2008~2013年女性生殖道金黄色葡萄球菌的临床分离和耐药变迁

Clinical distribution and drug-resistance of staphylococcus aureus isolated from female genital tract in 2008-2013

目的：了解女性生殖道金黄色葡萄球菌的临床分离和耐药变迁，为临床合理用药提供依据。方法收集2008年1月~2013年12月临床分离的女性生殖道非重复SAU，经VITEK-60微生物分析系统进行鉴定和药敏试验，数据分析采用WHONET 5.6软件进行。结果共检出SAU 247株，主要来源于门诊（69.2%），平均年龄（26.3±4.2）岁。甲氧西林耐药金黄色葡萄球菌（methicillin resistant staphylococcus aureus，MRSA）检出率从2008年的13.5%升至2013年的31.9%，呈逐年递增趋势。药敏结果显示SAU对青霉素和红霉素的耐药率较高（〉58.7%），对其他抗生素的耐药率较低（〈25.9%），未发现万古霉素和利奈唑烷耐药菌株。2008年与2013年相比，苯唑西林、左旋氧氟沙星和四环素的耐药率明显增加，差异有统计学意义（P〈0.05）。 MRSA与甲氧西林敏感金黄色葡萄球菌（methicillin sensitive staphylococcus aureus，MSSA）相比，对苯唑西林、氨苄西林/舒巴坦、庆大霉素、左旋氧氟沙星、莫西沙星、克林霉素、红霉素和四环素的耐药率均较高（P〈0.05）。结论女性生殖道SAU感染和MRSA检出率呈上升趋势，耐药性日趋严重。应加强SAU的培养检测和耐药性变迁监测，指导临床合理用药。

Objective To investigate the distribution and the change of drug resistance of staphylococcus aureus（SAU）isolated from female genital tract, and provide evidence for rational use of antibiotic. Methods Non-repetitive staphy-lococcus aureus isolates were collected from female genital tract from January 2008 to December 2013. The identifica-tion and susceptibility of the isolates were determined using auto-microbe analyzer. The data were analyzed by WHONET 5.6. Results A total of 247 SAU stains were determined, mainly from the outpatient （69.2%）, mean age（26.3±4.2） years old. The rate of Methicillin-resistant Staphylococcus aureus（MRSA） isolates rose from 13.5% in 2008 to 31.9% in 2013, and showed an increasing trend year by year. The results of antibiotic susceptibility test dis-played that the resistance rates of SAU to penicillin and erythromycin were higher than 58.7%,and the resistance rates to others antibiotic were low（〈25.9%）. No isolate was resistant to linezolid and vancomycin. Resistance rates to oxacillin,levofloxacin, tetracycline had a significant increasing trend from 2008 to 2013（P〈0.05）. MRSA strains to oxacillin,ampicillin/sulbactam,gentamicin,levofloxacin, moxifloxacin, clindamycin, erythromycin and tetracycline were higher than MSSA （P〈0.05）. Conclusion The female reproductive tract infection with MRSA had an upward trend, and its resistance became increasingly serious. therefore,we should reinforce the surveillance of this kind of strains for the guide of rational use of antimicrobial agents in clinic.