宁波地区社区获得性金黄色葡萄球菌重症感染危险因素及菌株药物敏感性分析

Risk factors and antimicrobial susceptibilities of severe community-acquired Staphylococcus aureus infections in Ningbo

目的：了解宁波地区社区获得性金黄色葡萄球菌重症感染发生的危险因素和菌株对常用抗菌药物的敏感性。方法连续收集2008年5月至2013年5月宁波地区4家医院184例社区获得性金黄色葡萄球菌感染病例的资料及分离的菌株。对患者一般特征（年龄、性别、基础疾病和入院史）进行回顾性分析，检测菌株的药物敏感性、毒力基因pvl和tst携带情况，并对耐甲氧西林金黄色葡萄球菌（ MRSA）菌株进行SCCmec分型。采用二元Logistic回归分析法分析以上因素与重症感染的相关性。结果184例社区获得性金黄色葡萄球菌感染病例中，重症感染39例，占21．20％。菌株对青霉素、红霉素和克林霉素的敏感性都较低，而对苯唑西林、氨基糖苷类、喹诺酮类、利福平及万古霉素的敏感率均在75％以上。 Logistic回归分析结果显示，高龄（ OR＝1．024，95％CI：1．005-1．043， P＜0．05）、恶性肿瘤（OR＝15．288，95％CI：1．609-145．229，P＜0．05）、自身免疫病或正接受长期激素治疗（ OR＝12．102，95％CI：2．082-70．338，P＜0．01）是社区金黄色葡萄球菌重症感染发生的危险因素。结论宁波地区社区获得性金黄色葡萄球菌感染中，菌株对苯唑西林、氨基糖苷类、喹诺酮类、利福平及万古霉素的敏感率较高，治疗时可优先选用上述抗菌药物。高龄、有恶性肿瘤、自身免疫病或正接受长期激素治疗的患者更容易发展为重症感染。

Objective To identify antimicrobial susceptibilities of community-acquired Staphylococcus aureus infections and the risk factors of severe infections.Methods Clinical data of 184 cases of community-acquired Staphylococcus aureus infections collected from 4 hospitals in Ningbo during May 2008 and May 2013 were reviewed.Microbial sensitivity test and virulence genes （ pvl and tst） detection were performed in clinical isolates, and SCCmec genotyping was performed in methicillin-resistant Staphylococcus aureus （ MRSA） strains.Binary logistic regression analysis was used to identify the risk factors for severe infections.Results Among 184 cases of community-acquired Staphylococcus aureus infections, 39 （ 21.20%） were severe cases. Staphylococcus aureus strains were highly resistant to penicillin, erythromycin and clindamycin, but more than 75% strains were sensitive to oxacillin, aminoglycosides, quinolones, rifampicin and vancomycin.Logistic regression analysis showed that advanced age （OR=1.024, 95%CI：1.005-1.043, P〈0.05）, malignant tumor （OR=15.288, 95%CI：1.609-145.229, P〈0.05） , autoimmune diseases or long-term hormone therapy （ OR=12.102, 95%CI：2.082-70.338, P 〈0.01 ） were risk factors for severe community-acquired Staphylococcus aureus infections. Conclusions Strains isolated from the patients with community-acquired Staphylococcus aureus infections in＆amp;nbsp;Ningbo are usually sensitive to oxacillin, aminoglycosides, quinolones, rifampicin and vancomycin, which may be recommended for clinical use.Elder patients and those with malignant tumor, autoimmune diseases or long-term hormone therapy are more likely to develop severe Staphylococcus aureus infections.