重度烧伤创面金黄色葡萄球菌感染的耐药性分析

Analysis of drug resistance of Staphylococcus aureus infection at severely burned wounds surface

目的了解重度烧伤患者创面金黄色葡萄球菌(SAU)感染的耐药性,为临床预防和治疗用药提供科学依据。方法共207株SAU均为2009年1月-2011年12月重度烧伤患者创面分离株;药敏试验采用K-B法;MRSA检测采用头孢西丁纸片法;克林霉素诱导性耐药采用D试验。结果 SAU对万古霉素、利奈唑胺、替加环素和呋喃妥因全部敏感,其他药物的耐药率:替考拉宁为1.4%,磺胺甲噁唑/甲氧苄啶为36.2%;对红霉素耐药而对克林霉素敏感的36株进行D试验,结果有19株阳性,阳性率52.8%;207株SAU共检出MRSA 134株,检出率64.7%;MRSA的耐药率明显高于MSSA。结论 SAU创面感染株的耐药性很高,临床应及时做病原菌检测,充分利用实验室所提供的细菌耐药趋势和有关耐药机制的信息,合理使用抗菌药物,积极处理烧伤创面,严格执行消毒隔离制度,有助于减少SAU感染,降低感染菌的耐药性。

OBJECTIVE To investigate the status of drug resistance of a Staphylococcus aureus （SAU ） isolated from a severe burn wound ,thereby providing the scientific evidence for the clinical prevention and treatment of pharmacy .METHODS From Jan .2009 to Dec .2011 ,samples of 207 strains of SAU were acquired from severe burn wounds and then their drug sensitivity tests were carried out by K-B .Cefoxitin disk was used to detect MRSA .D-test was used to detect the inducible resistance of clindamycin .RESULTS All bacterial strains were sensitive to vancomycin ,linezolid ,tigecycline and nitrofurantoin .The rate of drug resistance of other drugs were 1 .4% against teicoplanin , 36 .2% against sulfamethoxazole/trimethoprim ; The 36 strains resistant to erythromycin but sensitive to clindamycin were given D-test ,19 strains were positive ,accounting for 52 .8% ;Among 207 strains of SAU ,134 strains of MRSA were detected ,accounting for 64 .7% ;the resistant rate of MR-SA was obviously higher than MRSA .CONCLUSION It is important to reasonably use the antibacterial agents by timely detecting pathogenic bacteria ,taking full advantage of the tendency to the bacterial drug resistance supplied by the laboratory as well as the information related to the mechanism of drug resistance because of an increased rate of drug resistance of bacterial strains isolated from the burn wound .In addition ,other key approaches ,such as rational use of antibacterial agents and positive treatment to burn wound ,strict implement of disinfection and isolation regulation ,should not also be neglected ,by which the infection of SAU can be reduced and with its drug resistance lowered as well .