四川大学华西医院金黄色葡萄球菌临床分离株的分布及耐药变迁情况

Clinical Distribution and Changes of Antimicrobial Resistance Profiles of Staphylococcus Aureus in West China Hospital

目的了解临床分离金黄色葡萄球菌(SA)分布情况和耐药变迁,为有针对性的经验治疗和院感控制提供依据。方法回顾性分析2008年1月至2014年12月四川大学华西医院住院和门诊患者分离SA及其临床资料,采用WHONET5.5软件进行耐药分析。结果共纳入7年临床分离的5 698株SA,标本来源首位是分泌物(2721株,47.8%),其次是呼吸道标本(1 638株,28.75%),脓液(451株,7.9%)和血液(362株,6.4%)。呼吸道标本的耐甲氧西林金黄色葡萄球菌(MRSA)(811株,49.5%)检出率高于分泌物、脓和血液。分离SA数量最多的科室是皮肤科(1052株,18.5%),其次为骨科(604株,10.6%)、重症监护病房(ICU)(472株,8.3%)和烧伤科(471株,8.3%)。ICU的MRSA检出率(72.2%)最高。七年SA总分离率为8.2%,其中MRSA 1 858株,检出率为32.6%。7年中,MRSA的检出率呈下降趋势。SA对红霉素、克林霉素、四环素、庆大霉素、利福平、环丙沙星、左氧氟沙星、莫西沙星的耐药率呈下降趋势,对复方新诺明的耐药率呈上升趋势。SA中尚未发现对万古霉素、利奈唑胺、替考拉宁和替加环素耐药的菌株。MRSA对青霉素G、红霉素、克林霉素、四环素、庆大霉素、利福平以及氟喹诺酮类的耐药率明显高于甲氧西林敏感金黄色葡萄球菌(MSSA),但对复方新诺明的耐药率低于MSSA。结论与全国耐药监测数据比较,四川大学华西医院SA耐药性总体控制较好。但MRSA的经验治疗可选抗菌药物仍非常有限。重症患者中MRSA的检出率较高,应予以特别关注,进一步采取有效感控措施,减少MRSA感染的发生率。

Objective To analyze the clinical distribution and changes of antimicrobial resistance profiles of Staphylococcus aureus （SA）, as well as to provide the basis for the prevention and treatment of infection. Methods The clinical data and the antimicrobial resistance profiles of SA were collected from Jan, 2008 to Dec, 2014 in West China Hospital of Sichuan University. The WHONET 5.5 software was used to analyze the resistance data. Results A total of 5 698 SA isolates were included within 7 years. Of all strains, 2 721 （47.8%） were isolated from secretion, 1 638 （28.75%） were from respiratory tract specimens, 451 （7.9%） were from pus, and 362 （6.4%） were from blood. 811 （49.5%） SA isolates from respiratory tract specimens were MethiciUin-resistant Staphylococcus aureus （MRSA）, which was higher than those from secretion, pus and blood. 1 052 （18.5%） SA strains were isolated from the dermatological department, 604 （10.6%） were from the orthopedics department, 472 （8.3%） were from the intensive care unit （ICU）, 471 （8.3%） were from the department of burn, and the detection rate of MRSA from ICU （341, 72.2%） was the highest. During last 7 years, the total separation rate of SA was 8.2%, among them 1 858 （32.6%） MRSA were isolated, and the detection rate was 32.6%. The resistant rate of SA to erythromycin, clindamycin, tetracycline, gentamicin, rifampin, ciprofloxacin, levofloxacin and moxifloxacin had a statistically significant decrease from 2008 to 2014, while the resistant rate of SA to trimethoprim/sulfamethoxazole had increased. No vancomycin, linezolid, teicoplanin or tigecycline resistant strain was detected. The resistance rates of MRSA to common antibiotics such as penicillin G, erythromycin, clindamycin, tetracycline, gentamicin, rifampin and fluoroquinolones were higher than those of MSSA, while the resistance rate of MRSA to trimethoprim/sulfamethoxazole was lower than MSSA. Conclusion Compared with the monitoring data in China, the drug resistance of SA in West China Hospital is well controlled. However, experience-directed antibiotic treatment of MRSA infection is still limited. MRSA infection remains a serious problem in critically ill patients. The rational use of antibiotics and application of effective infection control measures are important to decrease the MRSA infection.