2012-2017年住院患者MRSA流行病学变化趋势分析

Epidemiological study and trend analysis of MRSA isolated from inpatients from 2012 to 2017

目的分析耐甲氧西林金黄色葡萄球菌(MRSA)临床感染特征及变化趋势,为进一步控制MRSA在医院传播提供依据。方法对2012年1月-2017年12月住院患者266 765例的各类送检标本81 861份中MRSA的检出、标本来源、科室及感染部位进行研究。结果共分离金黄色葡萄球菌673株,检出MRSA 292株,检出率为43.39%。发生医院感染部位284例次,社区获得MRSA(CA-MRSA)感染占72.54%,医院获得MRSA(HAMRSA)感染占27.46%。HA-MRSA感染中呼吸机相关性肺炎、手术部位感染和导管相关血流感染发生率较高,占64.10%(50/78);检出MRSA科室以重症医学科、神经外科、骨科、肾脏内科为主。检出MRSA标本以分泌物、痰和血液标本为主。结论积极开展MRSA医院感染流行病学研究,对医院制定、执行、评估医院感染防控措施具有重要意义;今后MRSA医院感染防控工作应重点关注高发科室、重点部位、重点人群的防控策略有效落实。

OBJECTIVE To characterize the clinical infections and prevalence of methicillin-resistant Staphylococcus aureus（MRSA）for further controlling the spread of MRSA in hospitals.METHODS The detection rate,sources of specimen,distributions and infection sites of MRSA isolated from 266 765 cases of inpatients from 2012 to 2017 were studied.RESULTS A total of 673 strains of S.aureus were isolated and 292 MRSA strains were detected with a detection rate of 43.39%.There were 284 cases of nosocomial infections,of which community acquired-MRSA（CA-MRSA）infections accounted for 72.54% and hospital acquired-MRSA（HA-MRSA）infections accounted for 27.46%.Among all the HA-MRSA infections,the incidences of ventilator-associated pneumonia,surgical site infection,and catheter-related bloodstream infection were significantly higher than others,which accounted for 64.10% totally（50/78）.The HA-MRSA infections mainly occurred in departments of intensive care,neurosurgery,orthopedics and kidney medicine.Secretions,sputum and blood were the most common specimens from which MRSA strains were isolated.CONCLUSIONIt is of great significance to actively execute epidemiological study of HA-MRSA for developing,implementing and assessing the prevention and control measures for nosocomial infections.The key emphasis in future work for preventing and controlling MRSA nosocomial infections should be focused on the effective implementation of prevention and control strategies aiming for high-risk departments,key sites and key populations.