二级医院和三级医院下呼吸道金黄色葡萄球菌耐药性及MRSA感染危险因素研究  

Study on the drug resistance of Staphylococcus aureus and risk factors of MRSA infection of lower respiratory tract in grade 2 and grade 3 hospitals

作　　者：魏旭锐 赖天文[2] 刘军[3] 

机构地区：[1]揭阳市蓝城区人民医院呼吸内科,广东揭阳522071 [2]广东医学院附属医院呼吸内科,广东湛江524001 [3]广东医学院病原生物学实验室,广东湛江524023

出　　处：《中国临床研究》2015年第9期1126-1130,共5页Chinese Journal of Clinical Research

基　　金：广东省医学科研基金课题(A2012430);湛江市财政资金科技专项(2013A01007);湛江市科技攻关计划项目(2012C3106022);广东医学院面上项目(M2012005)

摘　　要：目的探讨二级医院和三级医院下呼吸道金黄色葡萄球菌（SA）耐药性及耐甲氧西林金黄色葡萄球菌（MRSA）感染的危险因素。方法 2012年1月至2014年12月收集168株非重复下呼吸道SA,来源于广东揭阳市蓝城区人民医院的SA被定义为第1组（68株）,来源于广东医学院附属医院的SA被定义为第2组（100株）,分别采用全自动微生物分析仪和琼脂稀释法鉴定细菌和测定药物敏感性;统计两家医院的SA耐药性、两家医院不同临床科室的SA检出情况和MRSA感染的危险因素,采用χ2检验和多因素Logistic回归分析处理相关数据。结果MRSA在第1组和第2组中分别占SA的60.29%（41/68）和73.00%（73/100）。头孢西丁、阿米卡星、环丙沙星、克林霉素、红霉素、利福平和四环素对MRSA的耐药率明显高于甲氧西林敏感金黄色葡萄球菌（MSSA）（P均〈0.05）。环丙沙星、克林霉素、红霉素在第1组的耐药率低于第2组,而且阿米卡星、环丙沙星和克林霉素在两家医院MRSA中的耐药率差异有统计学意义（P均〈0.05）。在第1组中,呼吸内科是头孢西丁检出最常见的科室（30.88%）,而在第2组中却是ICU（26.00%）。MRSA感染的独立危险因素,在第1组中为基础疾病〉3种（OR=0.279,95%CI：0.084~0.932,P〈0.05）和抗菌药物使用〉14 d（OR=0.234,95%CI：0.068~0.811,P〈0.05）,在第2组中却是基础疾病〉3种（OR=3.200,95%CI：1.065~9.646,P〈0.05）、侵入性操作（OR=3.326,95%CI：1.023~10.811,P〈0.05）和住院时间〉14 d（OR=15.466,95%CI：2.243~106.625,P〈0.01）。结论下呼吸道SA的耐药形势严峻（特别是MRSA）,每家医院有自己特有的耐药特点和MRSA感染危险因素。Objective To investigate the drug resistance of Staphylococcus aureus（ SA） and the risk factors of methicillin resistant Staphylococcus aureus（ MRSA） infection in lower respiratory tract in the grade 2 and grade 3 hospitals. Methods A total of 168 strains of non-repetitive SA were collected from January 2012 to December 2014. Sixty-eight strains among them from the Lancheng District People＇ s Hospital of Jieyang City were defined as the first group（ group one）,and the other 100 strains from the Affiliated Hospital of Guangdong Medical College were defined as the second group（ group two）.The bacteria identification and detection of drug sensitivity were respectively performed by automated microbiology analyzer and agar dilution method. The data associated with antimicrobial resistance of SA,detection of SA and risk factors of MRSA infection in different clinical department of the two hospitals were analyzed by chi-square test and multifactor logistic regression analysis. Results Composition ratios of MRSA in SA of two groups were 60. 29%（ 41 /68） and 73. 00%（ 73 /100）,respectively. The drug-resistance rates of MRSA strains to cefoxitin（ SA）,amikacin（ AK）,ciprofloxacin（ CIP）,clindamycin（ DA）,erythromycin（ E）,rifampicin（ RD）,tetracycline（ TE） were all significantly higher than those of methicillin sensitive staphylococcus aureus（ MSSA） strains（ all P〈0. 05）. The drug-resistance rates of CIP,DA and E to SA in group one were lower than those in group two,and there were significant differences in the drug-resistance rates of AK,CIP,DA to MRSA between the two groups（ all P〈0. 05）. The most common department for checking out SA was respiratory medicine department（ 30. 88%） in group one,and it was ICU（ 26. 00%） in group two. The basic diseases more than three kinds（ OR = 0. 279,95% CI： 0. 084- 0. 932,P〈0. 05） and the time of taking antibacterial medicine more than 14 days（ OR = 0. 234,95% CI： 0. 068- 0. 811,P〈0. 05） were the inde

关 键 词：下呼吸道 金黄色葡萄球菌 耐甲氧西林金黄色葡萄球菌 耐药性 危险因素 

分 类 号：R446.5[医药卫生—诊断学]