2011—2015年山东省某院金黄色葡萄球菌耐药情况分析

ANTIBIOTIC RESISTANCE OF STAPHYLOCOCCUS AUREUS IN A HOSPITAL IN SHANDONG,CHINA,FROM 2011 TO 2015

目的了解某院2011—2015年金黄色葡萄球菌(SAU)的分布、流行病学情况及耐药变化,为临床合理使用抗生素提供参考依据。方法收集某院2011—2015年从临床各类标本中分离出的SAU菌株2 117株(剔除来自同一病人的重复菌株),采用VITEK MS质谱检测仪和VITEK2Compact全自动细菌鉴定及药敏分析仪进行菌株鉴定,采用K-B法和VITEK2Compact全自动细菌鉴定及药敏分析仪进行药敏试验,采用WHONET 5.6进行结果分析。结果 SAU菌株2 117株中,其标本来源占前3位的是创面分泌物(894株)、痰(843株)、胸腹水(126株);检出率占前3位的科室是普外科(421株)、重症监护室(ICU)(223株)、烧伤整形科(215株)。耐甲氧西林金黄色葡萄球菌(MRSA)588株,检出率为27.78%,其标本来源占前3位的是痰(248株)、创面分泌物(235株),胸腹水(45株);检出率前3位的科室是烧伤整形科(122株)、ICU(78株)、胸外科(38株)。SAU对青霉素G的耐药率最高(92.6%),其次是红霉素(80.8%),未发现耐万古霉素、替考拉宁、利奈唑胺的菌株。结论 SAU感染的主要途径为呼吸道和皮肤软组织,感染的高危人群为外科和ICU的病人。部分临床科室分离的SAU中MRSA耐药率较高,临床科室应加强MRSA耐药性监测,合理使用抗菌药物。医院感染管理部门可参考数据合理分配院内感染工作,以避免院内感染。

Objective To investigate the distribution,epidemiological features,and antibiotic resistance of Staphylococcus aureus（SAU）in one hospital in Shandong,China,from 2011 to 2015,and to provide a reference for rational use of antibiotics in clinical practice. Methods A total of 2 117 SAU strains isolated from various types of clinical specimens in our hospital from2011 to 2015were collected（the strains from the same patient were excluded）.VITEK MS mass spectrometer and VITEK2 Compact automatic microbial analysis system were used for strain identification,the K-B method and VITEK2 Compact automatic microbial analysis system were used for drug sensitivity test,and WHONET 5.6software was used for data analysis. Results Among the 2 117 SAU strains,894 were isolated from wound secretions,843 were isolated from sputum,and 126 were isolated from pleuroperitoneal fluid.Department of General Surgery had the highest detection rate（421strains）,followed by the intensive care unit（ICU）（223strains）and Department of Burns and Plastic Surgery（215strains）.There were 588 strains of methicillinresistant Staphylococcus aureus（MRSA）with a detection rate of 27.78%,which were commonly seen in sputum（248）,wound secretions（235）,and pleuroperitoneal fluid（45）;Department of Burns and Plastic Surgery（122strains）had the highest detection rate of MRSA,followed by Department of the ICU（78strains）and Thoracic Surgery（38strains）.SAU had the highest resistance rate to penicillin G（92.6%）,followed by erythromycin（80.8%）.No strains were found resistant to vancomycin,teicoplanin,or linezolid. Conclusion The major routes of SAU infection are respiratory tract and skin soft tissue,and patients in Department of Surgery and the ICU are at a high risk for infection.Among SAU strains isolated from some clinical departments,MRSA have a high resistance rate,and clinical departments should strengthen the monitoring of MRSA resistance and use antibiotics rationally.Hospital infection management department should distribute the work with reference to related data,in order to avoid nosocomial infection.