化脓性关节炎病原菌分布及耐药特点分析  

Analysis of bacterial distribution and resistance in patients with septic arthritis

作　　者：王立新[1,4] 王学民 孔海芳[2] 田彬 王冬梅[3] 杨雅琼 王毅[1] WANG Li-xin;WANG Xue-min;KONG Hai-fang(Department of Clinical Laboratory,Tianjin Hospital,Tianjin 300211)

机构地区：[1]天津医院检验科,天津300211 [2]天津医科大学总医院检验科,天津300052 [3]联勤保障部队第九八三医院,天津300142 [4]和田地区人民医院检验科,新疆维吾尔自治区848000

出　　处：《医学检验与临床》2021年第8期35-38,62,共5页Medical Laboratory Science and Clinics

摘　　要：目的:了解2016年1月~2021年3月天津地区三家三级甲等医院关节感染病原菌分布情况并对其耐药性进行分析。方法:菌株鉴定采用VITEK-2 compacts全自动细菌分析仪和VITEK MS全自动快速微生物质谱检测系统进行鉴定;采用仪器法、纸片扩散法对菌种进行药敏试验。结果:共分离菌株93株,其中革兰阳性球菌73株(78.5%),革兰阴性杆菌15株(16.1%),真菌5株(5.4%);分离率居于前3位的病原菌分别为金黄色葡萄球菌(31株,33.3%)、表皮葡萄球菌(13株,14.0%)、停乳链球菌(9株,9.7%)。甲氧西林耐药金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureus,MRSA)占金黄色葡萄球菌25.8%,甲氧西林敏感金黄色葡萄球菌(Methicillin-susceptible Staphylococcus aureus,MSSA)占74.2%。甲氧西林耐药表皮葡萄球菌(Methicillin-resistant Staphylococcus epidermidis,MRSE)占表皮葡萄球菌84.6%,甲氧西林敏感表皮葡萄球菌(Methicillin-susceptible Staphylococcus epidermidis,MSSE)占15.4%。MRSA对青霉素耐药率为100%,对红霉素、克林霉素耐药率87.5%;MSSA对青霉素耐药率为87%,对红霉素、克林霉素耐药率分别为69.6%、60.9%。葡萄球菌属未见万古霉素、替加环素、利奈唑胺耐药菌株。结论:本研究显示关节感染主要病原菌是以金黄色葡萄球菌为代表的革兰阳性球菌为主,停乳链球菌是引起关节感染的主要链球菌,革兰阴性杆菌菌株分布比较分散,未发现明显优势菌株,在临床治疗过程中应结合药敏试验结果合理选择抗菌药物。Objective:To determine the bacterial distribution and resistance in joint infections in 3 tertiary A hospital in Tianjin area from January 2016 to March 2021.Methods:The bacteria identification were conducted by VITEK-2 Auto Microbe System and VITEK MS IND MALDI TOF.Antimicrobial susceptibility testing was carried out by Kirby-Bauer method or automated systems.Results:A total of 93 pathogenic strains were isolated,with 73 Gram-positive cocci strains(78.5%),15 Gram-negative bacilli strains(16.1%)and 5 fungal strains(5.4%).The top three pathogens were Staphylococcus aureus(31,33.3%),Staphylococcus epidermidis,(13,14.0%),Streptococcus dysgalactiae(9,9.7%).Methicillin-resistant strains accounted for 25.8%in Staphylococcus aureus,84.6%in Staphylococcus epidermidis and Methicillin-susceptible strains accounted for 74.2%in Staphylococcus aureus,15.4%in Staphylococcus epidermidis.The resistance rates of Methicillin-resistant Staphylococcus aureus(MRSA)to Penicillin G was 100%,and to Erythromycin and Clindamycin were 87.5%;Methicillin-susceptible Staphylococcus aureus(MSSA)to Penicillin G was 87%,and to Erythromycin and Clindamycin were 69.6%and 60.9%,respectively.No staphylococcal strains were found resistant to vancomycin,linezolid and tigecycline.Conclusion:This research showed that the predominant pathogens in joint infections were gram-positive cocci such as Staphylococcus aureus and S.dysgalactiae.The distribution of gram-negative bacilli was relatively scattered,and no obvious dominant strain was found.Rationally use antibiotics according to drug susceptibility test is important for clinical treatment.

关 键 词：化脓性关节炎 金黄色葡萄球菌 关节液 耐药性 

分 类 号：R44[医药卫生—诊断学]