某院新生儿科6年间金黄色葡萄球菌临床分离株的分布及耐药情况

Resistant phenotype and clinical distribution of Staphylococcus aureus from neonatal department of a hospital in six years

目的了解该院新生儿科2012—2017年间分离出金黄色葡萄球菌(SA)临床分布情况及耐药性分析,为临床经验治疗SA相关感染和新生儿院内感染控制提供科学依据。方法回顾性分析2012年1月—2017年12月宜宾市第一人民医院新生儿科住院患者分离的SA的标本分布并采用WHONET5.6软件进行耐药性分析。结果6年间该科共送检细菌培养标本25543份,共分离出不重复SA509株检出率为1.99%。SA标本来源首位是呼吸道标本占86.25%,其次为脓液占5.11%,全血与分泌物标本各占3.54%;509株SA中甲氧西林敏感的金黄色葡萄球菌(MSSA)407株(79.96%),检出耐甲氧西林金黄色葡萄球菌(MRSA)102株,MRSA检出率为0.4%,占比为20.04%;MSSA除对庆大霉素耐药性高于MRSA外,其余抗生素耐药性均较MRSA低,差异具有统计学意义(P<0.05)。MRSA对红霉素、克林霉素耐药率分别为77.5%和62.7%,对四环素耐药率为45.1%,对复方磺胺甲噁唑耐药率为20.6%,对喹诺酮类、氨基糖苷类、利福平的耐药率均在10%以下。未发现万古霉素、利奈唑胺非敏感菌株。结论该院新生儿SA感染以呼吸道感染为主,新生儿MRSA的检出率及占比与国内已有报道存在较大差异,这可能与年龄段及地区差异有关。由于新生儿感染SA尤其MRSA感染的经验治疗可选抗菌药物非常有限。因此,一旦发生疑似感染应参考本院耐药检测数据及有关诊疗指南积极治疗并进一步采取有效感控措施,减少SA尤其是MRSA传播感染。

Objective To investigate the resistant phenotype and clinical distribution of Staphylococcus aureus from the neonatal department of a hospital from 2012 to 2017,and to provide scientific basis for selecting antibiotics in empirical therapy of Staphylococcus aureus infections and nosocomial infection control.Methods The data of resistant phenotype and clinical distribution of Staphylococcus aureus from the neonatal department of the First People's Hospital of Yibin City were analyzed by WHONET5.6 from 2012 to 2017.Results In the past six years,the Neonatology sent a total of 25,543 samples of bacterial culture samples.A total of 509 strains of Staphylococcus aureus were isolated,the detection rate was 1.99%.The dominant source of pathogens was respiratory tract specimen(86.25%),followed by pus(5.11%),blood(3.54%)and secretion(3.54%).The detection rate of methicillin-sensitive Staphylococcus aureus(MSSA)was 79.96%(407/509),and the proportion of methicillinresistant Staphylococcus aureus(MRSA)was 20.04%(102/509).The resistance rate of MSSA against gentamycin was higher than that of MRSA and the resistance rates of MSSA against other antibiotics were lower than those of MRSA.These differences have statistical signifficances(P<0.05).The resistant rates of MRSA against erythromycin,clindamycin,tetracycline and sulfamethoxazole compound of MRSA were 77.5%,62.7%,45.1%,and 20.6%,respectively.The resistance rates to quinolones,aminoglycosides and rifampicin were below 10%.Vancomycin and linezolid resistant strains were not found.Conclusion Staphylococcus aureus infections were mainly respiratory infections in the newborns of the hospital.The detection rate of neonatal MRSA was quite different from that reported in China before,which might be related to age and regional differences.Neonatal infections of Staphylococcus aureus,especially MRSA infections,are very limited in the treatment of antimicrobial agents.Thus,it is necessary to take active treatment and take effective measures to reduce Staphylococcus aureus,especially MRSA,once the suspected infection occurs.