耐甲氧西林葡萄球菌临床分布及耐药性变迁分析  

Analysis on the Clinical Distributing and Drug Resistance Change of MRS

作　　者：吴爱武[1] 庾凤娟[1] 徐霞[1] 

机构地区：[1]广州医学院检验系,广东510182

出　　处：《中国自然医学杂志》2006年第3期195-198,共4页Chinese Journal of Natural Medicine

基　　金：广州市医药卫生科技立项课题(项目编号2005YB135)

摘　　要：目的了解不同时期耐甲氧西林葡萄球菌(MRS)临床分布及耐药性变迁情况,为临床合理用药提供参考。方法采用K-B法进行耐甲氧西林葡萄球菌的耐药性检测和筛选。结果不同时期MRS在临床标本中的分布变化不大,主要分布在痰、中段尿、血液、脓液等标本中,但来自血液和脓液标本的比例有所下降(分别从1998年的12.5%和14.6%下降到2005年的6.9%和0.7%);MRS在病区分布上仍主要在内科、外科、ICU等处,但1998年以内科(占45.8%)为主,而2005年以外科(占33.0%)为主;与1998年相比,MRS中仍未出现万古霉素耐药菌株,对红霉素、青霉素仍显示很高的耐药性(耐药率均在75%以上),对氯林可霉素的耐药率则呈增加趋势(MRSA从1998年的77.8%到2005年的100.0%,MRCNS则从1998年的30.6%到2005年的55.5%),MRCNS对庆大霉素耐药率呈下降趋势(从1998年的73.6%到2005年的60.0%);MRS除对万古霉素、利福平和复方磺胺甲唑的敏感性相对较高外,对其他临床常用抗生素均表现较高的耐药性。结论与1998年相比耐甲氧西林葡萄球菌在临床标本和病区的分布变化不大,但来自血液和脓液标本的比率有所下降,内科MRS的分离率呈下降趋势,而外科则呈增加趋势;MRS对临床常用抗生素的耐药性高且呈增加趋势,MRS感染的治疗不能凭经验用药,合理使用抗菌药物以延缓细菌耐药性的产生非常重要。Objective To realize the clinical distributing and drug resistance change of MRS in different periods in order to provide some references for clinical rational drug use. Methods K - B disc agar diffusion method was used to detect the drug resistance of MRS and to filtrate MRS. Results The clinical distrbuting change of MRS was not obvious, MRS mainly came from sputum, urine, blood and pus, but tho MRS isolation proportion from blood and pus fell obviously （the isolation rate of MRSA and MRCNS was 12.5%, 14.6% in 1998 and 6.9%, 0.7% in 2005 respectively）; MRS strains mainly came from internal medicine （45.8%） in 1998 and surgery （33.0%） in 2005. Vancomycin resistance MRS has not been found yet, the clindamycin resistance rate of MRSA and MRCNS was 77.8%, 73.6% in 1998 and 100.0%, 55.5% in 2005 respectively, the resistance rate showed an increasing tendency. The gentamicin resistance rate of MRCNS was 73.6% in 1998 and 60.0% in 2005 respectively, the resistance rate showed a drop tendency. There was a high resistance rate of antibiotics to MRS except vancomycin, rifampicin and TIMP - SMZ. Conclusion From 1998 to 2005, the clinical distrbuting change of MRS was not obvious, but the MRS isolation proportion from blood and pus fell obviously, the MRS isolation rate showed a drop tendency in internal medicine and a increase tendency in surgery. There was a high resistance rate and a increase tendency about MRS drug resistance, so the experience treatment was not commended in MRS infection. It is very important to rationally use antibiotics for delaying drug resistance occurrence.

关 键 词：耐甲氧西林金黄色葡萄球菌 耐甲氧西林凝固酶阴性葡萄球菌 临床分布 耐药性 

分 类 号：R378.11[医药卫生—病原生物学]