重症监护室耐甲氧西林金黄色葡萄球菌耐药性及联合药敏分析

Drug resistance and antimicrobial combination against methicillinresistant Staphylococcus aureus isolated from ICU patients

摘要:

目的了解38株分离自重症监护室的耐甲氧西林金黄色葡萄球菌（MRSA）分布及联合药物体外抗菌活性，以指导临床合理选择抗菌药物。方法以常规方法培养分离细菌，用金黄色葡萄球菌乳胶试剂盒及VITEKⅡ细菌分析仪鉴定到种；采用乳胶凝集试剂盒鉴定MRSA。以微量稀释法测定利奈唑胺等5种抗菌药物对MRSA的体外抗菌活性，按美国临床实验室标准化研究所标准进行。结果38株MRSA对利奈唑胺、万古霉素和替考拉宁均敏感；对左氧氟沙星和利福平的耐药率分别为100.00%和78.95%。利福平分别与利奈唑胺、万古霉素和替考拉宁联合，联合抑菌指数（FIC）＜1者占13.16%～31.58%；左氧氟沙星分别与利奈唑胺、万古霉素和替考拉宁联合，FIC＜1者占2.63%～36.84%；各组联合药物间差异有统计学意义（P＜0.01）。结论对ICU病区MRSA感染者治疗时，应参考药敏试验结果并结合患者个体情况合理选择抗菌药物，制定个体优化治疗方案。

Abstract:

ObjectiveTo investigate drug resistance and antimicrobial combination against 38 strains of methicillinresistant Staphylococcu aureus (MRSA) isolated from intensive care unit (ICU) patients, so as to select rational antimicrobial agents to treat MRSA infection.MethodsThe isolates were identified by VITEK2 automatic bacterial identification system and Staphylococcus aureus latex coagulation method, MRSA were detected with Staphylococcus aureus latex coagulation method. Drug susceptibility tests were performed with microbroth dilution method based on Clinical and Laboratory Standards Institute (CLSI) Standard .ResultsThirtyeight MRSA stains were sensitive to linezolid (LZD), vancomycin (VAN), and teicoplanin (TEC)； the resistant rate to levofloxacin (LVX) and rifampicin (RIF) was 100.00% and 78.95% respectively. The fractional inhibitional concentration (FIC)<1 of RIF combining with LZD,VAN and TEC was 13.16%-31.58%; The FIC<1 of LVX combining with LZD,VAN and TEC was 2.63%-36.84%， the difference between antimicrobial combination had statistical significance （P<0.01）. ConclusionRational choice of antimicrobial agents to treat MRSA infection in ICU patients should be according to antimicrobial agents and patients’ state.