2017—2021年广东地区基层医疗机构金黄色葡萄球菌临床分离株耐药谱分析  

Antimicrobial resistance profiles of Staphylococcus auresus strains isolated from primary hospitals in Guangdong region from 2017 to 2021

作　　者：林舒楠 党文强 钟天[1] 梁斯欣 张磊 唐晓华 袁文常[1] Lin Shunan;Dang Wenqiang;Zhong Tian;Liang Sixin;Zhang Lei;Tang Xiaohua;Yuan Wenchang(Guangzhou key laboratory for clinical rapid diagnosis and early warning of infectious diseases,KingMed School of Laboratory Medicine,Guangzhou Medical University,Guangzhou Guangdong 510180,China;Guangzhou KingMed Center for Clinical Laboratory,Guangzhou Guangdong 510330,China;Department of Clinical Laboratory,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou Guangdong 510145,China)

机构地区：[1]广州市传染性疾病临床快速诊断与预警重点实验室、广州医科大学金域检验学院,广东广州510180 [2]广州金域医学检验中心有限公司,广东广州510330 [3]广州医科大学附属第三医院检验科,广东广州510145

出　　处：《中华临床实验室管理电子杂志》2023年第3期139-144,150,共7页Chinese Journal of Clinical Laboratory Management(Electronic Edition）

基　　金：广东省基础与应用基础研究基金自然科学基金(2021A1515011360);广东省医学科学技术研究基金项目(C2021077);广州市基础研究计划基础与应用基础研究项目(202102080469);广州医科大学2022年度学生创新能力提升计划项目。

摘　　要：目的回顾性分析金黄色葡萄球菌(SAU)临床分离株耐药谱特征,为临床治疗选择合理抗菌药物提供依据。方法收集2017年至2021年送检金域医学的广东地区临床分离的SAU,采用法国生物梅里埃VITEK®MS微生物质谱检测系统及Vitek-2 compact药物敏感性(简称药敏)分析系统进行细菌鉴定和药敏试验。用WHONET 5.6软件对病原菌的分布及耐药情况进行统计分析。结果共收集9713株非重复SAU,其中耐甲氧西林金黄色葡萄球菌(MRSA)4959株,分离率为51.06%。SAU主要标本来源为痰液(41.50%)、伤口分泌物(31.87%)、脓液(8.87%)、咽拭子(5.34%)以及血(4.74%)。痰液、咽拭子、血、尿液、穿刺液及肺泡灌洗液MRSA分离率超过50.00%。SAU对青霉素(PEN)、苯唑西林(OXA)、红霉素(ERY)、克林霉素(CLI)耐药率>50.00%。多重耐药甲氧西林敏感金黄色葡萄球菌(MSSA)2021年分离率为20.09%,并且呈现逐年递减的趋势。对PEN敏感的MSSA(MSSA-PENS)分离率呈现上升趋势。在MRSA中,有41.51%的菌株对10种抗生素耐药,12.54%的菌株对4种抗生素耐药,11.57%的菌株对5种抗生素耐药。MRSA对14种常见抗生素(组合)存在105种耐药谱,其中59种耐药谱分离到2株以上细菌,分离株超过100株的耐药谱有10种,分离率超过5%的优势耐药谱为耐药谱七:PEN/OXA/ERY/CLI/CIP;耐药谱八:PEN/OXA;耐药谱九:PEN/OXA/ERY/CLI;耐药谱十:PEN/OXA/TET/CIP/LEV/MXF/ERY/CLI/GEN。耐药谱七和耐药谱九的MRSA分离率呈现下降趋势,而耐药谱八和耐药谱十MRSA分离率呈现上升趋势。结论广东省基层医疗机构MRSA分离率较高,MSSA对PEN等抗生素敏感性增高,MRSA的耐药谱在发生变化。基层医疗机构需要加强院感监测、耐药检测等工作,同时提高医护人员防范意识,进一步合理规范地使用抗生素,防止SAU及MRSA的流行和暴发。Objectives To analyze the antimicrobial resistance profiles(ARPs)of Staphylococcus aureus(SAU)isolated from primary medical institutions in Guangdong region from 2017 to 2021,to provide a basis for the use of antibiotics in the treatment of SAU infections.Methods The SAU strains were collected from Guangdong region from 2017 to 2021 and inspected by Guangzhou Kingmed Center for Clinical Laboratory.Identification and antibiotic susceptibility tests were carried out by BioMérieux VITEK®MS microbial mass spectrometry system and Vitek-2 compact antibiotic susceptibility analysis system.Statistical analysis of the distribution and drug resistance of pathogenic bacteria were carried out using WHONET 5.6 software.Results A total of 9713 non-replicating SAU were collected from 2017 to 2021,in which 4959 strains(51.06%)were identified as methicillin-resistant Staphylococcus aureus(MRSA).The main specimen sources of SAU were sputum 41.50%,wound secretions 31.87%,pus 8.87%,pharyngeal swabs 5.34%,and blood 4.74%.Sputum,urine,alveolar lavage fluid,blood,puncture fluid and pharyngeal swab MRSA isolation rate exceeded 50.00%.For SAU,the resistance to penicillin,oxacillin,erythromycin and clindamycin were all up to 50.00%.The isolation rate of multidrug-resistant methicillin-susceptible Staphylococcus aureus(MSSA)was 20.09%,and showed a decreasing trend yearly.The isolation rate of penicillin-sensitive MSSA(MSSA-PENS)showed an increasing trend.Among the MRSA strains,41.51%were resistance to ten antibiotics,12.54%were resistant to four antibiotics and 11.57%were resistant to five antibiotics.There were 105 ARPs of MRSA,59 of which had more than two isolates,and 10 ARPs with more than 100 isolates.The dominant ARPs were ARPsⅦ:PEN/OXA/ERY/CLI/CIP;ARPsⅧ:PEN/OXA;ARPsⅨ:PEN/OXA/ERY/CLI;ARPsⅩ:PEN/OXA/TET/CIP/LEV/MXF/ERY/CLI/GEN.The isolation rate of MRSA on ARPsⅦandⅨwere decreasing,while the isolation rate of MRSA strains on ARPsⅧandⅩwere increasing.Conclusions The rate of MRSA isolation in primary care institutions in

关 键 词：金黄色葡萄球菌 耐药性 耐甲氧西林金黄色葡萄球菌 耐药谱 

分 类 号：R44[医药卫生—诊断学]