深圳市人民医院近五年临床分离金黄色葡萄球菌的分布及耐药性分析

Clinical distribution and drug resistance of Staphylococcus aureus isolated in Shenzhen People′s Hospital during past five years

目的分析医院感染患者金黄色葡萄球菌的临床分布特征及耐药性变化,为临床治疗金黄色葡萄球菌感染提供依据。方法回顾性分析2012年1月至2016年12月我院从临床各类标本中分离获得的1 141株金黄色葡萄球菌,统计其在各类标本和病区中的分布特点,并用K-B法测定该菌对常用抗菌药物的敏感性。结果 5年中共分离出1 141株金黄色葡萄球菌,标本来源构成比最多的是伤口分泌物(43.3%)、呼吸道标本(24.0%)和血液标本(10.2%)。耐甲氧西林金黄色葡萄球菌(MRSA)共有339株,占29.7%。各年MRSA的检出数依次为53株(31.9%)、51株(26.0%)、82株(35.2%)、81株(30.3%)和72株(26.0%)。MRSA主要分离自神经外科(13.8%)、呼吸监护室(10.6%)、重症监护室(8.8%)和骨科(7.7%)。MRSA对抗菌药物的耐药性普遍高于MSSA,二者比较差异有统计学意义(P<0.05)。未发现对万古霉素、利奈唑胺、替考拉宁耐药的金黄色葡萄球菌。结论 MRSA感染多发生于长期使用抗菌药物,有皮肤软组织伤口及侵入性操作的科室及患者。MRSA具有多重耐药性,应严格掌握抗菌药物的使用适应证;同时临床治疗应根据药物敏感性报告针对性地合理用药,以便及时有效地控制感染并防止耐药菌株的扩散。

Objective To analyze the clinical distribution and drug resistance of Staphylococcus aureus in nosocomial infections,and provide evidence for clinical treatment of Staphylococcus aureus infection.Methods 1,141 strains of Staphylococcus aureus isolated from various clinical specimens in our hospital from January 2012 to December 2016 were retrospectively analyzed for their distribution in various specimens and departments.The sensitivities to common antimicrobial agents were determined by using K-B method.Results Most of the 1,141 strains of Staphylococcus aureus were isolated from wound secretions（43.3%）,respiratory tract（24.0%）and blood samples（10.2%）.339 strains of Methicillin resistant Staphylococcus aureus（MRSA）were isolated,accounting for 29.7%.The number of MRSA strains isolated in each year was 53（31.9%）,51（26%）,82（35.2%）,81（30.3%）and 72（26.0%）respectively.The MRSA strains were mainly isolated from the Department of Neurosurgery（13.8%）,Respiratory ICU（10.6%）,ICU（8.8%）and Department of orthopedics（7.7%）.The resistance of MRSA to antibiotics was generally higher than that of MSSA with statistically significant difference（P〈0.05）.No strains were found resistant to Vancomycin,Linezolid and Teicoplanin.Conclusion MRSA infection usually occurs in patients who have long-term use of antibiotics,skin and soft tissue wound and invasive operation.Due to the multi-drug resistance of MRSA,we should strictly control the use of antibiotics in order to effectively control and prevent the infection and diffusion of drug-resistant strains.