血流感染金黄色葡萄球菌耐药性分析及对患者预后影响  

Analysis of antibiotic resistance in the Staphylococcus aureus strains isolated from bloodstream infections and associated patient outcome

作　　者：朱翠珍[1] 刘春林[1] 吴宝连 吴清念 黄德兵[1] 

机构地区：[1]南方医科大学附属南海医院检验科,广东佛山528200

出　　处：《中国感染与化疗杂志》2016年第1期1-4,共4页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探讨佛山南海医院血流感染金黄色葡萄球菌(金葡菌)耐药状况及对患者预后的影响。方法回顾性收集2011年1月—2014年12月,该院临床科室诊断为金葡菌血流感染患者及其临床资料。分析致血流感染金葡菌耐药性及影响患者预后的相关因素。结果共纳入64例患者,以医院感染为主(53例,占82.8%),64例患者中培养出金葡菌64株,其中耐甲氧西林金葡菌(MRSA)22株,占34.4%,甲氧西林敏感金葡菌(MSSA)42株,占65.6%。MRSA对常用抗菌药物的耐药性要高于MSSA菌株,均未发现对万古霉素、替考拉宁、利奈唑胺耐药株。MRSA组年龄、糖尿病、中心静脉置管、机械通气、不恰当用药显著高于MSSA组(P均<0.05);MRSA组病死率高于MSSA组(27.3%对14.3%),但差异无统计学意义(P=0.312);患者高龄OR 1.1(95%CI 1.004~1.108,P=0.036),不恰当用药OR 6.1(95%CI 1.2~35.2,P=0.048)是影响患者预后的独立危险因素。结论该院金葡菌血流感染以医院感染为主,金葡菌对抗菌药物呈现多重耐药性。高龄、不恰当用药是影响患者预后的独立危险因素。Objective To evaluate the susceptibility of the Staphylococcus aureus strains isolated from bloodstream infections and associated patient outcome. Methods The clinical data of patients with S. aureus bacteremia were retrospectively collected from January 2011 through December 2014 in a hospital to analyze the resistance profile of S. aureus and related prognostic factors. Results Sixty-four patients with S. aureus bacteremia were enrolled, including 53 （82.8%） cases of nosocomial bacteremia. Of the 64 isolates, 22 （34.4%） were methicillin-resistant S. aureus （MRSA） and 42 （65.6%） were methicillin-susceptible S. aureus （MSSA）. MRSA showed higher resistance rate than MSSA. No strain was found resistant to vancomycin, teicoplanin or linezolid. Age, diabetes, central venous catheter, mechanical ventilation, inappropriate antibiotic treatment were more prevalent in the patients with MRSA-associated bloodstream infection （P〈0.05）. The mortality of patients with MRSA-associated bloodstream infection was numerically higher than that of patients with MSSA-associated bloodstream infection （27.3% vs 14.3%, P=-0.312）. O^der age （OR I. 1, 95% CI 1.004-1.108, P=-0.036） and inappropriate antibiotic treatment （OR 6.1, 95% CI 1.2-35.2, P=-0.048） were independent risk factors of poor patient outcome. Conclusions The bloodstream infections caused by S. aureus were primarily nosocomial bacteremia in this hospital. S. aureus isolates showed resistance to multiple antibiotics. Older age and inappropriate antibiotic treatment are independent risk factor for poor patient outcome.

关 键 词：金黄色葡萄球菌 血流感染 耐药率 预后 

分 类 号：R515.3[医药卫生—内科学] R446.5[医药卫生—临床医学]