儿科病房耐甲氧西林金黄色葡萄球菌耐药性及感染危险因素分析

摘要

Objective The drug resistance and risk factors of methicillin resistant Staphylococcus aureus (MRSA) infected in the pediatric ward of the hospital were analyzed to provide a scientific basis for the con-trol of MRSA paediatric infection .Methods Totally 306 strains of Staphylococcus aureus were isolated from the pediatric wards in the Affiliated Hospital of Southwest Medical University from July 2015 to June 2016 , the bacterial species identification and drug susceptibility tests were performed by MicroScan WalkAway 96SI and the statistical analysis was carried out by WHONET 5 .4 softwate .The clinical data of 306 children were infected with staphylococcus aureus collected by retrospective survey ,the risk factors of MRSA infection were analyzed by the method of χ2 test and non-condition Logistic regression .Results A total of 90 strains of M R-SA were detected ,with a detection rate of 29 .41％ .MRSA was mainly isolated from sputum ,accounting for 74 .44％ ,followed by blood ,accounting for 10 .0％ .MRSA was mainly resistant to amikacin ,ampicillin ,eryth-romycin ,clindamycin and other antimicrobial agents (P< 0 .05) .Age< 1 years ,venous catheterization ,me-chanical ventilation ,tracheal intubation ,ventilator ,stay in ICU ,hospitalization time >7 d ,use of corticoste-roids ,low albumin ,and antibiotic use time >7 d were the main risk factors of MRSA in children (P<0 .05) . Admission to NICU ,venous catheterization ,mechanical ventilation and tracheal intubation were independent risk factors .Conclusion MRSA isolated from pediatric wards is resistant to many kinds of antibiotics .Infec-tion with MRSA is related to many factors .Hospitals should take corresponding measures to reduce the inci-dence of M RSA infection .%目的 通过对医院儿科病房感染耐甲氧西林金黄色葡萄球菌(MRSA)的耐药性及危险因素进行分析,为MRSA儿科感染的控制提供科学依据.方法 收集2015年7月至2016年6月在西南医科大学附属医院儿科临床分离的306株金黄色葡萄球菌,采用德国西门子公司MicroScan WalkAway 96SI进行菌种鉴定及药敏试验,使用WHONET5.4软件进行药敏统计分析,采用回顾调查方法对306例感染金黄色葡萄球菌患儿的临床资料进行研究,应用χ2检验和非条件Logistic回归对MRSA感染危险因素进行统计分析.结果 共有90株MRSA被检测出,检出率为29.41％.MRSA主要从痰液中分离出,占74.44％;其次是血液,占10.00％.MRSA主要对阿米卡星、氨苄西林、红霉素、克林霉素等抗菌药物耐药(P<0.05).年龄<1岁、静脉置管、机械通气、气管插管、使用呼吸机、入住ICU、住院时间>7d、使用皮质激素、低清蛋白、抗菌药物使用时间>7d是患儿感染MRSA的主要危险因素(P<0.05),其中入住NICU、静脉置管、机械通气、气管插管为独立危险因素.结论 儿科病房分离的MRSA对多种抗菌药物耐药,患儿感染MRSA与多种因素相关,医院应采取相应措施,减少MRSA感染的发生.