医院环境中金黄色葡萄球菌的污染状况及耐药趋势分析

Analysis of the contamination status of Staphylococcus aureus and trend of its drug resistance in hospital environment

目的了解江苏阜宁县医院环境中金黄色葡萄球菌的污染状况及耐药性变迁,为加强控制院内感染和临床用药提供依据。方法采集2012年-2015年本地区两级医院环境标本590份,按照《医院消毒卫生标准》(GB 15982—2012)方法分离鉴定并进行药敏试验。结果在590份医院环境标本中分离出金黄色葡萄球菌83株,总阳性检出率为14.1%(83/590),其中MRSA检出率占84.3%(70/83);4年来,金黄色葡萄球菌的检出率已由20.0%降至7.8%,其中门把手、病历夹中样本的检出率仍居高不下,分别达24.1%、22.8%;药敏结果显示,4年来青霉素耐药率由80.1%升至100.0%,加替沙星耐药率由85.0%升至100.0%,红霉素耐药率由45.0%升至78.3%,四环素耐药率由28.3%升至65.8%,未见万古霉素、替考拉宁和利奈唑胺的耐药株。结论本地区医院环境存在不同程度的金黄色葡萄球菌的污染,门把手、病历夹的污染严重,金黄色葡萄球菌的耐药谱逐年变宽,耐药率也逐年升高,应加强医院环境监测,严格控制院内感染的发生与流行。

Objective To investigate the contamination status of Staphylococcus aureus in hospital environment and the trend of its drug resistance,so as to provide basis for the control of hospital infection and clinical medication. Methods A total of 590 samples were collected from two kinds of level hospital environments from 2012 to 2015. Microbial identification and drug susceptibility were conducted according to the methods based on Health Standard for Hospital Disinfection GB 15982- 2012. Results A total of 83 stains of Staphylococcus aureus were isolated from 590 samples with the detection rate of 14. 1%（ 83 /590）,of which the detection rate of MRSA was 84. 3%（ 70 /83）. The detection rate of Staphylococcus aureus decreased from 20. 0% in2012 to 7. 8% in 2015. While the detection rate in doorknob and chart files still remained high（ 24. 1% and 22. 8%）. The drug susceptibility test results showed that in the past 4 years,the resistance rates of Staphylococcus aureus to Penicillin,Gatifloxacin,Erythromycin and Tetracycline rose from 80. 1% to 100. 00%,from 85. 0% to 100. 00%,from 45. 0% to 78. 3%,from 28. 3% to 65. 8%,respectively. No resistance to Vancomycin,Teicoplanin and Linezolid were found. Conclusion Contamination of Staphylococcus aureus remained to be a serious problem in this area,especially in doorknod and chart files. The drug- resistance spectrum of Staphylococcus aureus has widened year by year,and the drug resistance rates are rising all along.Surveillance of hospital environment should be strengthened to prevent the occurrence of hospital infection and epidemic.