2012-2014年临床常见葡萄球菌对万古霉素MIC值变化分析

Change of MIC of vancomycin to common clinical Staphylococcusisolates in 2012-2014

目的了解医院临床常见葡萄球菌对万古霉素MIC的变化情况,为临床应用万古霉素提供参考。方法 2012年1月-2014年12月利用Vitek2Compact全自动分析仪对常见葡萄球菌鉴定及药敏试验结果数据作回顾性统计分析。结果 2012年1月-2014年12月附属医院共分离出950株葡萄球菌,其中金黄色葡萄球菌470株占49.47%,表皮葡萄球菌194株占20.42%,溶血性葡萄球菌164株占17.26%,其他凝固酶阴性葡萄球菌122株占12.84%;三年间金黄色葡萄球菌分离率以及MRSA的检出率均呈逐年下降趋势;凝固酶阴性葡萄球菌480株占50.53%,呈逐年上升趋势,差异有统计学意义(P<0.05);共检出7株万古霉素中介菌株(VIS),其中4株为VISA;2014年均未检出万古霉素中介菌株(VIS),三年间葡萄球菌MIC值变迁不大,2014年MIC值均有不同程度的回落。MIC≤1μg/ml均为主要优势值(≥50%);三年MIC50(μg/ml)均为1,MIC90(μg/ml)几乎均为2,几何均值变化较小,均无某种趋势发生,无MIC漂移现象。结论 2012-2014年临床分离常见葡萄球菌对万古霉素MIC值、几何均值变化不大,均无某种趋势发生,MIC无漂移现象,仍需继续关注。

OBJECTIVE To understand the change of MIC of vancomycin to common clinical Staphylococcus isolates so as to provide guidance for clinical use of vancomycin.METHODS From Jan 2012 to Dec 2014,the common Staphylococcus isolates were identified by using Vitek2 Compact automatic analyzer,and the data of the drug susceptibility testing were statistically analyzed.RESULTS A total of 950 strains of Staphylococcus were isolated from Jan 2012 to Dec 2014,including 470（49.47%）strains of Staphylococcus aureus,194（20.42%）strains of Staphylococcus epidermidis,164（17.26%）strains of Staphylococcus haemolyticus,and 122（12.84%）strains of other coagulase-negative Staphylococcus.The isolation rate of S.aureus and the detection of MRSA were decreased year by year in the three years.The coagulase-negative Staphylococcus accounted for 50.53%（480 strains）,showing an upward trend,and there was significant difference（P〈0.05）.Totally 7vancomycin-intermediate strains were isolated,including 4strains of VISA.The vancomycin-intermediate strains were not found in2014,the MIC to the Staphylococcus strains did not change significantly during the three years,while the MIC declined to varying degrees in 2014.The MIC no more than 1μg/ml was the predominant value（no less than 50%）.The MIC50（μg/ml）was 1in the three years,almost all the MIC90（μg/ml）was 2,the geometric mean value showed little change,neither a trend nor MIC drift occurred.CONCLUSIONThere is a little change in the MIC of vancomycin or geometric mean value to the common clinical Staphylococcus strainsin 2012-2014,neither a trend nor MIC drift occurs,which still needs to pay attention to.