金黄色葡萄球菌分离株在住院患者中的临床分布及耐药性分析

Clinical distribution and drug resistance of Staphylococcus aureus isolates from inpatients

目的探讨某医院住院患者感染金黄色葡萄球菌分离株的临床分布特征及耐药状况,为临床抗感染治疗提供科学依据。方法选取2021年9月—2023年3月宣城市中心医院收治的金黄色葡萄球菌感染患者作为研究对象,通过聚合酶链反应(polymerase chain reaction,PCR)检测金黄色葡萄球菌的耐药基因mec A和杀白细胞素(Panton-Valentine leukocidin,PVL)基因,采用SPSS 20.0和WHONET 5.6软件分析金黄色葡萄球菌感染的临床分布特征及耐药状况。结果共有133例金黄色葡萄球菌感染患者纳入分析,单个科室中占比前两位的是呼吸与危重症医学科(21.8%,29/133)和重症医学科(18.8%,25/133)。感染主要类型为皮肤疖痈、褥疮类感染,占47.4%(63/133);上、下呼吸道感染分别占23.3%(31/133)、13.5%(18/133)。药敏结果显示金黄色葡萄球菌对万古霉素、利奈唑胺、替加环素、呋喃妥因及利福平敏感率为100.0%,对青霉素的耐药率最高(88.0%),其后为红霉素、克林霉素,耐药率分别为34.6%、30.1%。耐甲氧西林金黄色葡萄球菌检出率为23.3%(31/133)。31株耐甲氧西林金黄色葡萄球菌中有30株携带耐药基因mec A,6株携带PVL基因,其中5株同时携带mec A和PVL基因。结论宣城市中心医院住院患者感染金黄色葡萄球菌主要来自呼吸与危重症医学科和重症医学科,对青霉素、红霉素、克林霉素等药物耐药率较高,应根据药敏试验合理规范地选择抗菌药物治疗感染。

Objective To investigate the patterns of clinical distribution and drug resistance of Staphylococcus aureus strains isolated from hospitalized patients in a hospital for scientific evidence in the treatment of the infection in clinic.Methods Patients with Staphylococcus aureus infection treated in XuanCheng City Central Hospital were included from September 2021 to March 2023 as study subjects.The resistance genes mecA and Panton-Valentine leukocidin(PVL)of Staphylococcus aureus were detected by polymerase chain reaction(PCR),SPSS 20.0 and WHONET 5.6 soft-ware was used to analyze the clinical distribution patterns and drug resistance status of Staphylococcus aureus infection.Results A total of 133 patients with Staphylococcus aureus infections were included in the analysis.Among single de-partment,the top two departments were Pulmonary and Critical Care Medicine(21.8%,29/133)and the Intensive Care Unit(18.8%,25/133).The major types of infection were skin furuncle&carbuncle and bedsore(47.4%,63/133)as well as involvement of upper respiratory tract(23.3%,31/133)and lower respiratory tract(13.5%,18/133).The drug suscep-tibility tests showed that Staphylococcus aureus was 100.0%sensitive to vancomycin,linezolid,tigecycline,nitrofuran-toin and rifampicin.The resistance rate to penicillin was the highest,88.0%,followed by crythromycin and clindamycin,34.6%and 30.1%,respectively.The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)was 23.3%(31/133).Of 31 MRSA strains,30 carried mecA gene,6 carried PVL gene,and 5 carried both mecA and PVL genes.Conclusion Staphylococcus aureus infection in hospitalized patients in XuanCheng City Central Hospital primarily occurred in patients from Pulmonary and Critical Care Medicine and Intensive Care Unit.The rate of resistance to peni-cillin,erythromycin,clindamycin and other antibiotics was high,antibiotics should be rationally prescribed and standard-ized according to the drug susceptibility test results in clinical management of the infection.