蛛网膜下腔出血患者医院感染耐甲氧西林金黄色葡萄球菌耐药性变迁

Changes in drug resistance of MRSA in 118cases of subarachnoid hemorrhage with nosocomial infections

目的探讨118例蛛网膜下腔出血住院患者,医院获得性肺部感染耐甲氧西林金黄色葡萄球菌(MRSA)的临床分布及耐药性,为临床合理用药和有效地控制医院感染提供可靠依据。方法对医院2010年1月-2012年4月神经外科118例蛛网膜下腔出血患者肺部感染的各类标本进行细菌培养分离,并将临床分离出175株病原菌进行药敏试验。结果 MRSA主要分布于痰液、血液标本中,占81.7%和8.6%;MRSA对青霉素、庆大霉素和红霉素耐药率100.0%,对环丙沙星、利福平、四环素、克林霉素、阿莫西林/克拉维酸、亚胺培南、莫西沙星耐药率均>72.0%,未发现对万古霉素的耐药菌株。结论蛛网膜下腔出血的肺部感染患者MRSA多药耐药严重,结合药敏试验结果,正确合理使用抗菌药物,减少耐药菌株的产生。

OBJECTIVE To investigate clinical distribution and drug resistance of methicillin-resistant Staphylococ-cus aureus （MRSA） in 118 cases of subarachnoid hemorrhage with hospital acquired pulmonary infection, in order to provide reliable evidence for the guidance of clinical rational administration and effective control of the nosocomi-al infection. METHODS A total of 118 cases of various bacteria specimens of neurosurgery inpatients were cultured and isolated from Jan. 2010 to Apr. 2012, and the sensitivity test was performed on 175 strains of pathogens. RESULTS MRSA were mainly distributed in sputum specimen （81.7%） and blood （8.6%）. The resistance rates of MRSA were 100. 0% to benzylpenicillin, gentamicin and erythromycin, and 〉 72. 0% to eiprofloxacin, rifampicin, tetracycline, clindamycin, amoxicillin/elavulanic acid, imipenem and moxifloxacin. No MRSA strains were found with resistance to vaneomycin. CONCLUSION The condition of multidrug resistance is serious in subarachnoid hemorrhage patients with pulmonary infection. To reduce the generation of resistance bacteria, antibiotics should be used correctly and reasonably based on bacterial culture and drug susceptibility test.