慢性鼻-鼻窦炎伴或不伴鼻息肉患者中金黄色葡萄球菌的耐药特点及MRSA感染的危险因素分析

Drug resistance characteristics of Staphylococcus aureus and risk factors of MRSA infection in chronic rhinosinusitis with or without nasal polyps

目的探讨慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)或不伴鼻息肉(CRSsNP)患者中金黄色葡萄球菌(SA)的耐药特点及耐甲氧西林金黄色葡萄球菌(MRSA)感染的危险因素。方法收集CRSwNP和CRSsNP分离的SA各100株,用全自动微生物分析仪测定SA药物敏感性,多因素Logistic回归分析MRSA感染的危险因素。结果MRSA在CRSwNP和CRSsNP中分离率的差异无统计学意义(P>0.05)。CRSwNP中MRSA对环丙沙星和左氧氟沙星耐药率明显高于CRSsNP(P<0.05),而克林霉素低于CRSsNP(P<0.05)。CRSwNP感染MRSA的独立危险因素是鼻部解剖变异、抗菌药物使用时间>14d、手术次数>1次和男性,而CRSsNP为鼻部解剖变异、抗菌药物使用时间>14d、变应性鼻炎和男性(P<0.05或0.01)。结论CRSwNP和CRSsNP中MRSA对环丙沙星、左氧氟沙星和克林霉素耐药性存在明显差异;鼻部解剖变异、抗菌药物使用时间>14d和男性均是两者感染MRSA的独立危险因素。

Objective To investigate the drug resistance characteristics of Staphylococcus aureus (SA) and risk factors of methicillin resistant staphylococcus aureus (MRSA) infection in chronic rhinosinusitis with nasal polyps (CRSwNP) or without nasal polyps (CRSsNP). Methods Drug susceptibility of 200 SA strains from CRSwNP and CRSsNP was determined by automatic microbiological analyzer. Risk factors of MRSA infection were analyzed by multivariate logistic regression. Results The isolation rate of MRSA was comparable between CRSwNP and CRSsNP (P>0.05). Compared with CRSsNP, MRSA was resistant to ciprofloxacin and levofloxacin but sensitive to clindamycin in CRSwNP (P<0.05). Nasal anatomy variation, duration of antimicrobial use >14 d, operation frequency >1, and men were independent risk factors of MRSA infection in CRSwNP, while nasal anatomy variation, duration of antimicrobial use >14 d, allergic rhinitis, and men were independent risk factors in CRSsNP. Conclusion Drug resistance of MRSA against ciprofloxacin, levofloxacin and clindamycin is different between CRSwNP and CRSsNP. Nasal anatomy variation, duration of antimicrobial use >14 d and men are independent risk factors of MRSA infection in both CRSwNP and CRSsNP.