医院感染金黄色葡萄球菌的耐药性与临床分布

Drug-resistance and clinical distribution in nosocomial infections with Staphylococcus aureus

目的调查该院2009~2013年间金黄色葡萄球菌(SA)的耐药性与临床分布,为临床用药提供指导。方法对SA的耐药性和标本来源进行回顾性调查分析,使用ATB细菌鉴定仪及配套细菌鉴定条进行菌株鉴定,采用K-B法执行药敏试验。结果共分离到562株SA,主要来自分泌物、痰液和脓液,其中耐甲氧西林金黄色葡萄球菌(MRSA)218株,占总数的38.79%。SA对青霉素的耐药率最高,其次是红霉素和克林霉素。所有菌株均对万古霉素、阿米卡星、呋喃妥因和利奈唑胺敏感。MRSA对青霉素、红霉素、复方磺胺甲噁唑、克林霉素、庆大霉素、头孢西丁、四环素和利福平的耐药率高于甲氧西林敏感金黄色葡萄球菌(MSSA),二者的耐药性差异具有统计学意义(P<0.05)。结论该院SA和MRSA分离率有逐年下降的趋势,但耐药状况仍然严重,万古霉素依然是临床治疗的首选药物。因此,加强SA耐药性监测,避免抗菌药物的滥用,是预防SA感染的有效措施。

Objective To investigate the drug resistance and distribution of Staphylococcus aureus isolated from infected pa‐tients in our hospital from 2009 to 2013 ,and provide basis for clinical treatment .Methods Retrospective review was adopted to an‐alyze the antibiotic resistance and the specimen source of 562 SA strains .ATB Expression and ID 32 STAPH were used to identify SA .Antibiotic susceptibility testing was performed by K‐B method .Results 562 SA strains ,including 218 MRSA ,are mainly from secretions ,sputum and pus .Resistance was most frequently observed on penicillin ,followed by erythromycinand clindamycin .None of the isolates was resistant to vancomycin ,amikacin ,nitrofurantoin and linezolid .The resistance rates of MRSA to penicillin ,eryth‐romycin ,cotrimoxazole ,clindamycin ,gentamicin ,cefoxitin ,tetracycline and rifampicin were obviously higher than that of MSSA ,and there are very significant differences between them (P<0 .05) .Conclusion There is a declining trend in the isolation rates of SA and MRSA in our hospital ,but the drug resistance situation remains serious .Vancomycin is still the first option for the cure of MR‐SA infections .Therefore ,strengthening SA resistance monitoring and avoiding misuse of antimicrobial drugs is an effective way to prevent SA infection .