南充某三甲医院血培养分离耐甲氧西林金黄色葡萄球菌临床特征及危险因素分析  

Analysis on Clinical Characteristics and Risk Factors of Methicillin-resistant Staphylococcus aureus Isolated by Blood Culture from a Hospital in Nanchong

作　　者：邵俊杰 谢宁[1,2,3] 廖涛 刘婧[1,2,3] 郭杨柳 Shao Jun-jie;Xie Ning;Liao Tao;Liu Jing;Guo Yang-iu(School of Laboratory Medicine,North Sichuan Medical College,Nanchong Sichuan 637000;Department of CIinical Laboratory,Affiliated Hospital of North Sichuan Medical College,Nanchong Sichuan 637000;Translational Medicine Research Center,North Sichuan Medical College,Nanchong Sichuan 637000)

机构地区：[1]川北医学院检验医学院,四川南充637000 [2]川北医学院附属医院检验科,四川南充637000 [3]川北医学院转化医学研究中心,四川南充637000

出　　处：《国外医药（抗生素分册）》2024年第1期44-49,共6页World Notes on Antibiotics

基　　金：川北医学院附属医院院级课题(2020JC018)。

摘　　要：目的了解血培养分离出耐甲氧西林金黄色葡萄球菌的患者临床特征,探究血培养分离出耐甲氧西林金黄色葡萄球菌的危险因素。方法收集2017—2022年血培养分离出耐甲氧西林金黄色葡萄球菌的住院患者的临床病史资料和实验室数据,分析血培养分离出耐甲氧西林金黄色葡萄球菌的独立危险因素。结果2017—2022年血培养标本共分离金黄色葡萄球菌181株,其中耐甲氧西林金黄色葡萄球菌49株,总检出率27.07%,各年检出率变化无明显趋势。分离率科室构成比前三位为肾内科(20.41%)、骨科(10.20%)、儿科(10.20%)。患者以老年、男性为主,其感染部位以血流感染(83.67%)和肺部感染(48.98%)为主。49株耐甲氧西林金黄色葡萄球菌对青霉素(100%)、红霉素(87.76%)和克林霉素(73.47%)耐药率较高;132株对甲氧西林敏感的金黄色葡萄球菌仅对青霉素(91.67%)耐药率较高。使用头孢菌素过往史和年龄为血培养分离出耐甲氧西林金黄色葡萄球菌的独立危险因素。结论血培养分离出的耐甲氧西林金黄色葡萄球菌对多种临床常用抗菌药物耐药,使用头孢菌素过往史和年龄的因素在耐甲氧西林金黄色葡萄球菌感染中起着重要作用,临床应注意相关危险因素,合理防治。Objective To investigate clinical characteristics of patients with Methicillin-resistant Staphylococcus aureus(MRSA)isolated from blood culture and explore corresponding risk factors.Methods Techniques to identify independent risk variables,clinical records and experimental data regarding pertinent inpatients from 2017 to 2022 were gathered and statistically examined.Results 49 out of 181 cases showed MRSA positive with an aggregate examination rate of 27.07%and without an evident tendency from 2017 to 2022.Additionally,constituent ratios of 49 MRSA cases in different departments were ranked to get the top three ones(Nephrology 20.41%,Orthopaedics 10.20%and Paediatrics 10.20%).Patients involved were mainly the seniors and males,with bloodstream infection(83.67%)and pulmonary infection(48.98%)accounting for the most in both groups.Of all the 181 isolates from blood culture,none exhibited resistance to vancomycin,linezolid,tigecycline and quinuptine/dafoptin.Concerning antimicrobial susceptibility tests,the MRSA group demonstrated strong resistance to such regular antibiotics as penicillin(100%),erythromycin(87.76%)and clindamycin(73.47%),while Methicillin-sensitive Staphylococcus aureus(MSSA)group was highly resistant only to penicillin(91.67%).After statistical analysis of the quantities of potential risk factors,it was shown that the use of cephalosporin in the past and being older than 15 or 60 were independent risk factors.Conclusion MRSA isolated from blood culture presented multi-drug resistance.Being aged no more than 15 or more than 60 and prior use of cephalosporin functioned as staple impetuses when it comes to MRSA infection.In order to stop MRSA from spreading further,strict regulatory and monitoring measures must be implemented.

关 键 词：耐药 血培养 耐甲氧西林金黄色葡萄球菌 危险因素 

分 类 号：R978.1[医药卫生—药品]