社区感染金黄色葡萄球菌的耐药性及危险因素分析  

Analysis of antimicrobial resistance and risk factors of community-onset methicillin-resistant staphylococcus aureus infection

作　　者：沈跃云[1] 叶丽艳[1] 张永轻[1] 宋林键 赵乾 罗燕萍[1] 张樱[1] Shen Yueyun;Ye Liyan;Zhang Yongqing;Song Linfian;Zhao Qian;Luo Yanping;Zhang Ying(Department of Microbiology,General Hospital of PLA,Beijing 100853,China)

机构地区：[1]解放军总医院微生物科,北京100853

出　　处：《中华医学杂志》2018年第32期2588-2590,共3页National Medical Journal of China

摘　　要：目的通过对社区耐甲氧西林金黄色葡萄球菌（CO—MRSA）情况的调查，探讨CO—MRSA感染的危险因素及耐药特点。方法收集解放军总医院2016年7月至2017年6月的97例社区金黄色葡萄球菌（COSA）感染患者的临床资料，采用流行病学调查方法，根据专家咨询、文献及实际工作经验，最终确定变量，进行危险因素及耐药性分析。结果分离的97例COSA中，CO—MRSA检出率为21．65％（21／97），药敏结果显示：CO—MRSA对红霉素、四环素、克林霉素耐药比较严重，耐药率均超过50％；多因素Logistic回归分析显示，近3个月应用抗菌药物及1年内有过住院病史是影响MRSA的独立危险因素；近3个月应用抗菌药物MRSA感染率为57．89％（11／19）；1年内有过住院病史MRSA感染率为48．28％（14／29）；两种危险因素的OR值分别为10．006（95％CI：2．200～45．519，P=0．030）、11．519（95％CI：2．405～55．177，P=0．002）。结论多数社区感染金黄色葡萄球菌对甲氧西林敏感，但CO—MRSA呈多重耐药且危险因素较多，临床医生应根据药敏情况合理使用抗菌药物，防止多重耐药MRSA的产生。Objective To analyze risk factors and drug resistance of community-onset methicillin- resistant staphylococcus aureus （CO-MRSA） infection through the investigation of patients infected with CO- MRSA. Methods The clinical data of 97 eases infected with community-onset staphylococcus aureus （COSA） was collected in this hospital from July 2016 to June 2017. Epidemiological survey method and the variables were determined according to expert consultation, literature and practical work experience. Results Among 97 patients infected with COSA, the diagnosis rate of CO-MRSA was 21.65% （21/97）. The drug sensitivity results showed that： CO-MRSA was high resistant to erythromycin, tetracycline and clindamycin, and the drug resistance rate exceeded 50%. Muhiplc variables were analyzed by Logistic regression. The usage of antimicrobial agents in the past three months and the history of hospitalization within one year were the independent risk factors. The MRSA infection rate was 57.89% （11/19） of the persons who had taken antibacterial agents in the recent three months. The MRSA infection rate was 48.28% （14/29） of the persons who had been hospitalized in the past one year. OR value of two risk factors was respectively 10. 006（95% C1：2.200-45.519,P=0.030） and 11.519（95%CI：2.405-55.177,P=0.002）. Conclusions Most COSA is sensitive to methieillin, but CO-MRSA is muhidrug resistant and has more risk factors. The clinicians should reasonably use the antibacterial agents according to the drug sensitivity in order to prevent the occurrence of multidrug resistant MRSA.

关 键 词：医院 社区 葡萄球菌 金黄色 耐药性 危险因素 

分 类 号：R446.5[医药卫生—诊断学]