肿瘤专科医院金黄色葡萄球菌临床分布及耐药性分析

Clinical distribution and drug resistance of Staphylococcus aureus isolated from a cancer hospital

目的 分析四川省肿瘤专科医院金黄色葡萄球菌（SAU）及耐甲氧西林金黄色葡萄球菌（MRSA）的临床分布及耐药性,为临床合理使用抗菌药物提供依据。方法 收集2011—2016年肿瘤专科医院住院肿瘤患者的764株SAU,用Auto-Scan4细菌鉴定及药敏分析系统对菌落进行菌种鉴定及药敏试验。结果 764株SAU中检出MRSA 176株,占23.04%,6年间MRSA的检出率呈上升趋势;SAU主要分离自痰液、伤口和分泌物,分别占30.89%、19.63%和14.40%;MRSA分布最多的病区是ICU、骨科病区和胸科病区,分别占73.81%、46.43%和40.91%;SAU对青霉素的耐药率最高（〉95%）,对万古霉素和利奈唑胺的耐药率最低,均为0;MRSA对喹诺酮类药物、红霉素及克林霉素耐药率〉70%,对其他大部分药物耐药率明显高于甲氧西林敏感金黄色葡萄球菌（MSSA）。结论 肿瘤专科医院的SAU耐药率较高,且MRSA的检出有逐年增高趋势,临床应合理使用抗菌药物,定期监测其耐药性变迁,以避免院内传播。

Objective To investigate the clinical distribution and drug resistance of Staphylococcus aureus and methicillin- resistant Staphylococcus aureus （MRSA） isolated from a cancer hospital and provide guidance for the rational use of antibiotics. Methods The S. aureus strains, which were isolated from clinical samples of the patients of a cancer hospital during 2011 -2016, were collected, then the strains were identified by using Auto-Scan4 bacterial identification system, and the drug susceptibility test was performed by using drug susceptibility analysis system. Results Among 764 strains of S. aureus isolated, 176 strains of MRSA were detected （23.04%）. Moreover, the detection rate of MRSA showed an increasing trend. Among the isolated S. aureus strains, 30. 89% were isolated from respiratory tract samples, 19. 63% from wound samples and 14. 40% from secretion samples. The top three departments with high isolation rate of MRSA were ICU （73.81%） , department of orthopedics （46. 43% ） and thoracic ward （40. 91% ）. The drug resistant rate of S. aureus to penicillin was highest （ 〉95% ）, and the drug resistant rates of S. aureus to vancomycin and linezolid were lowest （0%）. The drug resistant rate to quinolones, erythromycin, and clindamycin were 〉 70%. Conclusion The drug resistant rate of S. aureus was high in the hospital during 2011 -2016, and the detection rate of MRSA increased with year. It is necessary to promote rational use of antibiotics and regularly monitor the change of the drug resistance in order to prevent nosocomial transmission.