院内感染金黄色葡萄球菌的耐药及抗菌药物使用情况

Analysis of the drug resistance of Staphylococcus aureus causing nosocomial infections and the usage of antibiotics

目的分析院内患者感染金黄色葡萄球菌的耐药情况,了解抗菌药物使用情况,为金黄色葡萄球菌耐药性控制及临床抗感染治疗提供有效指导。方法对普外科和妇科感染住院患者标本进行细菌培养,鉴定菌种。采用K-B法对金黄色葡萄球菌分离株进行药敏实验。分析2012-2014年金黄色葡萄球菌感染的常用抗菌药物的使用情况。结果共分离出1 066株病原菌,其中革兰阴性菌770株(占72.23%),革兰阳性菌276株(占25.89%),真菌20株(占1.88%)。革兰阳性菌中以金黄色葡萄球菌最多,共128株。2012-2014年金黄色葡萄球菌对左氧氟沙星、青霉素、苯唑西林、利福平的耐药率有所降低;对氨苄西林的耐药率达100%,已经完全耐药;对替考拉宁、万古霉素的耐药率为0。2012-2013年左氧氟沙星、青霉素、磷霉素、氨苄西林、利福平的用药频度始终依次位于前5位,2014年时氨苄西林的用药频度却超越了磷霉素,位居第3位;万古霉素3年间始终处于最低用药频度。结论金黄色葡萄球菌耐药严重,不建议使用氨苄西林进行抗感染治疗;应谨慎选择替考拉宁和万古霉素进行抗感染治疗。

Objectives To analyze the drug resistance of Staphylococcus aureus causing nosocomial infections and to determine the usage of antibiotics in order to provide effective guidance for control of drug resistance control and clinical treatment of infections. Methods Samples were collected from patients with a nosocomial infection in General Surgery or Gynecology.Samples were subjected to bacterial culturing and bacterial strains were identified.S.aureusisolates were subjected to a drug sensitivity test using the K-B method.Data on antimicrobials that were commonly used to prevent and treat infection with S.aureus from 2012 to 2014were collected from this Hospital＇s pharmacy management system,and the usage of antimicrobials was analyzed. Results One thousand and sixty-six strains of pathogens were isolated from patients with a nosocomial infection in General Surgery.Of these,most（47.00%）were Gram-negative bacteria while some（12.01%）were Gram-positive bacteria and a few（1.88%）were fungi.S.aureus accounted for the largest proportion of the Gram-positive bacteria.Drug sensitivity testing indicated that the resistance of S.aureus infecting patients in General Surgery to all types of antimicrobials changed from 2012 to 2014.The resistance of S.aureus to levofloxacin,penicillin,oxacillin,and rifampicin decreased,its resistance to clindamycin varied over the 3years,and its resistance to ampicillin reached 100%,indicating complete resistance.However,its resistance to teicoplanin and vancomycin remained at 0%.Statistical analysis of the frequency of antimicrobial use indicated that the top five drugs used from 2012 to 2013were,in order,levofloxacin,penicillin,fosfomycin,ampicillin,and rifampicin.The frequency of ampicillin use exceeded that of fosfomycin use in 2014,so ampicillin ranked third in terms of use.Over the 3years,vancomycin was used the least often. Conclusion Ampicillin should not be used for clinical treatment of an infection.Isolated strains had not developed resistance to teicoplanin and vancomycin,so these drugs should be used in the clinical treatment of infections.