皮肤及软组织感染中金黄色葡萄球菌临床分布和耐药特性分析

Clinical distribution and drug resistance analysis of Staphylococcus aureus causing infections of the skin and soft tissues

目的明确嘉兴医学院附属第二医院2014年10月—2015年10月皮肤软组织感染中分离获得的金黄色葡萄球菌临床分布特征和耐药特性,为临床合理用药提供理论依据。方法收集2014年10月—2015年10月期间嘉兴医学院附属第二医院皮肤及软组织感染的患者中分离获得的金黄色葡萄球菌,采用VITEK2-compact和BD-phoenix 100全自动微生物鉴定系统做菌株鉴定和抗菌药物敏感性试验;应用WHONET 5.4软件和SPSS 17.0软件进行耐药性统计分析;采用头孢西丁纸片法确定其中的耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)。结果共分离获得金黄色葡萄球菌103株,其中来自皮肤脓肿、疖、痈的37株(35.9%)、化脓性中耳炎6株(5.8%)、甲沟炎6株(5.8%)、皮肤蜂窝组织炎11株(10.7%)、新生儿脐炎7株(6.8%)、皮肤切口感染5株(4.9%)、足趾软组织感染6株(5.8%)、急性乳腺炎8株(7.8%)、烧伤2株(1.9%)、化脓性皮炎2株(1.9%)、其他包括毛囊炎、新生儿脓疱病等共13株(12.6%);金黄色葡萄球菌主要分离自门诊(60.2%,62/103)、儿科病区(7.8%,8/103)以及烧伤科、骨科等外科病区(32.0%,33/103);金黄色葡萄球菌中MRSA的检出率是19.4%,对青霉素的耐药率为97.1%,对四环素、复方磺胺甲噁唑、庆大霉素、环丙沙星的耐药率分别是18.4%、17.5%、11.7%和10.7%,对红霉素和克林霉素的耐药率在50%以上、对万古霉素、利奈唑胺敏感率均是100%。结论嘉兴地区皮肤及软组织感染中金黄色葡萄球菌主要为社区获得性感染。MRSA的携带率较高,应加强病原菌动态和耐药变迁的监测,尤其是目前敏感性较好的糖肽类抗菌药物。

Objective To determine the clinical distribution and drug resistance of Staphylococcus aureus isolated from SSTIs （skin and soft tissue infections） between Oct, 2014 and Oct, 2015 in the Second Affiliated Hospital of Jiaxing Medical University, so as to provide the evidence for clinical rational use of antibiotics. Methods VITEK 2-compact and BD-phoenixl00 were used to determine the Staphylococcus aureus and the antimicrobial susceptibility testing. WHONET 5.4 and SPSS 17.0 were used for analyzing the drug sensitivity results and statistical analysis, respectively. Cefoxitin disc diffusion method was used to detect the MRSA strains （methicillin-resistant Staphylococcus aureus）. Results There were totally 103 strains of Staphylococcus aureus isolated from SSTIs, including skin abscess/furuncle/carbuncle （37, 35.9%）, suppurative otitis media （6, 5.8%）, paronychia （6, 5.8%）, cellulitis （11, 10.7%）, neonatal omphalitis （7, 6.8%）, incision infection （5, 4.9%）, toe infection（6, 5.8%）, acute mastitis （8, 7.8%）, bum infection （2, 1.9%）, dermatitis （2, 1.9%） and others （13, 12.6%）. The Staphylococcus aureus collected from the out-patients, the pediatric ward accounted for 60.2% （62/103） and 7.8% （8/103）, respectively. The strains from the burns ward, the orthopaedic ward and other surgical wards totally accounted for 32.0% （33/103）. The detection rate of MRSA was 19.4%. The drug resistant rates to penicillin, tetracycline, trimethoprim-sulfamethoxazole, gentamycin and ciprofloxacin were 97.1%, 18.4%, 17.5%, 11.7% and 10.7%, respectively. The drug resistant rates of erythromycin and clindamycin were more than 50%, and all the isolates were sensitive to vancomycin and linezolid. Conclusions In Jiaxing, SSTIs caused by Staphylococcus aureus were mainly community-acquired infections. The detection rate of MRSA was high, and thus the surveillance of pathogens and drug-resistance especially in the glycopeptides should be paid more attention.