2013-2017年老年病医院金黄色葡萄球菌临床分布及耐药性分析

Clinical distribution and antimicrobial resistance of Staphylococcus aureus in a geriatric hospital from 2013 to 2017

目的了解某老年病医院金黄色葡萄球菌临床分布及耐药性变化趋势,为临床合理使用抗菌药物及有效控制医院感染提供依据。方法采用回顾性分析方法,对2013-2017年某医院住院患者分离的701株金黄色葡萄球菌进行标本来源、科室分布、耐药性变化等分析,数据采用WHONET 5.4和SPSS 13.0软件进行分析。结果2013-2017年共分离细菌14 363株,其中金黄色葡萄球菌701株,分离率4.88%,5年分离率呈逐年下降趋势(Trend χ^2=56.691,P<0.001);标本来源主要为痰,共493株占70.33%;分离科室主要为呼吸内科228株占32.52%、重症监护室174株占24.82%;药敏分析表明,对青霉素耐药率>80%;对利奈唑胺、奎奴普丁/达福普汀、替加环素、呋喃妥因、万古霉素敏感率为100.00%;对四环素、利福平、庆大霉素、左氧氟沙星的耐药率呈逐渐降低趋势(P<0.05)。结论该院金黄色葡萄球菌分离率呈逐年下降趋势;分离菌主要来源于痰标本,科室分布主要在呼吸内科、重症监护室;对多种抗菌药物耐药率虽有所下降,仍应加强监测,根据药敏结果、药物不良反应等合理选用治疗药物。

OBJECTIVE To analyze the clinical distribution and antimicrobial resistance of Staphylococcus aureus in a geriatric hospital, so as to guide the rational use of antibiotics and to provide basis for the prevention and control of nosocomial infection. METHODS A retrospective analysis was carried out on the specimen source, department distribution and drug resistance variation for the 701 strains of S. aureus isolated from inpatients in a hospital from 2013 to 2017. The data were analyzed by using WHONET 5.4 and SPSS 13.0 software. RESULTS A total of 14363 strains of bacteria were isolated from 2013 to 2017, including 701 strains of S. aureus with the isolation rate of 4.88%, and the isolation rate showed a decreasing trend(Trend χ^2=56.691,P<0.001).The samples were mainly from sputum(493 strains, 70.33%).The main departments were respiratory medicine(228 strains, 32.52%) and intensive care units(174 strains, 24.82%).The resistant rate of S. aureus to Penicillin was >80%. The sensitivity of S. aureus to linezolid, quinupristin/dalofopine, tigecycline, nitrofurantoin and vancomycin was 100.00%. The resistant rates of S. aureus to tetracycline, rifampicin, gentamicin and levofloxacin were gradually decreasing(P<0.05). CONCLUSION The detection rate of S. aureus in the hospital decreased from 2013 to 2017.The samples were mainly from sputum and the main departments were respiratory medicine and intensive care units. Although the resistant rates of S. aureus to various antibiotics are decreasing, the rational use of antibiotics should still be monitored and antibiotics should be selected according to the results of antimicrobial susceptibility test and adverse reactions.