耐甲氧西林金黄色葡萄球菌的分布及联合药物体外抗菌活性分析  

Distribution of methicillin-resistant staphylococcus aureus and in vitro antibacterial activity of combined drugs

作　　者：徐修礼[1] 张鹏亮[1] 樊新[1] 刘家云[1] 孙怡群[1] 郝晓柯[1] 

机构地区：[1]第四军医大学西京医院全军临床检验医学中心,陕西西安710032

出　　处：《中华医院感染学杂志》2011年第9期1895-1897,共3页Chinese Journal of Nosocomiology

摘　　要：目的了解110株耐甲氧西林金黄色葡萄球菌(MRSA)的分布及联合用药对其体外的抗菌活性,以指导临床治疗MRSA感染合理选择抗菌药物。方法常规方法培养分离细菌,用金黄色葡萄球菌乳胶试剂盒及VITEK-2细菌分析仪鉴定到种,MRSA鉴定应用乳胶凝集试剂盒;利用微量稀释法测定利奈唑胺等5种抗菌药物的物体外抗菌活性,按CLSI规定的标准进行。结果从医院感染的标本中分离获得110株MRSA,ICU分离率为36.4%;110株MRSA对利奈唑胺、万古霉素、替考拉宁均敏感;对左氧氟沙星、利福平耐药率分别为96.3%和71.8%;利福平分别与利奈唑胺、万古霉素、替考拉宁联合FIC<1的协同作用均>74.5%,左氧氟沙星分别与利奈唑胺、万古霉素、替考拉宁联合FIC<1的协同作用均<35.4%;各种联合药物间差异有统计学意义(P<0.01)。结论医院ICU是MRSA感染的重要来源,应对其加强医院感染的监测和控制;利奈唑胺、万古霉素、替考拉宁是治疗MRSA感染的首选药物,对中重度感染患者应参考药敏试验结果及患者的个体情况结合联合药物进行优化治疗。OBJECTIVE To understand the distribution and in vitro antibacterial activity of combined-use of drugs against 110 strains methicillin-resistant Staphylococcus aureus（MRSA） in order to indicate the rational use of antimicrobial agents to treat MRSA.METHODS All isolates were identified by routine procedure and Staphylococcus aureuslatex Coagulation method and VITEK-2 automatic bacterial identification instrument.MRSA were identified by latex Coagulation method.In vitroantibacterial activity of 5 kinds of antibiotics such as linezolid was determined by using micro broth dilution method following the instruction of CLSI.RESULTS A total of 110 stains of MRSA were isolated from nosocomial infectious specimen.The isolated rate of ICU ward was 36.4%.110 strains MRSA were all sensitive against linezolid（LZD）,teicoplanin（TEC） and vancomycin（VAN）.The resistant rates of levofloxacin（LVX） and rifampicin（RIF） were 96.3% and 71.8%,respectively.The FIC〈1 of RIF combining LZD,VAN and TEC was 74.5% upper,but the FIC〈1 of LVX combining LZD,VAN and TEC was 35.4% low.The differences between combined-use of antibiotics were significant.CONCLUSIONS MRSA is important source of infection in ICU ward.It should enhance nosocomial infectious control and supervision.LZD,VAN and TEC are the best choices to treat MRSA infection.The optimized treatments should be performed for the moderate and sever patients by using combination antibiotics according to the drug sensitive test results and patient self-situation.

关 键 词：耐甲氧西林金黄色葡萄球菌 抗菌药物 最低抑菌浓度 联合用药 

分 类 号：R378.11[医药卫生—病原生物学]