医院获得性耐甲氧西林金黄色葡萄球菌感染回顾性分析  

Nosocomial infection of methicillin-resistant Staphylococcus aureus:a retrospective anylysis

作　　者：邢茜[1] 江荣林[2] 马伟斌[2] 雷澍[2] 王灵聪[2] 智屹惠[2] 吴艳春[2] 黄立权[2] 朱美飞[2] 

机构地区：[1]浙江中医药大学第一临床医学院,杭州310053 [2]浙江中医药大学附属第一医院ICU

出　　处：《浙江医学》2014年第4期307-310,共4页Zhejiang Medical Journal

摘　　要：目的分析医院获得性耐甲氧西林金黄色葡萄球菌(MRSA)感染的高危因素、药物敏感率和临床转归,为临床诊治MRSA感染提供依据。方法对临床送检各类标本中分离出的110例次MRSA,按照科室分布、标本种类、药物耐药性及临床疗效等进行回顾性分析。结果医院获得性MRSA主要分布于ICU、神经内科、干部科,感染主要来源于痰液、手术切口分泌物、皮肤创面分泌物,分别占68.2%、11.8%和8.2%,对青霉素类、头孢菌素类、碳青霉烯类敏感率为0,对氟喹诺酮类、大环内酯类、氨基糖甙类抗生素呈不同程度耐药,对替考拉宁、替加环素、万古霉素、利奈唑胺、呋喃妥因和喹奴/达福普汀敏感率为100%;在ICU 90%以上的MRSA感染患者为年龄80岁以上、侵入性操作和长期使用广谱抗生素,在非ICU病房则以住院时间长和接受手术者居多。结论MRSA感染多发生于有多个基础疾病和高危因素者,临床表现复杂多样,临床上应加强对MRSA的防控,且应根据药敏合理使用抗生素,降低耐药菌株产生的概率。Objective To investigate the risk factors, antibiotic susceptibility rate and clinical sequelae of nosocomial in-fection of methicil in- resistant Staphylococcus aureus （MRSA）. Methods One hundred and ten strains of MRSA were isolated from Feb 2011 to Jan 2013. Drug resistance and clinical curative effect was retrospectively analyzed. Results MRSA infection mainly distributed in ICU, neurology and VIP Wards, and the strains of MRSA were mainly isolated from the sputum, the secretion of operative and skin wound, accounting for 68.2%, 11.2% and 8.2%, respectively. MRSA isolates were resistant to penicil ins, cefhalosporins and carbapenems; and the resistance to flouroquinolones, macrolides and aminologycosides varied among strains. The isolates were al sensitivive to teicoplanin, tigecycline, vancomysin, linezolid, furadantin and quinupristin/dalfopristin. In ICU over 90%patients with MRSA infection were those over age of 80, undergoing invasive procedures and long- time using broad- spectrum antibiotics;while in other wards most patients with MRSA infection were those undergoing operation and having long stay in the hospital. Conclusion Nosocomial MRSA infection usual y occurs in patients with multiple underlying diseases, undergoing invasive operation and the long- term using broad- spectrum antibiotics. The clinical isolates of MRSA are multiple drug resistant and the clinical manifestation were complex.

关 键 词：耐甲氧西林金黄色葡萄球菌 感染危险因素 耐药率 

分 类 号：R446.5[医药卫生—诊断学]