金黄色葡萄球菌血流感染的临床分布与耐药性分析

Clinical distribution and drug resistance of Staphylococcus aureus causing bloodstream infections

目的了解金黄色葡萄球菌血流感染的临床分布及细菌耐药情况,为临床合理用药提供参考。方法采集医院2009年1月-2015年5月由金黄色葡萄球菌致血流感染76例住院患者的相关临床资料,就其临床分布及细菌耐药情况进行回顾性分析。结果金黄色葡萄球菌血流感染多见于老年患者及新生儿;主要分布于肾脏病科(35.5%)、新生儿科(13.2%)及ICU(13.2%)。金黄色葡萄球菌对青霉素耐药率最高为94.7%,对替考拉宁、万古霉素、利奈唑胺敏感率均为100.0%,对夫西地酸的敏感率为96.1%。耐甲氧西林金黄色葡萄球菌(MRSA)检出率达40.8%,其对庆大霉素、克林霉素、左氧氟沙星、磺胺甲恶唑/甲氧苄啶的敏感率明显低于甲氧西林敏感金黄色葡萄球菌(MSSA)(P<0.05)。社区与医院获得性感染的MRSA或MSSA分别对常用抗菌药物敏感率进行比较均无显著差异性。结论金黄色葡萄球菌血流感染患者临床分布相对集中,MRSA检出率较高,细菌耐药性严重,临床应及早进行抗感染治疗,合理选择抗菌药物避免细菌耐药性的产生。

OBJECTIVE To investigate the clinical distribution and drug resistance of Staphylococcus aureus causing bloodstream infections so as to provide guidance for reasonable clinical use of antibiotics. METHODS The related clinical data were collected from 76 patients with S. aureus bloodstream infections who were hospitalized from Jan 2009 to May 2015. The clinical distribution and drug resistance of the strains were retrospectively analyzed. RESULTS The S. aureus bloodstream infection was prevalent in elderly patients and neonates; among the patients with bloodstream infection, 35.5% distributed in the renal disease department, 13. 2% in the neonatal depart- ment, 13.2% in the ICU. The drug resistance rate of the S. aureus to penicillin was the highest （94.7%） ; the drug susceptibility rates to teicoplanin, vancomycin, and linezolid were 100% ; the drug susceptibility rate to fu- sidic acid was 96.1 %. The detection rate of methicillin-resistant S. aureus （MRSA） reached up to 40.8%; the drug susceptibility rates of the MRSA strains to gentamicin, clindamycin, levofloxacin, and sulfamethoxazole-tri- methoprim were significantly lower than those of the methicillin-sensitive S. aureus （MSSA） （P〈0.05）. There was no significant difference in the drug susceptibility rate to the commonly used antibiotics between the MRSA strains causing the community-acquired infection and the MRSA strains causing the hospital-acquired infection or between the MSSA strains causing the community-acquired infection and the MSSA strains causing the hospital-ac- quired infection. CONCLUSION The clinical distribution of the patients with S. aureus bloodstream infections is rel- atively concentrated, the detection rate of the MRSA strains is relatively high. The strains are highly drug-resist- ant. It is necessary for the hospital to conduct the anti-infection therapy as early as possible and reasonably use an- tibiotics so as to avoid the emergence of drug resistance.