金黄色葡萄球菌临床分布与耐药性监测

Analysis of clinical distribution and antimicrobial monitoring of Staphylococcus aureus

目的分析某医院住院患者金黄色葡萄球菌(SA)分离株的临床分布及其耐药性。方法收集2010年1月-2014年12月临床分离的SA,应用VITEK-2Compact微生物全自动分析系统进行鉴定,采用AST-GP 67药敏卡进行药敏试验,用WHONET 5.6软件分析病原菌的分布及耐药情况。结果共检出SA 1 672株,临床分布前三位的科室分别为儿科(检出率为37.4%)、神经外科(13.8%)和普通外科(10.6%)。耐甲氧西林金黄色葡萄球菌(MRSA)在SA中的构成比为29.8%,临床科室ICU 57.1%、肿瘤科42.6%、神经外科40.4%最高。药物敏感试验结果显示,SA对常用抗菌药物的耐药率最高的是青霉素G(93.6%),其次为红霉素(58.3%)、克林霉素(40.8%),对其他抗菌药物耐药率均在30%以下,未检出万古霉素、利奈唑胺耐药菌株。2010-2014年,SA对青霉素、红霉素等14种抗菌药物的耐药率无明显趋势性变化;MRSA与甲氧西林敏感金黄色葡萄球菌(MSSA)相比,对苯唑西林、青霉素G、呋喃妥因、利福平、红霉素、克林霉素、庆大霉素、四环素、环丙沙星、莫西沙星、左旋氧氟沙星的耐药率较高(P<0.05)。结论该医院儿科检出SA数量最多,ICU、肿瘤科、神经外科耐药率较高;近五年SA对常用抗菌药物耐药率维持在相对稳定水平,加强耐药菌监测和严格执行消毒隔离制度是有效的防控措施。

Objective To investigate the clinical distribution and drug resistance of Staphylococcus aureus （SA） isolated from the hospitalized patients. Methods SA strains were collected from clinical specimens from lan 2010 to Dec 2014 ,VITEK -2 Compact automated microbial analysis system was used to identify the bacteria, and the AST -GP67 susceptibility cards were used to test antibiotics susceptibility. The WHONET 5.6 software was used for analyzing distribution and antibiotic resistance of SA. Results A total of 1672 SA strains were collected during five years, and the top three of clinical distributions were pediatrics （37.4%） ,neurosurgery （ 13.8% ） and forensic sursery （ 10.6% ）. The average of the composition ratio of Methi- cillin - resistant Staphylococcus aureus（MRSA） in SA was 29.8%, with the higher composition ratios in ICU57.1% ,Oncolo- gy Department 42.6% ,Neurosurgery Department 40.4%. Drug sensitivity test results showed that the resistant rate of SA to Penicillin- G（93.6% ） were much higher than that of any other antimicrobial agent, followed by Erythromycin （58.3%）, Clindamycin （40.8%）. The resistance rate to other antimicrobial agents was below 30%, vancomycin and Linezolid - resistant strain was not found. The resistance rate of Penicillin and Erythromycin and other antimicrobial agents had no obvious tenden- cy viariation from 2010 to 2014;Compared with MSSA, the MRSA strains had significantly higher resistance rates to the Oxac- illin ,Penicillin - G, Nitro - furantoin, Rifampicin, Erythromycin, Clindamycin, Gentamicin, Tetracycline, Ciprofloxacin, Moxi- floxacin and Levofloxacin（P 〈 0.05 ）. Conclusion The highest detection number of SA is obtained from pediatric in our hospital. The resistance rates are higher in ICU ,Oncology Department,Department of Neurosurgery. SA has maintained a relatively stable level of drug resistance to commonly used antimicrobial agents during five years, so strengthening the monitoring of drug resistance bacteria and strict implementation of disinfection and isolation system are effective prevention and control measures.