, and amoxicillin were higher than 84.6 %, the resistance rates to elindamycin, erythroein,and rifampicin were higher than 65.5 %, the resistance rates to sulfamethoxazole / trimethoprim and chloramphenicol were less than 25.5%. There were no vancomycin-resistant strains detected. The detection rate of the methicillin-resistant S. aureus was 100. 0% in 2008,88.5% in 2009,100.0% in 2010,and 90.9% in 2011. CONCLUSION The detection rates of both S. aureus and MRSA isolated from the ICU become increasingly higher and higher and the drug resistance is so serious that it is necessary to take effective measures to reduce the incidence of the bacterial resistance.