1874株金黄色葡萄球菌临床分布及耐药性结果分析
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摘要
目的了解四川省某医院甲氧西林敏感金黄色葡萄球菌(methicillin sensitive Staphylococcus aureus,MSSA)与耐甲氧西林金黄色葡萄球菌(methicillin resistant Staphylococcus aureus,MRSA)的临床科室分布和耐药性情况。方法回顾性分析2014年12月-2017年12月四川省某医院门诊及住院患者,包括8名因金黄色葡萄球菌引起的食物中毒患者,送检各类标本分离出SA(Staphylococcus aureus)可疑菌落1874株,对其进行鉴定和药敏检测。结果 MSSA和MRSA标本主要来源于痰液(51.31%,74.33%)、伤口分泌物(21.52%,8.96%)和脓液(10.07%,7.92%)。725株MSSA临床分离率依次为门诊(27.17%)、呼吸科(15.45%)、ICU(10.21%)、神经科(8.55%)和口腔科(5.52%),1149株MRSA依次为ICU(33.16%)、神经科(11.66%)、呼吸科(9.75%)、儿科(7.57%)和妇产科(6.27%)。耐药性结果表明,MSSA对苯唑西林、万古霉素、利奈唑胺、替考拉林敏感,对青霉素G、红霉素和阿莫西林/克拉维酸耐药率依次为89.38%、56.69%、21.51%外,对其他抗菌药耐药率均<18.00%; MRSA对万古霉素利、奈唑胺、替考拉林敏感,对苯唑西林、莫西沙星、克林霉素、红霉素、青霉素G、四环素、环丙沙星、阿莫西林/克拉维酸和氨苄西林/舒巴坦的耐药率均显著高于MSSA。结论四川省某医院2014年12月-2017年12月期间临床分离的SA以MRSA为主, MSSA和MRSA在标本来源、科室分布等方面存在较大差异, MRSA耐药情况更为严重,明显高于MSSA。若要评估金黄色葡萄球菌感染风险以及病人的治疗方案,应分别考虑MRSA和MSSA的感染来源和耐药性。
Objective To investigate the clinical distribution and drug resistance of methicillin sensitive Staphylococcus aureus(MSSA) and methicillin resistant Staphylococcus aureus(MRSA) in a hospital in Sichuan province.Methods The outpatients and inpatients in a hospital in Sichuan province from December 2014 to December 2017 were retrospectively analyzed, including 8 patients with food poisoning caused by Staphylococcus aureus, and 1874 strains of SA(Staphylococcus aureus) suspicious colonies were isolated from all specimens for identification and drug sensitivity detection. Results MSSA and MRSA specimens were mainly obtained from sputum(51.31%, 74.33%), wound secretions(21.52%, 8.96%) and pus(10.07%, 7.92%). The clinical isolation rate of 725 MSSA strains was outpatient(27.17%),respiratory(15.45%), ICU(10.21%), neurology(8.55%) and stomatology(5.52%), and 1149 MRSA strains were ICU(33.16%), neurology(11.66%), respiratory(9.75%), paediatrics(7.57%) and obstetrics and gynecology(6.27%),respectively. MSSA was sensitive to benzocillin, vancomycin, linezolid, tapocin, and the drug resistance rates to penicillin G, erythromycin and amoxicillin/clavuric acid were 89.38%, 56.69% and 21.51%, respectively, and to other antibiotics were all less than 18.00%. MRSA was sensitive to vancomycin, nezolid and tetracycline, and the drug resistance rates of benzocillin, moxifloxacin, clindamycin, erythromycin, penicillin G, ciprofloxacin, amoxicillin/clavulacin and ampicillin/sulbactam were significantly higher than those of MSSA. Conclusion From December 2014 to December2017, the clinical separation of SA in a hospital in Sichuan province is with MRSA as predominant. There are significant differences between MSSA and MRSA in specimen source and clinical distribution. The drug resistance of MRSA is more serious, significantly higher than that of MSSA. The source of infection and drug resistance of MRSA and MSSA should be considered to assess the risk of Staphylococcus aureus infection and the patient's treatment regimen.
Objective To investigate the clinical distribution and drug resistance of methicillin sensitive Staphylococcus aureus(MSSA) and methicillin resistant Staphylococcus aureus(MRSA) in a hospital in Sichuan province.Methods The outpatients and inpatients in a hospital in Sichuan province from December 2014 to December 2017 were retrospectively analyzed, including 8 patients with food poisoning caused by Staphylococcus aureus, and 1874 strains of SA(Staphylococcus aureus) suspicious colonies were isolated from all specimens for identification and drug sensitivity detection. Results MSSA and MRSA specimens were mainly obtained from sputum(51.31%, 74.33%), wound secretions(21.52%, 8.96%) and pus(10.07%, 7.92%). The clinical isolation rate of 725 MSSA strains was outpatient(27.17%),respiratory(15.45%), ICU(10.21%), neurology(8.55%) and stomatology(5.52%), and 1149 MRSA strains were ICU(33.16%), neurology(11.66%), respiratory(9.75%), paediatrics(7.57%) and obstetrics and gynecology(6.27%),respectively. MSSA was sensitive to benzocillin, vancomycin, linezolid, tapocin, and the drug resistance rates to penicillin G, erythromycin and amoxicillin/clavuric acid were 89.38%, 56.69% and 21.51%, respectively, and to other antibiotics were all less than 18.00%. MRSA was sensitive to vancomycin, nezolid and tetracycline, and the drug resistance rates of benzocillin, moxifloxacin, clindamycin, erythromycin, penicillin G, ciprofloxacin, amoxicillin/clavulacin and ampicillin/sulbactam were significantly higher than those of MSSA. Conclusion From December 2014 to December2017, the clinical separation of SA in a hospital in Sichuan province is with MRSA as predominant. There are significant differences between MSSA and MRSA in specimen source and clinical distribution. The drug resistance of MRSA is more serious, significantly higher than that of MSSA. The source of infection and drug resistance of MRSA and MSSA should be considered to assess the risk of Staphylococcus aureus infection and the patient's treatment regimen.
引文
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[7]刘小燕,李寅环,林晓晖,等.我院重症医学科2015年常见细菌及多重耐药菌监测结果分析[J].海南医学,2017,28(13):2124-2127.Liu XY,Li YH,Lin XH,et al.Monitoring results of commonly encountered bacteria and multidrug-resistant organisms in intensive care unit of our hospital in 2015[J].Hainan Med J,2017,28(13):2124-2127.
[8]王杉,董剑,杨静,等.2013-2017年某院耐甲氧西林金黄色葡萄球菌的临床分布及耐药性变迁分析[J].国际检验医学杂志,2018,39(17):2143-2146.Wang S,Dong J,Yang J,et al.The trend of clinical distribution and drug resistance of methicillin resistant staphylococcus aureu in our hospital during 2013-2017[J].Internat J Lab Med,2018,39(17):2143-2146.
[9]郑向真.2012~2013年医院感染病原菌检测及其耐药分析[J].国际检验医学杂志,2015,36(4):544-545.Zheng XZ.Nosocomial infection pathogen detection and drug resistance analysis during 2012-2013[J].Internat J Lab Med,2015,36(4):544-545.
[10]李奇,陆春强,陈湘,等.2013-2015年老年患者MRSA菌株分布和耐药性趋势分析[J].中华医院感染学杂志,2016,26(24):5542-5544.Li Q,Lu CQ,Chen X,et al.Distribution and drug resistance of MRSAamong elderly patients during 2013-2015[J].Chin J Nosocomiol,2016,26(24):5542-5544.
[11]朱吉超,魏莲花,杨永清,等.耐甲氧西林金黄色葡萄球菌临床分布及耐药性分析[J].中华医院感染学杂志,2017,27(7):1462-1465.Zhu JC,Wei LH,Yang YQ,et al.Clinical distribution and drug resistance of methicillin-resistant Staphylococcus aureus strains[J].Chin JNosocomiol,2017,27(7):1462-1465.
[12]张红旭,陈良安.异质性万古霉素中介的金黄色葡萄球菌耐药机制及临床意义[J].中华医院感染学杂志,2012,22(17):3923-3926.Zhang HX,Chen LA.Resistance mechanism and clinical significance of heterogeneous vancomycin-mediated Staphylococcus aureus[J].Chin JNosocomiol,2012,22(17):3923-3926.
[13]金仲品,王风秀.治疗耐甲氧西林金葡菌感染的药物选择[J].医师进修杂志(内科版),2004,27(2):53-54.Jin ZP,Wang FX.Drug selection for treatment of methicillin-resistant Staphylococcus aureus infection[J].J Postgraduates Med(Med Ed),2004,27(2):53-54.
[14]耿先龙,董亮,张秀红.5452株金黄色葡萄球菌临床分布及耐药性分析[J].现代预防医学,2017,44(3):546-549.Geng XL,Dong L,Zhang XH.Clinical distribution and drug resistance of5452 strains of Staphylococcus aureus[J].Mod Prev Med,2017,44(3):546-549.
[15]Jim ON.Tacking drug-resistant infections globally:Final report and recommendations[EB/OL].[2016-05-19].[2018-02-24].http://apo.org.au/node/63983.
[16]European Centre for Disease Prevention and Control.Antimicrobial resistance interactive database(EARS-NET)data for 2013[EB/OL].[2014-05-07].[2018-02-24].https://ecdc.europa.eu/en/antimicrobial-resistance.
[2]骆璇,郭红卫,李洁.两种金黄色葡萄球菌产肠毒素差异的Meta分析[J].环境与职业医学,2010,27(5):301-304.Luo X,Guo HW,Li J.Comparative prevalence of the enterotoxin-producing isolates in two strains of Saphylococcus aureus using meta-analysis[J].J EOM,2010,27(5):301-304.
[3]马萍,张秀梅,聂庆东,等.社区医院与三级综合医院MSSA与MRSA的耐药率比较[J].国际检验医学杂志,2012,33(13):1610-1612.Ma P,Zhang XM,Nie QD,et al.Comparison of the drug resistance of MSSA and MRAS between community hospital and three-level general hospital[J].Internat J Lab Med,2012,33(13):1610-1612.
[4]吴珍,王莉洁,喻航,等.耐甲氧西林与甲氧西林敏感金黄色葡萄球菌血流感染的临床特征与耐药性分析[J].解放军医学院学报,2016,37(12):1241-1244.Wu Z,Wang LJ,Yu H,et al.Clinical characteristic of MRSA and MSSAbloodstream infection and their drug resistance[J].Acad J Pla Postgrad Med School,2016,37(12):1241-1244.
[5]尚红,王毓三,申子瑜.全国临床检验操作规程(4版)[M].北京:人民卫生出版社,2014.Shang H,Wang LS,Shen ZY.National clinical laboratory procedures(4th Edtion)[M].Beijing:People’s Medical Publishing House,2014.
[6]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[S].Twenty Furth Informational Supplement,2016,M100-S26Vol34N0.1.
[7]刘小燕,李寅环,林晓晖,等.我院重症医学科2015年常见细菌及多重耐药菌监测结果分析[J].海南医学,2017,28(13):2124-2127.Liu XY,Li YH,Lin XH,et al.Monitoring results of commonly encountered bacteria and multidrug-resistant organisms in intensive care unit of our hospital in 2015[J].Hainan Med J,2017,28(13):2124-2127.
[8]王杉,董剑,杨静,等.2013-2017年某院耐甲氧西林金黄色葡萄球菌的临床分布及耐药性变迁分析[J].国际检验医学杂志,2018,39(17):2143-2146.Wang S,Dong J,Yang J,et al.The trend of clinical distribution and drug resistance of methicillin resistant staphylococcus aureu in our hospital during 2013-2017[J].Internat J Lab Med,2018,39(17):2143-2146.
[9]郑向真.2012~2013年医院感染病原菌检测及其耐药分析[J].国际检验医学杂志,2015,36(4):544-545.Zheng XZ.Nosocomial infection pathogen detection and drug resistance analysis during 2012-2013[J].Internat J Lab Med,2015,36(4):544-545.
[10]李奇,陆春强,陈湘,等.2013-2015年老年患者MRSA菌株分布和耐药性趋势分析[J].中华医院感染学杂志,2016,26(24):5542-5544.Li Q,Lu CQ,Chen X,et al.Distribution and drug resistance of MRSAamong elderly patients during 2013-2015[J].Chin J Nosocomiol,2016,26(24):5542-5544.
[11]朱吉超,魏莲花,杨永清,等.耐甲氧西林金黄色葡萄球菌临床分布及耐药性分析[J].中华医院感染学杂志,2017,27(7):1462-1465.Zhu JC,Wei LH,Yang YQ,et al.Clinical distribution and drug resistance of methicillin-resistant Staphylococcus aureus strains[J].Chin JNosocomiol,2017,27(7):1462-1465.
[12]张红旭,陈良安.异质性万古霉素中介的金黄色葡萄球菌耐药机制及临床意义[J].中华医院感染学杂志,2012,22(17):3923-3926.Zhang HX,Chen LA.Resistance mechanism and clinical significance of heterogeneous vancomycin-mediated Staphylococcus aureus[J].Chin JNosocomiol,2012,22(17):3923-3926.
[13]金仲品,王风秀.治疗耐甲氧西林金葡菌感染的药物选择[J].医师进修杂志(内科版),2004,27(2):53-54.Jin ZP,Wang FX.Drug selection for treatment of methicillin-resistant Staphylococcus aureus infection[J].J Postgraduates Med(Med Ed),2004,27(2):53-54.
[14]耿先龙,董亮,张秀红.5452株金黄色葡萄球菌临床分布及耐药性分析[J].现代预防医学,2017,44(3):546-549.Geng XL,Dong L,Zhang XH.Clinical distribution and drug resistance of5452 strains of Staphylococcus aureus[J].Mod Prev Med,2017,44(3):546-549.
[15]Jim ON.Tacking drug-resistant infections globally:Final report and recommendations[EB/OL].[2016-05-19].[2018-02-24].http://apo.org.au/node/63983.
[16]European Centre for Disease Prevention and Control.Antimicrobial resistance interactive database(EARS-NET)data for 2013[EB/OL].[2014-05-07].[2018-02-24].https://ecdc.europa.eu/en/antimicrobial-resistance.
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