耐甲氧西林金黄色葡萄球菌D试验检测与耐药性分析

Methicillin-resistant Staphylococcus aureus in children:D test and drug resistance analysis

目的了解耐甲氧西林金黄色葡萄球菌(MRSA)的感染特点和耐药性,为临床合理使用抗菌药物提供参考依据。方法统计分析2013年1月-2014年8月儿童医院住院及门诊973例SAU感染患儿临床资料,使用VITEK-2Compact全自动细菌鉴定仪进行细菌鉴定、药敏试验和D试验检测,用头孢西丁和苯唑西林两个指标确认MRSA。结果检出金黄色葡萄球菌共973株,其中检出MRSA 168株、检出率为17.27%,<2岁患儿中检出MRSA 132株、检出率为18.38%;MRSA中D试验阳性率为27.38%,MRSA对红霉素耐药、克林霉素敏感D试验阳性率为92.00%,MSSA诱导克林霉素耐药率为87.30%;MRSA对万古霉素、利奈唑胺、喹奴普汀/达福普汀、替加环素敏感率均为100.00%。结论 MRSA耐药严重,且多见于婴幼儿,患儿克林霉素诱导率较成人高,应加强对MRSA的管理与监测,防止其暴发与流行。

OBJECTIVE To assess the infection characteristics and antibiotic resistance status of methicillin‐resistant Staphylococcus aureus （MRSA ） in children ,so as to provide reference for clinical rational use of antibiotics . METHODS The clinical data of 973 children with SAU infection in inpatient and outpatient departments in Hang‐zhou Children′s Hospital from Jan .2013 to Aug .2014 were statistically analyzed .All the samples were tested by VITEK‐2 compact automatic bacterial identification instrument for bacterial identification ,drug susceptibility test and D test .MRSA was confirmed by the two indicators oxacillin and cefoxitin .RESULTS Totally 973 S .aureus strains were detected ,in which 168 strains were MRSA （17 .27% ） and 132 strains （18 .38% ） were detected in children younger than 2 years .The positive rate of D test for the MRSA cases was 27 .38% ,for erythromycin‐re‐sistant and clindamycin‐sensitive MRSA was 92 .00% .The rate of clindamycin induced resistance in methicillin sensitive S .aureus （MSSA） was 87 .30% .The susceptibility rates of MRSA to vancomycin ,linezolid ,quinupris‐tin/dalfopristin and tigecycline were all 100% .CONCLUSION Drug resistance of MRSA is severe ,and most fre‐quently seen in infants .The clindamycin induced resistance rate for children is higher than that for adults ,sugges‐ting the urgency of strengthening the management and monitoring of MRSA to prevent its outbreak and preva‐lence .