耐甲氧西林金黄色葡萄球菌感染的临床流行特点及耐药率监测  

Clinical feature of methicillin-resistant Staphylococcus aureus infection and monitor of drug resistance

作　　者：秋爽[1] 宋志香[2] 殷显德[1] 刘晓燕[1] 陈炜[3] 

机构地区：[1]北京世纪坛医院急诊科,北京100038 [2]北京世纪坛医院感染管理办公室,北京100038 [3]北京世纪坛医院重症监护病房,北京100038

出　　处：《临床荟萃》2009年第6期509-512,共4页Clinical Focus

摘　　要：目的探讨耐甲氧西林金黄色葡萄球菌(MRSA)感染的临床流行特点及其耐药率的监测,以期指导临床用药的合理性。方法采用回顾性方法对2001～2007年本院住院患者(2003年由于非典流行未做统计)痰、尿、血标本培养结果进行统计分析,并对其中金黄色葡萄球菌菌型分布、耐药性、MRSA的流行趋势进行评定。结果①分离出金黄色葡萄球菌3754株(15.2%),为球菌感染的第2位。其中MRSA3480株(92.7%),来源于60岁以上患者3360株(89.5%);甲氧西林敏感的金黄色葡萄球菌(MSSA)274株(7.3%)。MRSA标本的构成为院内感染2718株(78.1%);院外感染762株(21.9%);标本分布为痰3303株(94.9%),尿71株(2.0%),血106株(3.0%);②MRSA阳性检出率由2001年的7.3%增加至2007年的17.1%,有逐年增长的趋势(趋势χ2=115.276,P=0.000),而MSSA的阳性检出率变化不大(χ2=3.371,P>0.05)。③MRSA对20种常用抗生素的平均耐药率2001～2007年分别为79.9%、83.2%、78.4%、80.6%、77.1%、79.6%;MRSA除对万古霉素未产生耐药外,其他抗生素都产生了较高的耐药性,其中最高的为青霉素类、头孢菌素类、大环内酯类和环丙沙星,耐药率均在80%以上;磺胺甲口恶唑/甲氨嘧啶耐药率逐年下降分别为97.8%、69.7%、45.2%、31.6%、13.5%、3.8%。结论MRSA的检出率逐年升高及对抗生素多重耐药仍然是医院感染治疗的重要问题,制定对策以提高抗生素合理应用和院内感染防控水平甚为重要。Objective To investigate the clinical epidemiological characteristics and drug resistance of methicillin-resistant Staphylococcus aureus（MRSA） and to instruct rational administration. Methods A retrospective observational study was carried out in the hospital from 2001 to 2007 years（2003 was not covered for the SARS attack） ,specimens isolated from sputum,urine and blood of the patients were investigated and the distribution of the type, resistance and epidemiological characteristics of MRSA were evaluated. Results ①3 745 （15.2%） Staphylococcus aureus were isolated. Staphylococcus aureus was in the second place in Staphylococci infection. Among them,MRSA was 3 480 （97.2%）, MSSA 274 （7.3%）. 3 360 （89.5%） MRSA were isolated from specimens of the patients above 60 years old. 2 718 （78.1%） MRSA specimens were isolated from the hospital-acquired patients . 762 （21.9%） MRSA specimens were isolated from the community-acquired patients. Distributions of specimens were obtained 3 303 （94.9%） MRSA from sputum,71（2.0%） MRSA from urine and 106 （3.0%） MRSA from blood. O The detection rate of MRSA increased from 7.3% in 2001 to 17.1% in 2007. The yearly increasing tendency was notable（x^2 =115. 176, P =0. 000）. But the detection rate of MSSA did not change significantly. ②Through 2001 to 2007, the average drug-resistance rate of MRSA to 20 commonly-used antibiotics was 79.9 % ,83.2 %, 78.4 %, 80.6%, 77.1%, 79.6%. MRSA had resistance to most antibiotic except vancocin. The top of them were penicillins, cephalosporins,macrolides, Ciprofloxacin. the drug-resistance rates of MRSA were above 80%. But the resistance to sulfamethoxine decreased yearly with 77.8% ,69.7% ,45.2% ,31.6% ,13.5% ,3.8%. Conclusion The most impotant issues of nosocomial infections still are the increasing detection rate of MRSA and multidrug resistance to antibiotics. It is impotant to make the strategy of rational administration and to control and prevent nosocomial infection.

关 键 词：葡萄球菌 金黄色 甲氧西林 抗药性 交叉感染 

分 类 号：R515.92[医药卫生—内科学]