脓毒症金黄色葡萄球菌感染监测及治疗体会  

Monitoring and treatment of Staphylococcus aureus infection in patients with sepsis

作　　者：刘杜姣[1] 张新玲[2] 李菊莲[2] 贺建萍[3] 彭俊华[3] 金远林[1] 朱运奎[1] 

机构地区：[1]兰州军区兰州总医院呼吸内科,兰州730050 [2]兰州军区兰州总医院感染控制科,兰州730050 [3]兰州军区兰州总医院细菌室,兰州730050

出　　处：《中国实用内科杂志》2011年第2期149-151,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的分析常见抗菌药物敏感性及对确诊金黄色葡萄球菌感染脓毒症患者目标性治疗情况。方法收集兰州军区兰州总医院2009年1—3月送检血液标本及2010年1—3月送检的多种标本(血液、痰、支气管肺泡灌洗液等)。筛选送检的阳性标本中2次或2次以上培养出同一种金黄色葡萄球菌的脓毒症患者72例,记录用药情况,病情转归。结果 2010年1—3月共收集各种微生物标本3153份,检出阳性标本1108份,分离出细菌和真菌1557株,其中金黄色葡萄球菌106株(6.81%),耐甲氧西林金黄色葡萄球菌(MRSA)61株,占金黄色葡萄球菌的57.55%;2009年及2010年血液标本中金黄色葡萄球菌检出率分别为8.33%和10.71%。MRSA对万古霉素、利奈唑胺敏感性相当,对万古霉素耐药率为4.92%。对确诊金黄色葡萄球菌感染患者进行目标性治疗,临床疗效较好。结论金黄色葡萄球菌是脓毒症患者重要致病菌之一,耐药率较高,2010年同期检出率高于2009年,利奈唑胺是治疗耐药金黄色葡萄球菌感染的良好选择。Objective To detect Staphylococcus aureus in patients with sepsis and their sensitivity to common antibiotics, so as to observe the clinical response to target treatment with linezolid, vancomycin and teicoplanin to the confirmed Staphylococcus aureus infection patients with sepsis. Methods We collected the blood samples at 2 phases, January to March,2009 and January to March,2010. And during January to March 2010, at sputum, BAL fluid samples were colleted. The totally 72 sepsis patients confirmed with Staphylococcus aureus infection were in- cluded ,45 males and 27 females ,with the age ranged 15 -90 years old. They received target treatment by linezol- id, vancomycin and teicoplanin;the clinical response was observed. Results A total of 3153 samples were collected, 1108 gram positive isolates were detected,with 1557 isolated bacteria and fungi,including lab strains of Staph- ylococcus aureus, accounting for 6. 81% of all isolates. Methicillin-resistant Staphylococcus aureus were 61 （57.55%） strains of Staphylococcus aureus. In 2009 and 2010, the blood samples Staphylococcus aureus positive rates were 8.33% , 10. 71% , respectively. Methicillin-resistant Staphylococcus aureus were sensitive to vancomycin and linezolid, while 4. 92% were resistant to vancomycin. The target treatment to confirmed Staphylococcus aureus infection patients with sepses had a favorable clinical response. Conclusion Staphylococcus aureus is an important pathogen in patients with sepsis and possessed high resistance to antibioties;over the same period from 2009 to 2010,taphylococcus aureus was increased. Linezolid is a favorable choice in the treatment of antibiotics resistant strains.

关 键 词：利奈唑胺 金黄色葡萄球菌感染 恶性血液病 

分 类 号：R5[医药卫生—内科学]