金黄色葡萄球菌临床感染分布特点及耐药性分析

Analysis of nosocomial infection distribution and drug resistance of Staphylococcus aureus

目的 分析本院临床分离金黄色葡萄球菌的科室分布及耐药性情况,以及耐甲氧西林金黄色葡萄球菌（M RSA）检出动态.为临床合理选择抗菌药物和预防金黄色葡萄球菌,尤其是M RSA的院内传播提供科学依据.方法 回顾性分析本院2011~2015年住院患者各类标本中分离的938株金黄色葡萄球菌分布特点及耐药情况.采用VITEK2-compact系统进行鉴定和药敏试验.结果 5内共分离（非重复）鉴定金黄色葡萄球菌938株,样本分布比例以伤口分泌物最高（43.6% ）,其次是痰液（31.8% ）,各类标本中M RSA的检出率以咽拭子（21.4% ）,其次为痰液和血液,检出率分别为（18.5%、15.4% ）;主要科室分布为骨科（17.7% ）和血液内科（9.9% ）.各个科室中MRSA的检出率以重症监护室最高（29.4% ）,其次为神经外科和呼吸内科,检出率分别为（28.6%、27.4% ）.药敏结果显示,金黄色葡萄球菌对15种抗菌药物耐药率排在前3位的是青霉素占94.3%、红霉素占69%、克林霉素占49.8%;对万古霉素、替考拉宁、利奈唑胺100% 敏感.结论 本院分离的金黄色葡萄球菌耐药现象比较严重,尤其是M RSA耐药现象严重,在一些科室和标本中的检出率较高,临床在治疗金黄色葡萄球菌感染时应根据实验室药敏结果合理选择敏感药物,以避免抗菌药物使用不当而诱导细菌耐药的产生,同时院内感染部门应积极采取措施,做好防控工作,防止金黄色葡萄球菌尤其是M RSA的传播和扩散.

Objective To analyze the distribution and drug resistance of clinical isolates of Staphylococcus aureus in our hospi-tal,and the detection of methicillin resistant Staphylococcus aureus （MRSA）.To provide scientific basis for the rational selection of antibiotics and the prevention of S.aureus,especially MRSA in hospital.Methods the distribution and drug resistance of 938 strains of S.aureus isolated from inpatients in our hospital during 2011-2015 were analyzed retrospectively.VITEK2-compact sys-tem was used for identification and drug sensitivity test.Results Totally of 938 strains of S.aureus were isolated in the 5 years, mainly from the wound secretion （43.6% ）,and sputum （31.8% ）,the detection rate of MRSA in various specimens from swab （21.4% ）,followed by sputum（18.5% ）and blood（15.4% ）;the main distribution Department of Department of orthopedics （17. 7% ）and Department of Hematology（9.9% ）.The detection rate of MRSA in each department was the highest in the ICU （29. 4% ）,followed by the Department of neurosurgery（28.6% ）and department of Respiratory Medicine（27.4% ）.he drug susceptibili-ty test showed that all the S.aureus strains were sensitive to Vancomycin teicoplanin and linezolid but had a high resistance rate（〉49% ）for many antibiotics such as Penicillin、Erythromycin、Clindamycin.Conclusion the phenomenon of of resistance in our hos-pital is relatively serious,especially the M RSA resistant phenomenon is serious,in some departments and samples in the detection rate is higher,the clinical should choose sensitive drugs according to the laboratory results of drug sensitivity in the treatment of S. aureus infection,to avoid improper use of antibiotics and inducing bacterial resistance at the same time,the nosocomial infection de-partments should take active measures to do prevention work,to prevent S.aureus especially MRSA spread.