骨外伤病人耐甲氧西林金黄色葡萄球菌的耐药性变迁及感染因素分析  

Changes in the resistance of methicillin-resistant Staphylococcus aureus infecting patients with bone trauma and an analysis of factors influencing infection

作　　者：吕国庆[1] 朱劲松[1] 刘毅[1] 陈方[1] 洪嵩[1] 瓦庆德[1] 

机构地区：[1]遵义医学院附属医院,贵州遵义563000

出　　处：《中国病原生物学杂志》2016年第11期1039-1042,共4页Journal of Pathogen Biology

摘　　要：目的研究骨外伤病人耐甲氧西林金黄色葡萄球菌(MRSA)的耐药性变迁及相关感染因素,为控制病原菌感染及耐药性发展提供指导。方法收集本院2012-2015年骨外伤病人伤口分泌物等标本分离病原菌,鉴定MRSA菌株并进行药敏试验,对耐药性及影响因素进行分析。结果 1 874例骨外伤患者中共分离MRSA179株,其中分离自伤口分泌物、脓液分泌物、中心静脉血、痰咽拭子以及鼻拭子标本中的MRSA菌株数分别为72、46、33、19和9株。2012-2015年各年度分离菌株数分别为27、33、55和64株。2012年MRSA临床分离株对头孢唑啉、头孢噻肟、庆大霉素、环丙沙星、四环素、左氧氟沙星、克林霉素、万古霉素的耐药率分别为51.85%、33.33%、29.63%、22.22%、85.19%、37.04%、59.26%、0.00%;2013年MRSA耐药率分别为57.58%、33.33%、42.42%、33.33%、75.76%、51.52%、51.52%、0.00%;2014年MRSA耐药率分别为67.27%、38.18%、45.45%、36.36%、81.82%、49.09%、60.00%、0.00%;2015年MRSA耐药率分别为68.75%、42.19%、46.88%、39.06%、82.81%、60.94%、71.88%、0.00%。2012-2015年MRSA对万古霉素敏感,对其他各检测抗菌药物的耐药率呈逐年升高趋势。患者的年龄和治疗中联合用药种类与其感染MRSA的发生无关(P>0.05),而骨外伤患者感染MRSA的发生与患者性别、住院时间长短、是否接受手术治疗以及自身是否患有糖尿病有关(P<0.01)。结论骨外伤病人感染MRSA以伤口分泌物样本居多,菌株对各种抗菌药物的耐药程度呈整体增高趋势,但对万古霉素敏感。骨外伤病人MRSA感染治疗时时应考虑住院时间、是否接受手术治疗以及是否患有糖尿病等因素。Objectives To study changes in the resistance of methicillin-resistant Staphylococcus aureus infecting patients with bone trauma and to study factors related to infection in order to guide the control of pathogen infections and to control the development of drug resistance. Methods Specimens such as wound secretions,discharged pus,central venous blood,mucus swabs,and nasal swabs were collected from 1 874 patients with bone trauma seen between January2012 and December 2015.Pathogens in specimens from patients were cultured,isolated,and identified,and the distribution of strains,drug resistance,and factors influencing infection were statistically analyzed. Results Of 1 874 patients with bone trauma,213 were infected with methicillin-resistant S.aureus.One hundred and seventy-nine strains of methicillin-resistant S.aureus were isolated.Of those,72strains（40.22%）were isolated from wound secretions,46（25.70%）were isolated from discharged pus,33（18.44%）were isolated from central venous blood,19（10.61%）were isolated from mucus swabs,and 9（5.03%）were isolated from nasal swabs.Of the 179 strains of methicillin-resistant S.aureus,27 strains were isolated in 2012,33 were isolated in 2013,55 were isolated in 2014,and 64 were isolated in2015.Methicillin-resistant S.aureus that was isolated in 2012 was resistant to cefazolin at a rate of 51.85%,to cefotaxime at a rate of 33.33%,to gentamicin at a rate of 29.63%,to ciprofloxacin at a rate of 22.22%,to tetracycline at a rate of 85.19%,to levofloxacin at a rate of 37.04%,to clindamycin at a rate of 59.26%,and to vancomycin at a rate of0.00%.Methicillin-resistant S.aureus that was isolated in 2013 was resistant to cefazolin at a rate of 57.58%,to cefotaxime at a rate of 33.33%,to gentamicin at a rate of 42.42%,to ciprofloxacin at a rate of 33.33%,to tetracycline at a rate of 75.76%,to levofloxacin at a rate of 51.52%,to clindamycin at a rate of 51.52%,and to vancomycin at a rate of0.00%.Methicillin-resistant S.aureus that was isolated in 2014 was resistant to c

关 键 词：骨外伤病人 耐甲氧西林金黄色葡萄球菌 耐药性 影响因素 

分 类 号：R378.11[医药卫生—病原生物学]