金黄色葡萄球菌医院感染和社区感染分布及耐药性对比分析

Distribution and drug resistance of Staphylococcus aureus strains causing nosocomial infection and community-acquired infection:a comparative study

目的探讨某院患者医院感染和社区感染金黄色葡萄球菌分布及耐药率对比,为临床预防和治疗金黄色葡萄球菌感染提供科学依据。方法本研究回顾性分析2015年5月-2017年5月本院检出的82例金黄色葡萄球菌感染住院患者的临床资料,根据患者感染的来源将患者分为医院感染组56例和社区感染组26例,比较两组患者金黄色葡萄球菌的标本来源、感染部位分布及对不同抗菌药物的耐药率。结果共17 322例患者进行病原菌培养,其中金黄色葡萄球菌感染患者82例,感染率为0.47%,其中医院感染组56例,占68.29%,社区感染组26例,占31.71%。两组患者的金黄色葡萄球菌感染的感染部位的差异均无统计学意义,两组患者均以呼吸系统感染为主。两组患者检出的金黄色葡萄球菌对青霉素、苯唑西林、阿莫西林的耐药率均较高,且差异无统计学意义,医院感染组对利福平、四环素、庆大霉素、复方新诺明、环丙沙星、莫西沙星的耐药率均高于社区感染组,差异具有统计学意义(P<0.05),两组患者检出的金黄色葡萄球菌对万古霉素、达福普汀、替加霉素、利奈唑胺、替考拉宁均100%敏感。结论金黄色葡萄球菌感染部位主要是呼吸系统,医院感染金黄色葡萄球菌的耐药率高于社区感染金黄色葡萄球菌,在制定临床治疗方案时,要区别治疗医院感染和社区感染金黄色葡萄球菌,对预防和治疗金黄色葡萄球菌感染具有重要意义。

OBJECTIVE To explore the distribution and drug resistance rates of Staphylococcus aureus strains causing nosocomial infection and community-acquired infection so as to provide guidance for clinical prevention and treatment of S.aureus infection.METHODS The clinical data of 82 patients with S.aureus infection who were hospitalized from May 2015 to May 2017 were retrospectively analyzed,the enrolled patients were divided into the nosocomial infection group with 56 cases and the community-acquired infection group with 26 cases according to the source of infection.The specimens sources,infection sites and drug resistance rates were observed and compared between the two groups of patients.RESULTS Of totally 17322 patients for whom the culture of pathogens was performed,82 had S.aureus infection,with the infection rate 0.47%;there were 56（68.29%）cases of S.aureus infection in the nosocomial infection group and 26（31.71%）in the community-acquired infection group.There were no significant differences in the sites of S.aureus infection between the two groups.The patients with respiratory tract infection were dominant among the two groups of patients.The S.aureus strains isolated from the two groups of patients were highly resistant to penicillin,oxacillin and amoxicillin,and there were no significant differences.The drug resistance rates of the strains isolated from the nosocomial infection group to rifampin,tetracycline,gentamicin,cotrimoxazole,ciprofloxacin and moxifloxacin were higher than those of the strains isolated from the community-acquired infection,and there were significant differences（P〈0.05）.The drug susceptibility rates of the S.aureus strains isolated from the two groups of patients to vancomycin,dalfopristin,tegafur,linezolid and teicoplanin were 100%.CONCLUSION The respiratory tract is the major infection site of the patients with S.aureus infection.The drug resistance rate of the S.aureus strains causing nosocomial infection is higher than that of the strains causing community-acquired infection.It is of great significance to distinguish the nosocomial infection and the community-acquired infection caused by the S.aureus when the clinical treatment programs are formulated so as to prevent and treat the S.aureus infection.