2007～2013年某院693株金黄色葡萄球菌的临床分布及耐药变迁

Clinical Distribution and Changes of Antimicrobial Resistance of 693 Strains among Staphylococcus Aureus from 2007 to 2013

目的：调查本院临床分离金黄色葡萄球菌（SAU）分布及耐药变迁,了解抗菌药物专项整治活动对细菌耐药的影响,为临床控制院内感染及合理使用抗菌药提供参考。方法：对2007～2013年本院分离693株SAU进行回顾性分析。结果：693株SAU,65.8%为50岁以上患者,科室主要分布骨科、普外科;标本主要分布伤口分泌物、痰液、尿液。7年间,SAU对青霉素、氯霉素耐药率分别由25.7%上升到95.9%、6.3%上升到20.6%;对红霉素、克拉霉素、利福平等耐药率振荡上行或直接上行到2011年达耐药最高点;2012年、2013年耐药率明显下降;未发现万古霉素、利奈唑胺耐药株;耐药率〈30.0%的抗菌药有喹奴普汀/达福普汀、呋喃妥因、复方磺胺甲噁唑等8种;对青霉素、克拉霉素表现高耐药性分别达95.0%、80.0%以上。7年间耐甲氧西林金黄色葡萄球菌（MRSA）检出率在13.9%～42.9%之间。MRSA对苯唑西林、红霉素、克林霉素等7种抗菌药耐药率明显高于甲氧西林敏感金黄色葡萄球菌（MSSA）;对复方磺胺甲噁唑耐药率显著低于MSSA,差异有统计学意义（P〈0.01）。结论：与其他医疗机构监测结果比,本院SAU耐药性控制较好。2011～2013年抗菌药物专项整治活动显著降低SAU耐药率。临床抗SAU抗菌药可供选择品种较多。

Objective：To investigate the clinical distribution and changes of antimicrobial resistance of Staphylo- coccus aureus （SAU） isolated from the hospitalized patients and analyse the influence of special rectification activities of antibacterial on clinical use of antibacterials so as to provide the clinical reasonable medication. Methods： A retrospective analysis was performed for the clinical distribution and antimicrobial resistance of 693 strains of SAU from 2007 to 2013. Results ：There were 65.8% people above 50 years old among the SAU, were mainly isolated from the wound secretions, sputum and urine specimens, isolation rate was relatively high in orthopedic, general surgery department. Since 2007 the drug resistance rate to penicillin and chloramphenicol had risen from 25.7% to 95.9%. The drug resistance rate to erythro- mycin, clarithromycin and rifampicin reached the highest point in 2011 and had a statistically significant decline between 2012 and 2013. No vancomycin and linezolid resistant strains detected, the drug resistant rate to quinupristin-dalfopristin, nitrofurantoin and trimethoprim/sulfamethoxazole were lower than 30%, and the drug resistance rate to penicillin was 95.0%, and the drug resistance rate to clarithromycin was 80.0%. Meticillin-resistant Staphylococcus aureus （MRSA） was between 13.9% and 42.9% in the last seven years. The drug resistance rate of MRSA to 9 different antibiotics like ox- acillin, erythromycin and clarithromycin were higher than those of the methicillin-sensitive Staphylococcus aureus （ MSSA）, the drug resistance rate of MRSA to trimethoprim/sulfamethoxazole was lower than MSSA （P 〈 0.01 ）. Conclusion： Compared with other medical organizations, the drug resistance of SAU in our hospital was well controlled. The special rectification activity of antimicrobial agents between 2011 and 2013 has paid off. There was a great variety of products for you to choose.