社区获得性与医院获得性MRSA感染监测

Surveillance on infections caused by communityassociated and healthcareassociated MRSA

摘要:

目的了解社区获得性耐甲氧西林金黄色葡萄球菌 (CAMRSA)与医院获得性MRSA（HAMRSA）的耐药特征，为临床经验性选择抗菌药物提供参考依据。方法回顾性分析某院中医外科和重症监护室(ICU)2006年1月—2008年12月临床标本中分离的MRSA菌株资料，并对2个病区分离的CAMRSA 、HAMRSA及其耐药性进行统计分析。结果ICU分离的87株 MRSA来源：痰液71株，咽拭子6株，伤口分泌物 5株，血液、静脉穿刺管各2株，胸腔积液1株；其中HAMRSA占98.85%（86/87）。中医外科的41株MRSA均分离自伤口脓液，其中CAMRSA占48.78%（20/41），且有逐年上升趋势，由2006年的20.00%上升至2008年的71.43%（χ2=8.24，0.01＜ P＜0.025）。药敏结果显示，HAMRSA 对克林霉素（98.13%）、四环素（98.13%）、红霉素（100.00%）、环丙沙星（100.00%）、左氧氟沙星（100.00%）、庆大霉素（100.00%）的耐药率显著高于CAMRSA（分别为42.86%、66.70%、33.33%、0.00%、0.00%、4.76%） ,两两比较，差异均有统计学意义（均P＜0.005）。结论住院患者中CAMRSA感染呈上升趋势。CAMRSA 与HAMRSA的耐药性并不一致,对非β内酰胺类抗菌药物多敏感。

Abstract:

ObjectiveTo analyze the drug resistance of communityassociated methicillinresistant Staphylococcus aureus (CAMRSA) and healthcare associated MRSA(HAMRSA), so as to provide reference on empirical antimicrobial  therapy for treating MRSA infection. MethodsMRSA isolated from clinical specimens from surgical department and intensive care unit (ICU) in a hospital between January 2006 and December 2008 were analyzed retrospectively , distribution and drug resistance of CAMRSA and HAMRSA were analysed statistically.ResultsEightseven strains were from ICU , the sources were as follows: 71 strains were from sputum, 6 from throat swabs, 5 from wound secretion, 2 from blood and venipuncture tubes respectively, and 1 from pleural effusion; HAMRSA accounted for 98.85%(86/87). Fortyone MRSA strains from surgical department were all isolated from wound pus, CAMRSA accounted for 48.75%(20/41) , and showed an increasing tendency year by year, which increased from 20.00% in 2006 to 71.43% in 2008 (χ2=8.24, 0.01<P<0.025). Antimicrobial susceptibility test results showed that the resistant rates of  HAMRSA to clindamycin,tetracycline,erythromycin,ciprofloxacin,levofloxacin , and gentamycin was 98.13%,98.13%,100.00%, 100.00%,100.00% ,and 100.00% respectively, which was significantly higher than that of CAMRSA (which was 42.86%,66.70%,33.33%,0.00%,0.00% , and 4.76% respectively), there was significant difference between the two respectively(all P<0.005).ConclusionThere is an increasing tendency of CAMRSA infection in hospitalized patients , drug resistance of CAMRSA is different from that of HA MRSA , CAMRSA strains are usually susceptible to nonβlactam agents.