重症监护室耐甲氧西林金黄色葡萄球菌耐药性及联合药敏分析  

Drug resistance and antimicrobial combination against methicillin-resistant Staphylococcus aureus isolated from ICU patients

作　　者：刘家云[1] 徐修礼[1] 张鹏亮[1] 樊新[1] 孙怡群[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：《中国感染控制杂志》2011年第4期269-271,共3页Chinese Journal of Infection Control

摘　　要：目的了解38株分离自重症监护室的耐甲氧西林金黄色葡萄球菌(MRSA)分布及联合药物体外抗菌活性,以指导临床合理选择抗菌药物。方法以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-Ⅱ细菌分析仪鉴定到种;采用乳胶凝集试剂盒鉴定MRSA。以微量稀释法测定利余唑胺等5种抗菌药物对MRSA的体外抗菌活性,按美国临床实验室标准化研究所标准进行。结果 38株MRSA对利奈唑胺、万古霉素和替考拉宁均敏感;对左氧氟沙星和利福平的耐药率分别为100.00%和78.95%。利福平分别与利奈唑胺、万古霉素和替考拉宁联合,联合抑菌指数(FIC)<1者占13.16%～31.58%;左氧氟沙星分别与利奈唑胺、万古霉素和替考拉宁联合,FIC<1者占2.63%～36.84%;各组联合药物间差异有统计学意义(P<0.01)。结论对ICU病区MRSA感染者治疗时,应参考药敏试验结果并结合患者个体情况合理选择抗菌药物,制定个体优化治疗方案。Objective To investigate drug resistance and antimicrobial combination against 38 strains oi methieil lin-resistant Staphylococcu aureus （MRSA） isolated from intensive care unit （ICU） patients, so as to select rational antimicrobial agents to treat MRSA infection. Methods The isolates were identified by VITEK-2 automatic bacterial identification system and Staphylococcus aureus latex coagulation method, MRSA were detected with Staphylococcus aureus latex coagulation method. Drug susceptibility tests were performed with micro-broth dilution method based on Clinical and Laboratory Standards Institute （CLSI） Standard . Results Thirty eight MRSA stains were sensitive to linezolid （LZD）, vancomycin （VAN）, and teicoplanin （TEC） ; the resistant rate to levofloxacin （LVX） and rifampicin （RIF） was 100. 00% and 78. 95 % respectively. The fractional inhibitional concentration （FIC） 〈1 of RIF combining with LZD,VAN and TEC was 13. 16% - 31. 580/00; The FIC〈1 of LVX combining with LZD,VAN and TEC was 2. 63% -36. 84%, the difference between antimicrobial combination had statistical significance （P〈 0. 01）. Conclusion Rational choice of antimicrobial agents to treat MRSA infection in ICU patients should be according to antimicrobial agents and patients＇ state.

关 键 词：重症监护室 耐甲氧西林金黄色葡萄球菌 抗菌药物 抗药性 微生物 最低抑菌浓度 联合用药 

分 类 号：R378.11[医药卫生—病原生物学]