2006-2011年金黄色葡萄球菌耐药性变迁分析

摘要

Objective To investigate the distribution and drug resistance changing of pathogens from 2006 to 2011 in our hospital,and provide the basis for clinical use of antimicrobial drugs.Methods Vancomycin were determined by E-test,susceptibility testing of other drugs were tested by disk diffusion method(K-B),the results of antimicrobial susceptibility were determined according to CLSI 2011 criteria.All data were analyzed by WHONET5.4 software.Results 3156 strains of Staphylococcus aureus were isolated,1903 strains methicillin-resistant Staphylococcus aureus (MRSA) was detected,the detection rate was 60.3％,The detected rate of MRSA showed an ascending trend,also rised with age increasing.Sputum and secretions were the main sources of specimen,general surgery and ICU were the main wards.In ICU ward,MRSA with the highest detection rate,was 87.4％,followed by general surgery and neurosurgery wards,were 85.7％ and 84.3％,respectively.The resistance rates of MRSA to antibacterial drugs were more than 90％ in addention to fosfomycin,trimethoprim/sulfamethoxazole,clindamycin,erythromycin,and glycopeptide.The resistance rate of MSSA to gentamicin increased from 9.5％ to 16.2％,there was statistical significance(P＜0.05).Sensitive rates of MRSA and MSSA to trimethoprirn/sulfamethoxazole were more than 80％.The vancomycin,teicoplanin or linezolid-resistant strains were not found.Conclusion Resistance rate of SAU kept high level during the six years,drug resistance was quite severe,moreover,the detection rate of MRSA was increasing every year.Clinician should use antimicrobial drugs rationally,and furthermore,we should regularly monitor the change of resistance and prevent nosocomial transmission.%目的 分析我院2006年1月—2011年12月金黄色葡萄球菌的临床分布和耐药性变迁,为临床合理使用抗菌药物提供依据.方法 万古霉素采用E-test法检测最小抑菌浓度(MIC),其余抗菌药物敏感性试验采用纸片扩散法(K-B法),判断标准均按CLSI2011年规定标准判定结果,以WHONET5.4统计软件进行数据分析.结果 共分离出金黄色葡萄球菌3156株,其中耐甲氧西林金黄色葡萄球菌(MRSA)1903株,检出率为60.3％,MRSA检出率呈上升趋势,且随年龄增长而逐渐上升.痰、分泌物为主要标本来源,普外科及ICU病房为金黄色葡萄球菌的主要分离病区.各病区以ICU MRSA检出率最高,为87.4％,其次为普外科和神经外科,分别为85.7％和184.3％.MRSA对除磷霉素、复方磺胺甲嗯唑、克林霉素、红霉素及糖肽类以外的抗菌药物耐药性均在90％以上,MSSA对庆大霉素的耐药率由9.5％上升至16.2％,差异有统计学意义(P＜0.05).复方磺胺甲嗯唑对MRSA和MSSA均保持较好的敏感性,敏感率在80％以上.未发现万古霉素、替考拉宁及利奈唑胺耐药的菌株.结论 6年间金黄色葡萄球菌的耐药率持续保持较高的水平,耐药现象严重,并且MRSA检出率有逐年上升的趋势,临床应合理使用抗菌药物,定期监测其耐药性变迁,避免院内传播.