重症监护病房耐甲氧西林金黄色葡萄球菌感染流行病学调查、耐药性及危险因素分析

Molecular epidemiology,antibiotic resistance and risk factors of methicillin-resistant Staphylococcus aureus isolated from intensive care unit

目的调查2014—2015年郑州人民医院重症监护病房中耐甲氧西林金黄色葡萄球菌(MRSA)的分子流行病学分布,耐药性特征及感染危险因素。方法采用葡萄球菌蛋白A基因(spa)分型技术对53株MRSA进行分子流行病学研究,并进行17种抗菌药物的药敏试验。然后采用1:2成组病例对照方法选取同时期苯唑西林敏感金黄色葡萄球菌感染患者作为对照组,对MRSA感染危险因素进行分析。结果 53株MRSA的分子克隆型全部为t-030。MRSA敏感性最高的抗菌药物为万古霉素,替考拉宁,甲氧苄啶和复方新诺明(100%)。Logistic回归分析显示,重症监护病房(ICU)中心静脉置管和气管插管是MRSA感染的独立危险因素。结论重症监护病房MRSA克隆株由t-030引起,这与之前在郑州人民医院呼吸肿瘤病房的研究一致。MRSA耐药性强,中心静脉置管和气管插管等有创性治疗是MRSA感染的独立危险因素,加强对这些独立危险因素的控制可有效预防其感染扩散。

Objective To investigate the molecular epidemiology, antimicrobial resistance and risk factors of methicillin - resistant Staphylococcus aureus （MRSA） strains collected from Intensive Care Unit. Methods A prospective observational study was conducted from 2014 to 2015. Staphylococcus protein A gene （spa） typing were used to type 53 strains of MRSA and antibiotic susceptibility testing was performed. Potential risk factors independently associated with MRSA were determined. Results All 53 strains were t -030 types. Vancomycin, teicoplanin, trimethoprim and trime- thoprim -sulfamethoxazole were most active against all the MRSA strains（ 100% ）. Logistic regression analysis indicated that central venous catheter and tracheal intubation were the independent risk factors of infection by MRSA. Conclusion Theprevalence of MRSA in ICU is predominated by t - 030 clones, which is consisteni with the situation in the respiratory oncology ward. Infection by MRSA could be correlated with central venous catheter and tracheal intuba- tion, which should be effectively controlled.