医院内外感染葡萄球菌的耐药性分析

Analysis of drug resistance of staphylococcus in patients infected inside and outside hospitals

目的分析医院内与院外感染葡萄球菌的耐药性,为临床用药提供依据。方法收集2011年1月至2013年12月黄石市中心医院门诊(院外)、住院(院内)患者各种标本中分离的454株葡萄球菌,用VITEK-32专用卡GPI及血浆凝固酶试验进行鉴定,药敏试验按K-B琼脂扩散法进行,根据美国临床和实验室标准化协会2006对头孢西丁的耐药情况进行分类分析,数据分析用WHONET 5.5药敏分析软件。结果在379株金黄色葡萄球菌(SA)中,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为41.2%,医院内、外标本MRSA检出率分别为44.1%和19.6%,差异有统计学意义(P<0.05);共检出凝固酶阴性葡萄球菌75株,医院内、外标本耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为61.1%和38.1%,差异有统计学意义(P<0.05)。未检出万古霉素、替考拉宁耐药菌株。结论耐甲氧西林葡萄球菌具有多重耐药性;院外SA感染者首选药物为庆大霉素、苯唑西林;若为院内SA和对于MRCNS引起的不论是院内或院外感染,均推荐首选万古霉素或替考拉宁。

Objective To analyze the drug resistance of staphylococcus aureus （SA） in patients infected inside and outside hospitals in order to provide a basis for clinical drug use. Methods A total of 454 strains of staph were discreted from various kinds of examples of patients inside and outside hospitals in the hospital from Jan 2011 to Dec 2013, which were identified with GPI of VITEK‐32 system and plasma‐coagulase test, the disk diffusion method and classification analysis about drug fast of cefoxitin was performed according to guidelines of the CLSI （2006）, WHO‐NET 5. 5 software was used to analyze the data. Results The detection rate of methicillin resistant staphylococcus aureus（MRSA） was 41. 2% of all 379 strains SA, which was 44. 1% and 19. 6% of samples inside and outside hospi‐tals, respectively, the difference was statistically significant （P〈0. 05）;in total, 75 strains coagulase negative staphy‐lococcus（CNS） were collected, the detection rate of methicillin resistant coagulase negative staphylococcus （MRCNS） was 61. 1% and 38. 1% of samples inside and outside hospitals, respectively, the difference was statistically signifi‐cant（P〈0. 05）. The drug resistant strain about vancomycin、teicoplanin wasn′t been detected. Conclusion MRS had multidrug resistance, the choice drug of patients infected outside hospitals by SA was gentamycin、oxacillin ;if hospital onset of infection of SA and hospital onset of infection or community infection of MRCNS, the choice drug was vanco‐mycin or teicoplanin.