金黄色葡萄球菌耐药性变迁及抗菌药物应用分析  

Change of drug resistance of Staphylococcus aureus and use of antibiotics

作　　者：陈叶红[1] 丁洁卫[1] 金燕[1] 张林[1] 张生大[1] 

机构地区：[1]绍兴市人民医院药剂科,浙江绍兴312000

出　　处：《中华医院感染学杂志》2014年第2期342-344,共3页Chinese Journal of Nosocomiology

摘　　要：目的了解医院感染金黄色葡萄球菌的分布、耐药性变化及相应抗菌药物的使用情况，为控制医院感染和临床合理选用抗菌药物提供依据。方法采用K—B纸片扩散法进行抗菌药敏试验，采用限定日剂量（DDD）、用药频度（DDDs）等指标，按季度对抗菌药物的使用情况进行分析。结果全年共分离出金黄色葡萄球菌320株，其中耐甲氧西林金黄色葡萄球菌（MRSA）68株，占21．3％；阳性标本主要来源于痰液及咽拭子195株占60．9％，其次是脓液56株占17．5％；4个季度金黄色葡萄球菌对青霉素G耐药率均〉90．0％；对红霉素耐药率〉50．0％；对克林霉素耐药率48．7％～57．3％；全年发现1株耐替考拉宁菌株；未发现耐呋喃妥因、喹奴普汀／达福普汀、利奈唑胺、替加环素、万古霉素菌株；15种抗菌药物中各季度DDDs排序一直在前5位的是左氧氟沙星注射液、注射用青霉素、注射用磷霉素、左氧氟沙星片、注射用氨苄西林／舒巴坦。结论MRSA主要引起下呼吸道感染，检出率相对较低，要继续加强耐药性监测；可将替考拉宁、呋喃妥因、喹奴普汀／达福普汀、利奈唑胺、替加环素、万古霉素作为保护性用药，合理使用抗菌药物。OBJECTIVE To understand the clinical distribution and change of drug resistance of Staphylococcus au- reus and observe the use of antibiotics so as to provide guidance for control of nosocomial infections and reasonable clinical use of antibiotics. METHODS The drug susceptibility testing was conducted by K-B methods, then the use of antibiotics was analyzed in terms of quarters by determining the DDD and DDDs. RESULTS Totally 320 strains of S. aureus were isolated, among which there were 68 （21.3%） strains of methicillin-resistant S. aureus（MR- SA）. There were 195 （60.9%） isolates of S. aureus isolated from the sputum and throat swab specimens and 56 （17.5 %） isolates of S. aureus isolated from the pus. The drug resistance rate of the S. aureus strains to penicilli G were over 90.0% in the four quarters% the drug resistance rate to erythromycin was more than 50.0 % the drug resistance rate to clindamycin varied from 48.7 %to 57.3 % ; only one isolate of teicoplanin-resistant S. aureus was detected in the whole year; the strains resistant to nitrofurantoin, quinupristin-dalfopristin, linezolid, tigecycline, or vancomycin have not been detected. Among the 15 tested antibiotics, the levofloxacin injection, benzylpenicillin sodium for injection, fosfomycin sodium for injection, levofloxacin tablets, ampicillin sodium, and sulbactam sodi- um for injection ranked the first five of DDDs in each quarter. CONCLUSION The MRSA is the main cause of lower respiratory tract infection, and the detection rate was relatively low; the drug resistance surveillance needs to be further strengthened; the teicoplanin, nitrofurantoin, quinupristin-dalfopristin, linezolid, and vancomycin should be used as protective antibiotics, which should be used reasonably.

关 键 词：金黄色葡萄球菌 耐药性 抗菌药物 应用分析 

分 类 号：R378.11[医药卫生—病原生物学]