2007—2010年金黄色葡萄球菌临床分离与耐药变迁

Isolation and antimicrobial resistance of Staphylococcus aureus from 2007 to 2010

摘要:

目的研究某院临床标本分离的金黄色葡萄球菌（SA）与耐甲氧西林金黄色葡萄球菌（MRSA）的分布及其耐药性。方法收集该院2007—2010年细菌室分离的SA，采用全自动微生物分析仪VITEK2Compact进行鉴定；采用纸片扩散法（KirbyBauer）进行药敏试验。应用WHONET5.5软件对数据进行统计分析。结果4年共检出689株SA，其中MRSA347株，占50.36%。SA主要分离自重症监护室（119株，17.27%）和神经外科（109株，15.82%）。MRSA主要分离自神经外科（63株，18.16%）和重症监护室（61株，17.58%）；检出率最高的科室是呼吸科，达79.49%（31/39）；痰标本中分离的MRSA最多（255株，73.49%），其次为伤口分泌物（45株，12.97%）。MRSA对大多数抗菌药物耐药，但对复方磺胺甲口恶唑的耐药率为21.1%～42.7%，且有降低趋势；而对甲氧西林敏感的SA（MSSA）对除青霉素外的大多数抗菌药物敏感；未发现耐万古霉素菌株。结论该院MRSA检出率较高，应加强对SA耐药性的监测，严格隔离MRSA感染者，加强医务人员手卫生，合理使用抗菌药物，以有效预防和控制多耐药MRSA的产生。

Abstract:

ObjectiveTo analyze the distribution and antimicrobial resistance of Staphylococcus aureus (SA) and methicillinresistant Staphylococcus aures（MRSA） isolated from clinical samples in a hospital.MethodsSA isolated from 2007 to 2010 were identified with automatic microorganism analyzer (VITEK2Compact); antimicrobial susceptibility testing was performed by disk diffusion method, and the data were analyzed with WHONET5.5.ResultsA total of 689 SA isolates were isolated within 4 years, 347 (50.36%) of which were MRSA. Of all SA strains, 119 (17.27%) were isolated from intensive care unit (ICU), 109 (15.82%) were from neurosurgery department. Of all MRSA strains, 63 (18.16%) were isolated from neurosurgery department and 61(17.58%）were from ICU; 79.49%（31/39）of SA from respiratory department were MRSA; 73.49% (225 isolates) of MRSA were from sputum, and 12.97% (45 isolates）from wound secretion. MRSA were resistant to most antimicrobial agents, the resistant rate to trimethoprimsulfamethoxazole was 21.1%-42.7%, and there was a decreasing tendency in resistance ; methicillinsensitive Staphylococcus aureus (MSSA) were sensitive to the majority of antimicrobial agents except penicillin; No strains were found resistant to vancomycin in this study.ConclusionIsolation of MRSA is high in this hospital, monitoring of drugresistance of SA should be strengthened, patients with MRSA should be strictly isolated, hand hygiene of health care workers should be stressed, antimicrobial agents should be used rationally, so as to prevent and control the emergence of MRSA.