耐药金黄色葡萄球菌医院感染的临床特征及危险因素分析

Clinical characteristics and risk factors analysis of nosocomial infection caused by drug-resistant Staphylococcus aureus

本研究旨在分析某医院两年来引起医院感染的耐药金黄色葡萄球菌(Staphylococcus aureus,S.aureus)体外药敏试验结果、耐药类型及感染危险因素,探讨其在临床控制耐药菌的发生、医院感染和合理应用抗菌药物方面的参考价值。分析2020—2021年度从本院医院感染患者体内分离的耐药金黄色葡萄球菌的药敏试验结果,并采用单因素和Logistic回归分析探讨耐药金黄色葡萄球菌感染的独立危险因素。结果显示,多重耐药的金黄色葡萄球菌菌株占49.7%(69/139),耐甲氧西林金黄色葡萄球菌(methicillin resistant Staphylococcus aureus,MRSA)菌株占41.0%(57/139),产β-内酰胺酶(BETA-LACT)菌株占72.7%(101/139),克林霉素诱导型(INDUC-CLI)耐药菌株占15.1%(21/139)。金黄色葡萄球菌主要分离自呼吸道和伤口感染部位(36.0%和48.9%),其对多种抗菌药物的耐药率较高,对万古霉素和替加环素敏感率达100%,对利奈唑胺和氯霉素敏感率分别为99.28%和93.85%。回归分析显示,侵入性操作的OR值为3.184,P<0.05。本研究证实金黄色葡萄球菌主要从伤口部位样本分离,临床多重耐药细菌占比较高,多数为耐甲氧西林和产β-内酰胺酶菌株,临床常用抗菌药物的耐药率较高;侵入性操作是耐药S.aureus感染的独立危险因素。

This study analyzed the clinical drug-sensitivity results,types of drug resistance Staphylococcus aureus(S.aureus)isolated from the patients of nosocomial infection and risk factors for nosocomial infection over two years to explore its reference value in clinical control of the occurrence of drug-resistant S.aureus,hospital infection and rational application of antimicrobial drugs.The clinical characteristics and drug resistance of drug-resistant S.aureus isolated from 2020 to 2021 were analyzed,and independent risk factors of nosocomial infection caused by drug-resistant S.aureus in our hospital were explored using univariate and logistic regression.Multi-drug resistant S.aureus accounted for 49.7%(69/139),methicillin resistant S.aureus(MRSA)strains accounted for 41.0%(57/139),β-lactamase-producing strains accounted for 72.7%(101/139),and clindamycin-induced resistant strains accounted for 15.1%(21/139).S.aureus was mainly isolated from respiratory and wound infection sites(36.0%and 48.9%),and it had a high rate of resistance to a variety of antimicrobial drugs,with 100%sensitivity to vancomycin and tigecycline,the sensitivity rate to linezolid and chloramphenicol was 99.28%and 93.85%,respectively.Regression analysis showed OR value of 3.184 for invasive manipulation,with P<0.05.S.aureus was mainly isolated from wound site specimens,with a high occupancy of clinical multi-drug resistant bacteria,mostly are MRSA andβ-lactamase-producing strains,and a high prevalence of common antibiotic resistance.Invasive manipulation is an independent risk factor for drug-resistant S.aureus infection.