住院患儿皮肤软组织感染金黄色葡萄球菌临床特征及耐药性分析

Clinical features and drug resistance analysis of infection in skin and soft tissue in hospitalized children caused by Staphylococcus aureus

目的了解海口市妇幼保健院住院患儿皮肤软组织感染金黄色葡萄球菌临床分布及耐药性,为指导临床抗菌药物的合理使用提供依据。方法收集2013-2017年皮肤软组织感染患儿临床资料,分析病原菌分布及金黄色葡萄球菌药敏试验结果。结果从973份送检标本中共分离金黄色葡萄球菌297株,检出率为30. 52%。其中检出耐甲氧西林金黄色葡萄球菌(MRSA) 119株,占金黄色葡萄球菌的40. 06%。MRSA主要来源于外科、年龄≤1岁和发生复杂性软组织感染的患者,其检出率分别为14. 20%、25. 27%和27. 20%。金黄色葡萄球菌对16种常用抗菌药物的耐药性5年内未发生明显变化,对青霉素G耐药率高达96. 30%～100. 00%;对红霉素的耐药率达64. 80%～77. 90%;对利福平、莫西沙星的耐药率均<10. 00%;对利奈唑胺、替加环素、万古霉素、呋喃妥因和喹努普汀/达福普汀均未产生耐药性。结论住院患儿皮肤软组织感染金黄色葡萄球菌中MRSA所占比例较高,应依据药敏结果合理用药,需重点关注外科低龄患儿复杂性软组织感染MRSA的预防和控制。

Objective To investigate clinical features and drug resistance of infection in skin and soft tissue in hospitalized children from Haikou Maternity and Child Care Hospital caused by Staphylococcus aureus,so as to provide basis for the clinical reasonable use of antibiotics.Methods Collecting clinical data of children with skin and soft tissue infection from 2013 to 2017 and analyzing the distribution of pathogenic bacteria and S.aureus drug sensitivity test results.Results 297 strains of Staphylococcus aureus were detected from 973 specimens,that accounted for 30.52%.Totally 119 strains of Methicillin-resistant Staphylococcus aureus were isolated,which accounted for 40.06%.MRSA mainly isolated from Surgical,age ≤1 year old and with complex soft tissue infection,accounted for 14.20%,25.27% and 27.20% respectively.In 5 years,the resistance of Staphylococcus aureus to 16 commonly used antimicrobial drugs did not change significantly,and the resistance to penicillin G was the strongest,and the resistance ate was as high as 96.30%-100.00%.The resistance to Erythromycin was followed with the resistance rate of 64.80%-77.90%;the resistance to Rifampicin and Moxifloxacin was low with the resistance rate of both < 10.00%.There was no resistance to Linezolid,Tetracycline,Vancomycin,Kuinupu and Dafuputing.Conclusion The proportion of MRSA in the skin and soft tissue infection is high in hospitalized children.Antibiotics should be used reasonably according to the drug sensitivity results.It is necessary to focus on the prevention and control of complex soft tissue infection of MRSA in young surgical children.