2003年至2012年儿科临床分离金黄色葡萄球菌的分布及耐药性变迁

Changing patterns and antibiotic resistance of Staphylococcus aureus in a pediatric clinic from 2003 to 2012 year

目的 了解目前儿科临床分离金黄色葡萄球菌的分布及对抗菌药物耐药性的变化.方法 对2003年1月至2012年12月首都医科大学附属北京儿童医院患儿标本中分离的金黄色葡萄球菌进行分析,药敏试验使用纸片扩散法和Phoenix 100微生物分析仪检测,按照临床实验室标准委员会（CLSI） 2012年标准进行结果判断.使用WHONET 5.6软件进行数据的统计分析.结果 2003年1月至2012年12月共分离出 2 843株金黄色葡萄球菌,每年送检的阳性标本中检出金黄色葡萄球菌的百分率依次为10.0％、8.7％、9.0％、11.6％、12.7％、11.7％、10.5％、10.8％、11.9％和 11.7％.其中,甲氧西林耐药金黄色葡萄球菌（MRSA）的总检山率为10.9％ （309/2 843株）,2003年至2012年每年MRSA检山率依次为3.1％、5.4％、6.4％、4.1％、6.0％、10.6％、11.2％、12.7％、14.1％和20.1％.分离出甲氧西林敏感金黄色葡萄球菌（MSSA）和MRSA对各种抗菌药物的耐药率分别为：青霉素91.4％和100.0％、苯唑西林0和100.0％、头孢呋辛0.5％和87.7％、头孢曲松0.1％和90.3％、阿莫西林-克拉维酸0.9％和86.7％、红霉素72.4％和92.2％、克林霉素50.6％和80.3％、环丙沙星2.2％和30.1％、复方磺胺甲（口恶）唑12.2％和13.9％.末发现对万古霉素的中介和耐药的菌株.结论 儿科临床分离的MRSA正在逐渐增多,耐药现象日趋严重.在儿科连续监测金黄色葡萄球菌的分布情况和耐药特性,对指导临床合理使用抗菌药物、有效控制儿科金黄色葡萄球菌感染和暴发流行都有重要意义.

Objective To investigate the changing patterns of Staphylococcus aureus （SA） and its resistance from a paediatric clinic in Beijing Children＇s Hospital Affiliated to Capital University of Medical Sciences.Methods SA isolated from hospitalized patients in Beijing Children＇s Hospital Affiliated to Capital University of Medical Sciences from Jan.2003 to Dec.2012 were analyzed.Antimierobial susceptibility was determined by disk diffusion method and Phoenix 100 microbiological system.Results were analyzed according to the 2012 guidelines of Clinical and Laboratory Standard Institute.WHONET 5.6 software was used to analyze the data.Results The clinical isolates of SA from inpatient were 2 843.The positive rates of SA were 10.0%,8.7%,9.0%,11.6%,12.7%,11.7%,10.5%,10.8%,11.9% and 11.7% form 2003 to 2012,respectively.The positive rate of Methicillin-resistant Staphylococcus aureus （MRSA） from inpatients was 10.9%.The positive rates of MRSA were 3.1%,5.4%,6.4%,4.1%,6.0%,10.6%,11.2%,12.7%,14.1% aid 20.1% form 2003 to 2012,respectively.The resistant rate of Methicillin-susceptible Staphylococcus aueus and MRSA to Penicillin were 91.4% and 100.0%,Oxacillin were 0 and 100.0%,Cefuroxime were 0.5% and 87.7%,Ceftriaxone were 0.1% and 90.3%,Amoxicillin-clavulanic acid were 0.9% and 86.7%,Erythromycin were 72.4% and 92.2%,Clindamycin were 50.6% and 80.3%,Ciprofloxacin were 2.2% and 30.1%,Trimethoprim-sulfamthhoxazol were 12.2% and 13.9%.Vancomycin-intermediate and Vancormycin-resistant Staphylococcus aureus were not found.Conclusions The prevalence of MRSA is increasing in paediatric inpatients.And MRSA isolates exhibit multidrug resistance.The sequential surveillance about SA is very important for guiding rational antimicrobial therapy and effective control of infections in paediatric patients.