2015—2020年杭州市某医院儿童耐甲氧西林金黄色葡萄球菌感染的分布特征及耐药性变迁

Distribution characteristics and drug resistance changes of methicillin-resistant Staphylococcus aureus infection in children in a hospital in Hangzhou,from 2015 to 2020

目的 分析儿童感染耐甲氧西林金黄色葡萄球菌(methicillin resistant Staphylococcus aureus,MRSA)的分布特征及对常用抗菌药物耐药性变迁情况,为临床规范、合理使用抗菌药物提供参考。方法 选取2015年—2020年杭州市儿童医院患儿送检的病原学标本中,检出SA的标本作为研究对象,去除同一患儿、相同部位的重复菌株。使用VITEK-2 Compact全自动细菌鉴定仪进行细菌鉴定、药敏试验,用苯唑西林耐药来确认MRSA菌株,对不同年份、年龄、来源及病种的MRSA层次分布进行统计分析,并比较MRSA与甲氧西林敏感金黄色葡萄球菌(MSSA)的多药耐药性。结果 研究年限内分离到儿童SA菌株2 850株;其中,MRSA占比23.79%(678/2 850),且逐年升高(χ^(2)=11.665,P<0.05)。低龄组的MRSA构成比(75.96%)高于高龄组(24.04%);来源于呼吸道的标本最多(85.99%),以肺炎的MRSA占比最高(58.26%)。MRSA菌株对红霉素、克林霉素的耐药率(81.56%、79.35%)高于MSSA(45.44%、41.50%),差异均有统计学意义(P<0.05);前后三年对比,MRSA对红霉素、克林霉素的耐药率分别由85.48%、83.10%下降至76.36%、74.03%,差异有统计学意义(χ^(2)=8.499、8.640,均P<0.05)。复方新诺明、左氧氟沙星、环丙沙星、莫西沙星对MRSA、MSSA均保持较好的敏感性。结论 低龄儿童更易感染MRSA,呼吸道标本来源最多。复方新诺明等多种抗菌药物可应用于儿童MRSA感染的临床治疗。

Objective To analyze the distribution characteristics of methicillin-resistant Staphylococcus aureus(MRSA) in children infected with MRSA and the changes of resistance to commonly used antibiotics,so as to provide reference for clinical standardization and rational use of antibiotics.Methods From 2015 to 2020,the pathogenic samples of children from Hangzhou Children’s Hospital were selected,and the samples with SA were selected as the research object,and the duplicate strains of the same patient and the same part were removed.VITEK-2 Compact fully automatic bacterial identification instrument was used for bacterial identification and drug sensitivity test.Oxacillin resistance was used to confirm MRSA strain.Statistical analysis was made on the hierarchical distribution of MRSA in different years,ages,sources,and disease species.The multi-drug resistance of MRSA and methicillin sensitive Staphylococcus aureus(MSSA) was compared.Results A total of 2 850 strains of SA were isolated from children during the study period.Among them,MRSA accounted for 23.79%(678/2 850) and increased year by year(χ^(2)=11.665,P<0.05).The composition ratio of MRSA in the younger group(75.96%) was higher than that in the older group(24.04%).The samples from respiratory tract were the most(85.99%),and MRSA from pneumonia accounted for the highest(58.26%).The resistance rate of MRSA strains to erythromycin and clindamycin(81.56%,79.35%) was higher than that of MSSA strains(45.44%,41.50%).The differences were statistically significant(P<0.05).Compared with the previous three years,the drug resistance rate of MRSA to erythromycin and clindamycin decreased from 85.48% and 83.10% to 76.36% and 74.03%,respectively.The differences were statistically significant(P<0.05).MRSA and MSSA were sensitive to compound sulfamethoxazole,levofloxacin,ciprofloxacin,and moxifloxacin.Conclusions Young children are more likely to be infected with MRSA,and the source of respiratory tract samples is the most.Compound sulfamethoxazole and other antibacterial agents can be used in the clinical treatment of children with MRSA infection.