不同来源金黄色葡萄球菌的分布特征及耐药性分析

Distribution characteristics and drug resistance analysis of Staphylococcus aureus from different sources

目的了解不同标本来源、不同科室来源的金黄色葡萄球菌的耐药性及分布差异,为临床合理用药提供依据。方法常规方法分离金黄色葡萄球菌,采用ATB Expression系统进行菌种鉴定和药敏试验,以美国临床和实验室标准化协会(CLSI)2016判断标准分析临床分离株。结果共分离金黄色葡萄球菌394株,分泌物、痰液、脓液、血液为主要标本来源;泌尿外科、骨科、烧伤整形科、神经外科为主要检出科室。全院耐甲氧西林金黄色葡萄球菌(MRSA)总分离率为44.6%,导管、痰液、血液、脓液、分泌物MRSA的分离率分别是66.7%、55.6%、51.7%、40.0%、38.9%,导管MRSA的分离率高于血液、脓液、分泌液(P<0.05);导管分离株对常用抗菌药物的耐药率最高,其次是痰液、血液,分泌物、脓液较低。重症医学科(ICU)、内科、外科、儿科MRSA的分离率分别为69.2%、55.6%、41.8%、20.0%,ICU的MRSA的分离率高于儿科、外科和全院(P<0.05)。ICU分离株对大部分常用抗菌药物的耐药率最高。未分离出耐万古霉素、替考拉宁、奎奴普丁/达福普汀、呋喃妥因的金黄色葡萄球菌株。结论该院MRSA的检出率高,不同标本来源、不同科室来源的金黄色葡萄球菌的耐药性有差异,临床医生应根据药敏结果合理使用抗菌药物。

Objective To understand the drug resistance and distribution difference of Staphylococcus aureus from different sources and different departments so as to provide the basis for rational drug in clinic.Methods Staphylococcus aureus was isolated by the using routine method,and the ATB Expression system was adopted to perform the species identification and drug susceptibility test.The clinically isolated strains were analyzed by using CLSI2016 criteria.Results A total of 394 strains of Staphylococcus aureus were isolated,and the secretions,sputum,pus and blood were the main sources of specimens;the departments of urology,orthopedics,burn plastic surgery and neurosurgery were the main detection departments.The total isolating rate of methicillin-resistant Staphylococcus aureus（MRSA）in the whole hospital was 44.6%,the MRSA isolating rates of catheter,sputum,blood,pus and secretions were 66.7%,55.6%,51.7%,40.0% and 38.9%respectively;the MRSA isolating rate of catheter was higher than that of blood,pus and secretions（P〈0.05）.The catheter isolated strains had the highest resistance to commonly used antibacterial drugs,followed by which from sputum,blood,secretion and which from pus was lower.The MRSA isolated rates of ICU,internal medicine,surgery and pediatric department were 69.2%,55.6%,41.8% and 20.0% respectively,the MRSA isolated rate of ICU was higher than that of pediatrics,surgery and the whole hospital（P〈0.05）.The strains isolated from ICU had the highest resistance rates to most commonly used antibacterial drugs.No Staphylococcus aureus strains resistant to vancomycin,teicoplanin,quinupristin/Dalfopristin and nitrofurantoin were isolated.Conclusion The detection rate of MRSA in this hospital is high,and the drug resistance of Staphylococcus aureus from different sources and departments is different.Clinicians should rationally use antibacterial agents according to the susceptibility test results.