2014-2017年耐甲氧西林金黄色葡萄球菌医院感染目标性监测分析

目的了解耐甲氧西林金黄色葡萄球菌(MRSA)临床分布及耐药性,为防治MRSA提供参考依据。方法收集2014-2017年赣州市人民医院住院患者微生物标本检出金黄色葡萄球菌(SA)的临床资料,回顾性分析其中MRSA医院感染目标性监测结果。结果 2 083株SA中MRSA检出率为28.47%,其中MRSA定植菌株占16.36%、社区感染菌株占52.95%、医院感染菌株占30.69%;4年间MRSA检出率逐年上升,差异有统计学意义(P<0.05);MRSA多见于老年患者,标本主要为痰液和分泌物,分别占49.58%及33.22%;科室主要为神经外科(含神外ICU)和神经内科(含神内ICU),分别占16.36%及12.98%;药敏结果显示,MRSA对青霉素G、苯唑西林、庆大霉素等11种药物的耐药率明显高于甲氧西林敏感金黄色葡萄球菌,医院感染MRSA对庆大霉素、环丙沙星、左氧氟沙星等6种药物的耐药率明显高于社区感染MRSA,差异有统计学意义(均P<0.05)。结论 MRSA检出率较高且逐年上升,感染主要来自社区,临床分布相对集中;对常用抗菌药物耐药率较高,尤其是医院感染MRSA;应加强MRSA的主动监测防控和抗菌药物的合理应用。     

耐甲氧西林金黄色葡萄球菌院内感染调查分析

目的了解耐甲氧西林金黄色葡萄球菌（MRSA）感染状况、发生特点及MRSA耐药性,为采取有效治疗与预防措施提供参考。方法采取现场调查、追踪和回顾性调查相结合的方法收集病例资料,对MRSA病例的临床特征及耐药谱进行综合分析。结果2006—2007年,共从住院患者标本中分离出金黄色葡萄球菌126株,其中MRSA67株,占53．17％。67例MRSA感染者年龄以≥70岁居多（占83．5％）,男性（61例）多于女性（6例）。下呼吸道是MRSA院内感染的首发部位（占85．0％）。病例主要分布于神经内科（38例）和呼吸内科（17例）。MRSA菌株对万古霉素100．00％敏感,对其他抗生素敏感率低。结论MRSA在金黄色葡萄球菌感染中所占比例较高,且MRSA菌株对多种抗生素耐药。有必要采取相应的防治措施预防院内MRSA感染的发生。     

耐甲氧西林金黄色葡萄球菌感染的流行病学及耐药性研究

目的探讨城市中心城区耐甲氧西林金黄色葡萄球菌(MRSA)感染的流行病学及耐药性。方法采用回顾性调查方法,对医院2009年住院患者进行MRSA感染的统计分析。结果在2009年40 846份标本中,检出265株金黄色葡萄球菌,检出率为0.65%;265株金黄色葡萄球菌检出MRSA 229株,检出率为86.42%;MRSA229株中9株是院内MRSA感染,占3.93%;220株为社区MRSA感染,占96.07%;该菌株对临床常用10种抗菌药物的耐药率>60.00%,但对万古霉素的敏感率为100.00%。结论城市中心城区社区MRSA感染现状已相当严重,应当和地段医院或社区医院一起加强MRSA的预防及治疗工作。     

住院患儿MSSA与MRSA的分布特点及耐药性

目的比较住院患儿甲氧西林敏感金黄色葡萄球菌(MSSA)与耐甲氧西林金黄色葡萄球菌(MRSA)的分布及耐药特点,为临床经验治疗提供依据。方法回顾性分析2011—2015年某院住院患儿分离的金黄色葡萄球菌及其临床资料,比较MSSA与MRSA的分布及耐药特点。结果共分离金黄色葡萄球菌919株,其中MSSA632株(68.77%),MRSA 287株(31.23%)。MSSA与MRSA感染患儿中29d~1岁婴儿组所占比率最高,分别为65.03%、64.11%。MSSA和MRSA标本主要来自痰(80.38%、79.09%)。MSSA和MRSA主要分布科室均为儿童呼吸科(50.73%、45.89%)和儿童神经内科(22.98%、26.84%)。MSSA对除青霉素和红霉素外的抗菌药物耐药率均20.00%;MRSA对青霉素、苯唑西林、红霉素及克林霉素的耐药率均40.00%;MRSA对四环素、红霉素、克林霉素、左氧氟沙星、环丙沙星、莫西沙星、呋喃妥因及利福平的耐药率均高于MSSA。结论住院患儿分离的金黄色葡萄球菌以MSSA为主,1岁以内婴儿为主要分离人群;呼吸道标本来源的MSSA和MRSA主要分布科室相似,MRSA的耐药率普遍高于MSSA。     

综合医院感染耐甲氧西林金黄色葡萄球菌耐药性监测

目的 调查医院临床分离耐甲氧西林金黄色葡萄球菌(MRSA)对抗菌药物的耐药现状,为临床治疗用药提供参考.方法 采用法国生物梅里埃公司ATB分析仪进行细菌鉴定,K-B法做体外药敏试验.结果 181株金黄色葡萄球菌中MRSA检出率为58.0%,MRSA检出率以老年病科最高(73.5%),其次是普外科(69.4%)及骨外科(61.9%);社区获得性感染MRSA检出率远低于住院患者;药敏结果显示,MRSA耐药率明显高于甲氧西林敏感金黄色葡萄球菌(MSSA),未检出对万古霉素及替考拉宁耐药菌株.结论 金黄色葡萄球隋耐药严重,MRSA的高检出率给临床治疗及控制医院感染带来较大困难;糖肽类抗菌药物可作为多药耐药金黄色葡萄球菌重症感染的首选抗菌药物.     

医院环境与住院患者耐甲氧西林金黄色葡萄球菌分布与耐药性分析

目的了解耐甲氧西林金黄色葡萄球菌(MRSA)在医院内的流行及耐药情况,为MRSA医院感染的预防与控制提供科学依据。方法以某三级甲等综合医院2010年6-12月,医院环境分离的40株金黄色葡萄球菌(SAU),与临床标本分离的155株SAU为研究对象,采用K-B纸片法进行MRSA鉴定与药物敏感性试验。结果 195株SAU中,MRSA检出率为88.72%,其中临床分离株和环境分离株中的MRSA检出率分别为88.39%和90.00%,两者相比差异无统计学意义;临床MRSA株,主要分布于痰液及伤口分泌物;环境MRSA株主要分布于病房空气及病床架与床旁桌;MRSA对β-内酰胺类抗菌药物耐药率为100.00%,万古霉素的敏感率为100.00%,对其他抗菌药物不同程度耐药。结论 MRSA在医院内有较高的流行度,且呈多药耐药性,应长期进行MRSA感染目标性监测,切实做好MRSA感染或定植患者的消毒隔离工作。     

肿瘤专科医院金黄色葡萄球菌的分布与耐药性分析

目的了解肿瘤专科医院金黄色葡萄球菌及耐甲氧西林金黄色葡萄球菌(MRSA)的临床分布及耐药性,为临床合理使用抗菌药物提供依据。方法分析2009-2013年肿瘤专科医院住院肿瘤患者分离到的424株金黄色葡萄球菌的感染情况及耐药性,并用WHONET5.6软件进行统计分析。结果 424株金黄色葡萄球菌中检出MRSA170株,占40.1%;金黄色葡萄球菌主要分离于呼吸道、引流液和分泌物,分别占49.1%、18.2%和13.9%;MRSA在ICU的检出率最高,为72.6%;MRSA对万古霉素和利奈唑胺100.0%敏感,对其他抗菌药物均有不同程度的耐药;甲氧西林敏感金黄色葡萄球菌(MSSA)对青霉素耐药率>80.0%,对其他多种药物敏感,耐药率<30.0%。结论肿瘤医院金黄色葡萄球菌具有多药耐药性,应加强MRSA的监测,为临床合理使用抗菌药物提供依据。     

耐甲氧西林金黄色葡萄球菌的临床分布及耐药性分析

目的分析2011-2013年耐甲氧西林金黄色葡萄球菌(MRSA)在浙江省仙居县第一人民医院住院患者的临床分布及耐药性。方法对本院2011-2013年临床住院送检的各类标本分离出的204例MRSA,按照检出率、科室分布、标本种类、药物耐药性进行分析。结果共分离到MRSA204例,检出率为38.1%,MRSA感染的科室前三位是ICU、呼吸内科、小儿科,分别占41.2%、25.0%、11.3%;标本的来源主要为呼吸道标本、脓/分泌物、血液,分别占50.5%、19.1%、10.3%;全部MRSA菌株对万古霉素、利奈唑胺、奎奴普丁/达福普汀、呋喃妥因100%敏感,对其他的9种抗菌药物呈现不同的耐药性,耐药率50%,其中对青霉素G、苯唑西林的耐药率为100%。结论本院MRSA对常用的抗菌药物有较高的耐药性,临床应根据药敏结果合理选择抗菌药物,同时应采取措施控制院内感染的发生。     

神经外科患者耐甲氧西林金黄色葡萄球菌感染病原菌耐药性分析

目的探讨神经外科患者耐甲氧西林金黄色葡萄球菌(MRSA)感染部位分布及病原菌耐药性,以期为临床提供参考。方法回顾性分析医院2008年9月-2014年1月住院患者送检各类标本细菌培养及药敏试验结果,对确诊存在MRSA感染的61例患者细菌培养及药敏试验结果进行分析,采用SPSS16.0软件进行统计分析。结果神经外科61例MRSA感染患者感染部位主要为下呼吸道感染为主,共35例占57.38%;MRSA对青霉素、氨苄西林、头孢唑林、哌拉西林、头孢西丁、哌拉西林、克林霉素、阿奇霉素、左氧氟沙星耐药率达100.00%。结论神经外科MRSA感染患者感染部位以下呼吸道感染及切口感染多见,对临床多种抗菌药物完全耐药,了解MRSA的感染部位分布及耐药性,加强MRSA监测,合理使用抗菌药物,严格执行手卫生及消毒隔离等制度,避免MRSA的医院感染发生及传播。     

肿瘤患者耐甲氧西林金黄色葡萄球菌医院感染耐药性分析

目的研究肿瘤患者耐甲氧西林金黄色葡萄球菌(MRSA)医院感染现状及耐药性,以指导临床合理选用抗菌药物并为预防与控制医院感染提供科学依据。方法严格按照《全国临床检验操作规程》进行MRSA分离、鉴定,采用K-B法进行药敏试验,依据CLSI最新拆点判读结果。结果 67株葡萄球菌属中金黄色葡萄球菌18株,占26.87%,其中MRSA12株,MRSA分离率66.67%;MRSA主要分离自痰标本5株,占41.67%,其次是腹水标本3株,占25.00%;科室来源主要为肿瘤内科及肿瘤外科,分别占50.50%、41.67%;MRSA除对替考拉宁、夫西地酸、万古霉素等100.00%敏感外,对常用抗菌药物均存在较高的耐药性,MRSA对苯唑西林和青霉素耐药率100.00%,对氨基糖苷类、大环内酯类等抗菌药物耐药率>80.00%,未发现耐万古霉素菌株。结论了解MRSA感染的分布与特征、监测其耐药性,有助于临床及时采取合理的防治措施,有效预防与控制MRSA医院感染的暴发流行。     

Prevention of percutaneous endoscopic gastrostomy site infections caused by methicillin-resistant Staphylococcus aureus

Percutaneous endoscopic gastrostomy (PEG) is widely used to maintain enteral nutrition in patients who are unable to swallow. Peristomal wound infection is the most common complication of this procedure. In a hospital endemic for methicillin-resistant Staphylococcus aureus (MRSA), MRSA can be the most common organism associated with these infections. We have evaluated a strategy consisting of screening, skin decontamination and glycopeptide prophylaxis for preventing PEG-site infections. None of the 34 patients who received the decontamination protocol and glycopeptide prophylaxis (Group A) developed PEG-site infections within one month of surveillance. Two patients were infected with MRSA after that period. One of seven patients who received the decontamination protocol alone (Group B) was infected within the period of surveillance, while another patient was infected after that period. Both were infected with MRSA. None of nine patients who received glycopeptide prophylaxis alone (Group C) were infected. The results suggest that the strategy of screening, decontamination and glycopeptide prophylaxis is effective in the prevention of PEG-site infections with MRSA. Further trials are necessary to confirm these findings.     

MRSA in the critically ill.

MRSA colonization and infection rates were prospectively examined over an 18 month period in a general Intensive Care Unit. Of 642 admissions, 305 were in ICU for longer than 48 h and were hence included and a further three patients were already colonized at admission but stayed less than 48 h. Ninety-seven patients were colonized with MRSA including 19 who were already colonized at admission. There were 56 episodes of clinical infection in 43 patients. The mortality rates in the colonized and infected groups, were 14.8% and 16.2% respectively, while the rate in those not colonized was 23%. These figures were not statistically different. Those colonized or infected with MRSA had significantly longer ICU stays than those not colonized. Sputum colonization and infection was a major site for MRSA. There was diagnostic certainty of MRSA infection in 40% of cases emphasizing the difficulty in diagnosis of infection due to MRSA in the critically ill.Both colonization and infection with MRSA are associated with longer ICU stay but do not appear to influence mortality.     

Epidemiology of hospital-acquired infections in cirrhotic patients: effect of carriage of methicillin-resistant Staphylococcus aureus and influence of previous antibiotic therapy and norfloxacin prophylaxis.

We assessed the prevalence of carriage of methicillin-resistant Staphylococcus aureus (MRSA) in anterior nares and stools, and of third-generation cephalosporin resistant enterobacteriaceae and non-fermenting gram-negative bacilli (RE/RNF) in stools of 748 hospitalized long-stay cirrhotic patients. We also evaluated the consequences of carriage on the epidemiology of hospital-acquired spontaneous bacterial peritonitis, bacteraemia and urinary tract infection (UTI) in these patients. The prevalence of carriage of MRSA and RE/RNF was 16.7% and 14.7% respectively. Whereas RE/RNF carriage did not lead to an increased risk of infection due to RE/RNF, the overall risk of infections caused by MRSA was more than tenfold higher in MRSA carriers. MRSA and RE/RNF carriers had received prior antibiotic therapy to a greater extent than non-carriers (P < 0.001) and MRSA carriers had received prior norfloxacin prophylaxis to a greater extent than the two other groups (P < 0.02). The mortality rate during hospital stay was higher in MRSA and RE/RNF carriers than in non-carriers (P < 0.001). Pugh score (P < 0.0001), age (P < 0.0001), MRSA carriage (P = 0.0018) and bacteraemia (P = 0.0017) were associated independently with mortality. MRSA carriage in hospitalized cirrhotic patients leads to the emergence of infections due to this strain, mainly SBP and bacteraemia. Prior antibiotic therapy and norfloxacin prophylaxis increase the risk of carriage of MRSA.     

住院患者与医院环境耐甲氧西林金黄色葡萄球菌耐药性分析

[目的]了解耐甲氧西林金黄色葡萄球菌（MRSA）在医院内的流行及耐药特征,为预防和控制MRSA引起的院内感染提供科学依据。[方法]以上海某区一家综合性二级医院临床患者标本中分离的78株金黄色葡萄球菌（SA）和同时期该医院诊疗环境中分离的53株sA共131株sA为研究对象,分别用头孢西丁药敏纸片法和PCR法检测MRSA,K-B法检测该131株sA对15种抗菌药物的敏感性。[结果]131株SA中,MRSA构成比为55．73％（73／131）。其中,临床分离株和环境分离株中的MRSA构成比分别为52．56％（41／78）和60．38％（32／53）,两者相比差异无统计学意义（JP〉0．05）。临床MRSA株主要分布于痰液及伤口分泌物;环境MRSA株主要分布于床头柜、监护仪以及医护人员手。抗菌药物敏感性实验显示,MRSA对β-内酰胺类药物耐药率100％,对糖肽类药物、利奈唑胺、利福平高度敏感,对其他抗菌药物均呈多重耐药。[结论]MRSA在医院内有较高流行度,而且呈多重耐药性。应加强抗生素的合理使用,及时进行MRSA院内感染目标性监测,切实做好MRSA感染患者的消毒隔离工作。     

院感控制措施对控制ICU耐甲氧西林金黄色葡萄球菌感染的效果评价

目的对重症监护病房(ICU)耐甲氧西林金黄色葡萄球菌(MRSA)感染实施监控措施后效果的评价,探讨如何更好的控制其感染。方法 2008年8月-2010年9月长沙市某医院重症监护病房内MRSA感染共164例患者,分析其可能引起感染的因素并采取相应的消毒隔离等监控措施,对效果进行评价。结果实施相应的监控措施后ICU患者的MRSA感染率较实施监控措施前明显下降,两者比较差异有统计学意义(P<0.05),控制感染实施干预措施后ICU环境院感监测MRSA检出率较之前明显下降,两者比较差异有统计学意义(P<0.01)。结论对ICU实施消毒隔离等监控措施能有效降低MRSA感染率,并可以预防感染。     

烧伤创面耐甲氧西林金黄色葡萄球菌感染暴发流行的调查

目的了解烧伤患者创面耐甲氧西林金黄色葡萄球菌(MRSA)流行的情况,找出传染源、传播途径,防止再流行. 方法对某院烧伤科创面感染的6例患者及医院环境进行了流行病学调查. 结果烧伤科患者MRSA感染的罹患率31.58%,患者创面MRSA和环境中培养的MRSA耐药菌谱基本一致;环境细菌培养结果:烤灯架、陪护手、门把手、床面均分离出MRSA,提示通过污染的烤灯架、陪护手而引起传播. 结论警惕区域性暴发的同源性交叉感染;不容忽视陪护手、门把手、公用医疗用品的消毒.     

Comparison of routine prophylaxis with vancomycin or cefazolin for femoral neck fracture surgery: microbiological and clinical outcomes.

OBJECTIVE: To assess the impact of antibiotic prophylaxis on the emergence of vancomycin-resistant strains of Enterococcus faecium, Enterococcus faecalis, and Staphylococcus aureus and the incidence of surgical site infection (SSI) after vancomycin or cefazolin prophylaxis for femoral neck fracture surgery. DESIGN: Prospective cohort study. SETTING: A hospital with a high prevalence of methicillin-resistant S. aureus (MRSA) carriage. PATIENTS: All patients admitted with a femoral neck fracture from March 1, 2004 through February 28, 2005 were prospectively identified and screened for MRSA and vancomycin-resistant (VRE) carriage at admission and at day 7. Deep incisional and organ/space SSIs were also recorded. RESULTS: Of 263 patients included in the study, 152 (58%) received cefazolin and 106 (40%) received vancomycin. At admission, the prevalence of MRSA carriage was 6.8%; it was 12% among patients with risk factors and 2.2% among patients with no risk factors (P=.002). At day 7 after surgery, there were 6 patients (2%) who had hospital-acquired MRSA, corresponding to 0.7% in the cefazolin group and 5% in the vancomycin group (P=.04); none of the MRSA isolates were resistant to glycopeptides. The rate of VRE carriage at admission was 0.4%. Three patients (1%) had acquired carriage of VRE (1 had E. faecium and 2 had E. faecalis); all 3 were in the cefazolin group (2% of patients) and none in the vancomycin group (P=.27). Eight SSIs (3%) occurred, 4% in the cefazolin group and 2% in the vancomycin group (P=.47). CONCLUSIONS: This preliminary study demonstrates that cefazolin and vancomycin prophylaxis have similar impacts on the emergence of glycopeptide-resistant pathogens. Neither MRSA infection nor increased rates of SSI with other bacteria were observed in the vancomycin group, suggesting that a larger multicenter study should be initiated.     

口腔医院多重耐药菌感染住院患者病房环境污染调查

目的了解病区环境中多重耐药菌(MDRO)检出情况,为临床预防和控制MDRO传播提供依据。方法某口腔专科医院2012年9月—2014年7月收治MDRO感染患者作为实验组,随机抽取的12例未感染MDRO患者作为对照组,对其周围环境物品表面进行微生物采样和培养,对微生物进行鉴定和药敏试验。结果 44例MDRO感染者中,13例患者周围环境中检出相应的MDRO,总体MDRO检出率为29.55%(13/44)。耐甲氧西林金黄色葡萄球菌(MRSA)在环境各物体表面均有检出,检出率为45.45%(5/11),多重耐药鲍曼不动杆菌(MDRAB)检出率为66.67%(2/3),耐甲氧西林表皮葡萄球菌(MRSE)检出率为66.67%(6/9)。MRSA感染患者鼻腔、手MRSA检出率分别为72.73%、54.54%,其陪护人员鼻腔、手MRSA检出率分别为36.36%、18.18%。实验组和对照组周围环境物品细菌菌落数比较,差异无统计学意义(均P0.05)。结论口腔医院MDRO感染者周围环境物品表面MDRO检出率高于非MDRO感染者,应加强MDRO感染者周围环境的监控、清洁和消毒,预防MDRO医院传播。     

ICU多药耐药菌感染的调查分析

目的 ICU多药耐药菌感染的情况,探讨有效措施进行控制。方法 2009、2010年ICU多药耐药菌感染情况进行调查、统计分析。结果 2009年多药耐药菌感染率为29.98%,2010年感染率为36.36%;2010年MRSA占全部多药耐药菌感染患者的21.98%,明显低于2009年的47.97%;感染部位主要为呼吸道。结论合理应用抗菌药物是控制多药耐药菌感染产生的关键。     

重症监护室耐甲氧西林金黄色葡萄球菌监控研究

目的了解某院重症监护室（ICU）耐甲氧西林金黄色葡萄球菌（MRSA）医院感染情况,评价干预效果。方法收集2008年8月-2010年9月间ICU住院患者MRSA医院感染病例,对分离的阳性菌株用分子生物学方法验证。2009年9月-2010年9月,对ICU MRSA医院感染患者实施具体干预、监控,并与干预前一年的MRSA医院感染率进行比较,评价干预效果。结果ICU环境中MRSA检出率,干预前为29.90%（87/291）,干预后为7.90%（23/291）,两者比较,差异有统计学意义(χ2=45.910,P＜0.05); ICU住院患者MRSA医院感染率,干预前为35.87％（113/315）,干预后为14.66%(51/348),两者比较,差异有统计学意义(χ2=25.11,P＜0.05)。干预前后ICU内的MRSA感染危险因素相同,主要是气管插管及使用呼吸机等侵入性操作、神经外科大手术、广谱抗菌药物的长期使用、免疫抑制剂的应用和未采取隔离措施等。MRSA新发感染主要集中在入住ICU 2周后,入住时间越长,干预效果越不明显。结论ICU获得性感染MRSA发生率较高。早期强化干预措施,加强监测、控制,可有效降低MRSA医院交叉感染率。