医院耐甲氧西林金黄色葡萄球菌的流行分布及耐药性监测  

Distribution and drug resistance of methicillin-resistant Staphylococcus aureus

作　　者：黄晓文[1] 陆建红[1] 陈国军[1] 董长林[1] 张月红[1] 

机构地区：[1]武警浙江省总队医院检验科,浙江嘉兴314000

出　　处：《中华医院感染学杂志》2014年第9期2091-2093,共3页Chinese Journal of Nosocomiology

基　　金：嘉兴市植物克隆基地科普宣传基金项目(嘉财预[2013]271)

摘　　要：目的分析医院耐甲氧西林金黄色葡萄球菌(MRSA)的流行分布、耐药性监测和预后相关因素,为临床合理用药提供科学依据。方法采用回顾性调查方法对2007年1月-2011年12月临床分离的860株金黄色葡萄球菌进行分析,使用美国BD公司的Phoniex-100微生物全自动细菌分析仪进行鉴定及药敏试验,采用SPSS17.0软件进行数据分析,计数资料行χ2检验,P<0.05为差异有统计学意义。结果 2007-2011年共分离出金黄色葡萄球菌860株,检出MRSA 418株,总检出率为48.6%,5年MRSA的检出率分别为33.6%、42.2%、49.5%、50.7%、56.2%;MRSA排前3位的科室依次为呼吸科、烧伤外科和ICU,分别占40.9%、24.2%、19.1%;标本来源以痰液、伤口分泌物、中段尿为主,分别占59.3%、21.5%、7.7%;MRSA对青霉素、头孢西丁、阿米卡星的耐药率均>80.0%,对庆大霉素、妥布霉素、氨苄西林的耐药率>50.0%,但对万古霉素、替考拉宁和喹奴普汀/达福普汀仍保持100.0%敏感。结论临床合理使用抗菌药物、严格执行无菌操作、采取有效的消毒隔离、减少侵入性操作等措施是控制MRSA感染的重要环节;糖肽类抗菌药物可作为多药耐药金黄色葡萄球菌感染的首选抗菌药物;对于MRSA感染的患者和重点科室应尽早进行监控、隔离和治疗。OBJECTIVE To explore the distribution and drug resistance of methicillin-resistant Staphylococcus aureus（MRSA）and analyze the related factors for prognosis so as to provide scientific basis for reasonable clinical use of antibiotics.METHODS By means of the retrospective survey,totally 860strains of Staphylococcus aureus isolated from Jan 2007to Dec 2011were analyzed,then the identification of the strains and the drug susceptibility testing were performed by using the phoniex-100automatic bacteria analyzer of BD company,the United States; the statistical analysis was performed with the use of SPSS17.0software,the count data were analyzed by means of the chi-square test,and P＆lt;0.05was considered to show statistical significant.RESULTS A total of 860strains of S.aureus have been isolated from 2007to 2011,in which 418strains of MRSA were detected with the total detection rate of 48.6%;the detection rate of MRSA was 33.6%in 2007,42.2%in 2008,49.5%in 2009,50.7% in 2010,56.2%in 2011.40.9%of the MRSA strains were isolated from the department of respiratory medicine, 24.2%from the department of burn surgery,19.1%from the ICU.59.3% of the strains were isolated from the sputum specimens,21.5% from the wound secretions specimens,7.7% from the midstream urine specimens. The drug resistance rates of the MRSA strains to penicillin,cefoxitin,and amikacin were more than 80.0%,the drug resistance rates to gentamicin,tobramycin,and ampicillin were more than 50.0%,however,the strains remained 100.0%susceptible to vancomycin,teicoplanin,and quinupristin-dalfopristin.CONCLUSIONThe reasonable clinical use of antuibiotics,rigid implementation of aseptic operation,effective disinfection and isolation,and reduction of invasive procedures are the key links for the control of MRSA infection.The glycosides antibiotics can be used as the preferred antibiotics for the treatment of MRSA infection.For the patients with MRSA infection in the key departments,it is necessary to perform the monitoring,isolation,and treatment in a timely mann

关 键 词：耐甲氧西林金黄色葡萄球菌 流行分布 耐药性 预后 

分 类 号：R378.11[医药卫生—病原生物学]