2015-2019年重症监护病房医院获得性肺炎患者中MRSA菌株的临床分布及耐药性分析  

Distribution and Drug-resistance of MRSA Strain in Cases with Hospital-acquired Pneumonia in ICU from 2015 to 2019

作　　者：纪风兵[1] 王丹[2] 许颖[2] 胡章勇[3] Ji Fengbing;Wang Dan;Xu Ying;Hu Zhangyong(Department of Infection Control,the First Affiliated Hospital of Chengdu Medical College,Chengdu,Sichuan Province,610500,P.R.China;Clinical Laboratory,the First Affiliated Hospital of Chengdu Medical College,Chengdu,Sichuan Province,610500,P.R.China;Department of Infectious Disease,the First Affiliated Hospital of Chengdu Medical College,Chengdu,Sichuan Province,610500,P.R.China)

机构地区：[1]成都医学院第一附属医院医院感染管理部,四川成都610500 [2]成都医学院第一附属医院医院检验科,四川成都610500 [3]成都医学院第一附属医院医院感染科,四川成都610500

出　　处：《西南军医》2020年第4期318-322,共5页Journal of Military Surgeon in Southwest China

摘　　要：目的研究2015-2019年重症监护病房医院获得性肺炎(HAP)患者中耐甲氧西林金黄色葡萄球菌(MRSA)的临床分布及耐药性,为临床抗菌药物的合理选择以及今后MRSA的动态监测提供重要依据。方法收集2015-2019年成都某三甲医院重症监护病房HAP患者分离的40株MRSA,对这些菌株进行菌株鉴定、药敏试验与临床分布分析。结果 40株MRSA中70. 0%的菌株由老年患者体内分离出,MRSA在金黄色葡萄球菌(SAU)中的检出率最高的科室为呼吸ICU(占50%),全院ICU该检出率逐年增高;MRSA与同期自ICU分离的甲氧西林敏感金黄色葡萄球菌(MSSA)对多种抗菌药物的耐药率有显著的统计学差异(P <0. 05);万古霉素MIC值为2 mg/L的MRSA占5. 0%;近4年重症监护病房MRSA对抗菌药物的整体耐药率仍较高,近1年对莫西沙星、利福平、复方新诺明耐药率均低于30%。结论应高度重视ICU内65岁以上老年肺部感染患者,尽早进行MRSA的主动筛查,加强呼吸道管理及医院感染的监测及防控工作;重症监护病房MRSA菌株的整体耐药性较高,对大多数抗菌药物耐药程度较严重;应动态监测重症监护病房内万古霉素对MRSA菌株的MIC值。Objective To study the clinical distribution and drug-resistance of methicillin-resistant Staphylococcus aureus(MRSA)in cases with hospital-acquired pneumonia(HAP)in intensive care unit(ICU)during the period from 2015 to 2019 so as to provide basis for reasonable use of antibiotics and dynamic monitoring of MRSA.Methods 40 MRSA strains were isolated from the cases with HAP in ICU during the period from 2015 to 2019;strain identification and drug-sensitive test were performed,and the clinical distribution was analyzed.Results 70%out of the 40 MRSA strains was isolated from the elderly cases;the highest detection rate of MRSA in Staphylococcus Aureus(SAU)was found in respiratory ICU,taking up 50%of the all;the detection rate of MRSA in SAU in the ICUs of the whole hospital kept raising with each passing year;there existed a significant statistical difference in drug-resistance to various antibiotics between MRSA and methicillin-sensitive Staphylococcus aureus(MSSA)isolated within the same time period(P<0.05);the MIC value of vancomycin was 1 mg/L in 50.0%MRSA;the total drug-resistance to antibiotics was high in ICU in the 4 years while the drug-resistance to moxifloxacin,rifampicin and sulfamethoxazole compound was found to be lower than 30%last year.Conclusions More attention should be paid to the elderly cases aged over 65 years with pulmonary infection in ICU and earlier active screening of MRSA be performed;respiratory tract management and nosocomial infection control should be enhanced;MRSA strains are of high drug-resistance to most antibiotics in ICU,the MIC of vancomycin in MRSA needs to be dynamically monitored.

关 键 词：重症监护病房 医院获得性肺炎 耐甲氧西林金黄色葡萄球菌 临床分布 耐药性 

分 类 号：R378.1[医药卫生—病原生物学]