神经外科耐甲氧西林金黄色葡萄球菌感染的临床调查

目的了解神经外科耐甲氧西林金黄色葡萄球菌(MRSA)感染患者感染部位分布、危险因素及病原菌耐药性,为制定医院感染的预防和控制措施提供参考依据。方法对2008年6月至2009年12月神经外科住院的32例MRSA感染患者进行跟踪调查并对病原菌耐药情况进行分析。同时将上述资料与医院其它科室同期住院的42例MRSA感染患者的资料进行对比。结果神经外科住院病人的MRSA感染率为0.96%,明显高于同期其它科室的住院患者MRSA感染率0.09%(P0.01)。神经外科住院的32例MRSA感染患者中17例为ICU病人,感染率为1.86%,明显高于神经外科普通病房的MRSA感染率0.62%(P0.01)。感染部位以下呼吸道感染为主(26/32,81.25%);感染的危险因素包括气管切开、广谱抗菌药物滥用等。药敏结果显示MRSA除对万古霉素、利奈唑胺、替考拉宁等糖肽类抗菌药物较敏感外,对其它抗菌药物均具有较强的耐药性。结论神经外科ICU是MRSA感染的高危部门,应加强神经外科ICU患者MRSA的筛查,加强气管切开等侵入性操作患者的管理,严格环境和物品的消毒处理,严格手卫生,避免MRSA的院内传播。

Clinical investigation into methicillin-resistant Staphylococcus aureus infections in the patients undergoing neurosurgery

Objective To provide the basis for the prevention and control of nosocomial infection produced by methicillin-resistant Staphylococcus aureus （MRSA）. Methods The neurosurgical inpatients with MRSA infection who were in hospital from June, 2008 to December, 2009 were investigated. Their data were analyzed and compared to the data of all the inpatients with MRSA infection who were in the hospital for the corresponding period. Results Thirty-two （0.96%） neurosurgical inpatients suffered from MRSA infection and 42 （0.09%） the others, except the neurosurgical inpatients suffered from MRSA infection in the hospital. The MRSA infection rate in the neurosurgery inpatients was significantly higher than that in the others except the neurosurgical inpatients （P0.01）. Seventeen of 32 neurosurgical inpatients with MRSA infection were in ICU. The rate of MRSA infection in neurosurgical ICU was 1.86% ,which was siginificantly higher than that （0.62%）in the ordinary neurosurgical ward （P0.01）. The inpatients with lower respiratory tract MRSA infection accounted for the 81.25% （26/32） of the neurosurgical inpatients with MRSA infection. The risk factors of MRSA infection included tracheotomy, abuse use of broad-spectrum antibiotics, etc. MRSA was resistant to all the antibiotics except vancomycin, linezolid and teicoplanin. Conclusions There is highly risk of the inpatients in the neurosurgical ICU being infected with MRSA. The measures such as the screening of patients with MRSA infection, enhancement of management of the patients undergoing invasive procedure （for example, tracheotomy）, strict disinfection of environment and medical device, and keeping medical staffs’hands clean are very important to the preventing MRSA infection.