耐甲氧西林金黄色葡萄球菌的临床分布及危险因素分析

Clinical distribution and risk factors of methicillin-resistant Staphylococcus aureus

目的分析新疆军区总医院2018年耐甲氧西林金黄色葡萄球菌(MRSA)的临床分布特征及危险因素,为治疗及预防金黄色葡萄球菌(SA)感染提供全面、准确的依据。方法收集2018年1-12月新疆军区总医院的MRSA临床分离株进行回顾性分析。结果2018年SA共分离出148株,其中MRSA 45株,占30.41%,重症治疗科病区和骨三科病区比例相对较高。分离出MRSA最多的标本来源为分泌物(20株)和痰液(17株),占全部分离菌株的82.22%。中青年组(≤45岁)是感染占的比例最高的年龄段,达到48.89%。MRSA对苯唑青霉素和青霉素(G)耐药率高达100.00%,对红霉素、克林霉素、四环素耐药率均达到了50.00%以上,未检出对万古霉素、替加环素、利奈唑胺和喹奴普汀/达福普汀耐药的菌株。多因素Logistic回归分析显示,住院时间(>5 d)、手术是MRSA感染的独立危险因素。结论医院需加强对MRSA的持续监测,做好MRSA的主动筛查工作,合理选择抗菌药物治疗方案,预防MRSA的产生和传播,加强抗菌药物合理应用。

Objective To analyze the clinical distribution and drug resistance of methicillin-resistant Staphylococcus aureus(MRSA)in 2018,to provide the basis for clinical treatment Staphylococcus aureus(SA)infection and more comprehensive and accurate understanding of the dynamic of MRSA infection.Methods The clinical isolates of MRSA from January 2018 to December 2018 in the General Hospital of Xinjiang military region were collected for retrospective analysis.Results A total of 148 strains of SA were isolated in 2018,of which 45 strains were MRSA,accounting for 30.41%.The proportion of ICU and Orthopedics was relatively high.The most common MRSA sources were secretions(20 strains)and sputum(17 strains),accounting for 82.22%of the total isolates.The young and middle-aged group(≤45 years old)is the age group with the highest infection proportion,reaching 48.89%.The drug resistance rate of MRSA to oxacillin and penicillin(G)was as high as 100%,and to erythromycin,clindamycin and tetracycline was more than 50%.No strains resistant to vancomycin,tigecycline,linezolid,and quinolone/daptin were detected.Multivariate logistic regression analysis showed that hospital stays more than five days and operations were independent risk factors for MRSA infection.Conclusion The hospital needs to strengthen the continuous monitoring of MRSA,do an excellent job in the active screening of MRSA,choose a reasonable antibacterial treatment plan,prevent the generation and spread of MRSA,and strengthen the rational application of antibacterial drugs.