2015—2017年耐甲氧西林金黄色葡萄球菌的耐药性及临床特征分析

Analysis on clinical distribution and drug resistance of methicillin resistant Staphylococcus aureus from 2015 to 2017

目的了解耐甲氧西林金黄色葡萄球菌(MRSA)的药物敏感性及临床特征,为临床治疗及医院感控提供依据。方法选取2015—2017年自贡市第一人民医院微生物室分离的临床菌株,采用Whonet 5.6和SPSS 19.0软件对数据进行分析。结果共分离出金黄色葡萄球菌1018株,其中2015—2017年分别为249、377和392株,MRSA的检出率分别为18.07%、16.18%和19.90%,MRSA的总体检出率为18.07%。科室分布以儿科(40.22%)、耳鼻喉科(9.78%)、重症医学科(8.70%)、神经外科(7.61%)及骨科(5.43%)为主。标本类型中,以痰液最为常见,占64.13%,其次为创面分泌物,占27.17%。184株MRSA对红霉素和克林霉素的耐药率较高(≥69.6%),对环丙沙星、左氧氟沙星、庆大霉素、莫西沙星、复方磺胺甲噁唑及奎奴普丁/达福普汀的耐药率均较低(<20.0%),未分离出耐万古霉素、利奈唑胺、替加环素、利福平的菌株。临床治疗以一种或两种抗菌药物联合应用为主(占88.05%),约1/5的患者接收了糖皮质激素的抗炎治疗。相比甲氧西林敏感的金黄色葡萄球菌(MSSA)患者,MRSA患者的平均住院费用和平均住院天数均明显增加。结论我院MRSA以呼吸道感染为主,多见于儿科患者,其感染会增加患者经济负担、延长住院时间,临床及感控部门应采取相应措施以减少其流行。

Objective To understand the drug sensitivity and clinical characteristics of methicillin resistant Staphylococcus aureus (MRSA) , and provide evidence for clinical treatment and hospital control. Methods The clinical isolates isolated from the Microbiology Laboratory of Zigong First People's Hospital from 2015 to 2017 were selected, and the data were analyzed by Whonet 5.6 software and SPSS 19.0 software. Results A total of 1018 Staphylococcus aureus isolates were isolated, of which 249, 377 and 392 strains were detected in 2015, 2016, and 2017 respectively, and the detection rates of MRSA were 18.07%, 16.18%, and 19.90% respectively. The overall detection rate of MRSA was 18.07%. The departments were mainly distributed in Pediatrics, ENT, Intensive Medicine Department, Neurosurgery, and Department of Osteology, and the constituent ratios of them were 40.22%, 9.78%, 8.70%, 7.61%, and 5.43% respectively. Of the specimens, sputum was the most common one, followed by wound secretions, and the constituent ratios of them were 64.13% and 27.17% respectively. The proportion resistant to erythromycin and clindamycin were more than 69.6%, and the proportion resistant to ciprofloxacin, gentamicin, levofloxacin, moxifloxacin, cotrimoxazole, and quinupristin/dalfopristin were low, and all of them were less than 20.0%. In addition, there was no isolate resistant to vancomycin, linezolid tigecycline or rifampicin. One or two antimicrobial agents were used dominantly for treatment, and about one in five of patients received anti-inflammatory treatment with glucocorticoids. The average costs and length of hospital stay in MRSA patients significantly increased, compared with methicillin-sensitive Staphylococcus aureus (MSSA) patients. Conclusion The respiratory tract is the most common site of MRSA infections, which is often seen in pediatric patients in our hospital. The MRSA infections increase the economic burden of the patients, and extend the length of hospital stay. The clinical and sensory control departments should take appropriate measures to control the epidemic of MRSA.