医院获得性与社区获得性耐甲氧西林金黄色葡萄球菌耐药性差异

Difference in antimicrobial resistance between hospital-and communityassociated methicillin-resistant Staphylococcus aureus

目的对比分析某院医院获得性与社区获得性耐甲氧西林金黄色葡萄球菌(MRSA)的耐药性,为临床治疗和合理应用抗菌药物提供参考。方法收集并分析2013年5月—2014年6月某院分离的金黄色葡萄球菌,采用VITEK2 Compact全自动微生物鉴定仪及药敏系统进行鉴定和药物敏感性试验,并结合临床资料进行医院与社区获得性感染的诊断。结果共分离MRSA84株(医院获得性61株、社区获得性23株),医院获得性与社区获得性MRSA对青霉素G、苯唑西林的耐药率均为100.00%;对氨苄西林/舒巴坦的耐药率分别为100.00%和95.65%;对复方磺胺甲口恶唑的耐药率分别为39.34%和34.78%。医院获得性MRSA对庆大霉素、四环素、红霉素、克林霉素、左氧氟沙星、环丙沙星、莫西沙星、呋喃妥因、利福平的耐药率均高于社区获得性MRSA,差异均有统计学意义(均P<0.001)。结论医院获得性与社区获得性MRSA的耐药性均比较严重,应加强监测,临床治疗中要根据药敏试验合理选择抗菌药物。

Objective To analyze antimicrobial resistance of hospital-associated methicillin-resistant Staphylococ-cusaureus（HA-MRSA）and community-associated methicillin-resistant Staphylococcus aureus （CA-MRSA）,and provide reference for clinical treatment and rational antimicrobial use. Methods From May 2013 to June 2014, Staphylococcus aureus in a hospital were collected and analyzed,strains were identified and performed antimicrobial susceptibility testing by using VITEK 2 Compact system,diagnosis of HA-MRSA and CA-MRSA were confirmed in combined with clinical symptoms.Results A total of 84 MRSA isolates were isolated （61 were HA-MRSA strains,23 were CA-MRSA）.Resistant rates of HA-MRSA and CA-MRSA to penicillin G and oxacillin were both 100.00% ;to ampicillin/sulbactam was 100.00% and 95.65% respectively;to compound sulfamethoxazole was 39.34% and 34.78% respectively. Antimicrobial resistant rates of HA-MRSA to gentamicin,tetracycline,erythro-mycin,clindamycin,levofloxacin,ciprofloxacin,moxifloxacin,nitrofurantoin,and rifampicin were all higher than CA-MRSA,the difference were significant（all P〈0.001）.Conclusion Antimicrobial resistance of HA-MRSA and CA-MRSA are all serious,monitor should be intensified,antimicrobial use should be chosen according to antimicro-bial susceptibility testing result.