1996～2001年内科、外科、ICU和门诊患者分离的金黄色葡萄球菌耐药性分析

目的 通过对1996～2001年60家三级甲等医院不同科别住院患者和门诊患者分离的金黄色葡萄球菌的耐药性分析，探讨不同科别来源菌株耐药率间的差别及变迁。方法 药敏试验采用纸片扩散法，用WHONET5软件分析结果。结果 6年间内科住院患者分离的金黄色葡萄球菌对苯唑陛西林的耐药率维持在40％；磺胺甲恶唑／甲氧苄啶(SMZ／TMP)和氯霉素的耐药率从1998年的51．4％和39．6％降低到2001年的36．2％和23．6％。外科住院患者分离菌株对苯唑西林的耐药率从1996年的26．3％增加到2001年的45．9％；庆大霉素和环丙沙星耐药率从1996年的24．6％和17．5％增到2001年的43．5％和43．1％。ICU患者分离的大多数菌株对苯唑西林和环丙沙星耐药。门诊患者分离菌株对苯唑西林的耐药率从1996年的17．2％增加到2001年的24．9％；环丙沙星的耐药率超过30％；SMZ/TMP的耐药率从1998年的61％降低到2001年的38．3％。结论 调查不同科别住院患者和门诊患者来源的金黄色葡萄球菌对常用抗生素耐药性的变迁和现状，对于临床抗感染治疗的经验用药具有一定的指导意义。

Study on drug resistance of Staphylococcus aureus isolates from the inpatients in the internal medicine, surgery, intensive care unit, and the outpatients from 1996～2001

Objective To investigate the antimicrobial resistance of Staphylococcus aureus isolates form the inpatients in the different departments and the outpatients, and study on the differences of resistant rates and the changes among the clinical isolates form 1996 to 2001. Methods Disc diffusion test (K-B method) was used to study the antimicrobial resistance, and WHONET 5 was applied for statistics analysis. Results In the period of study from 1996 to 2001, the resistant rates of Staphylococcus aureus strains from the inpatients in the internal medicine remained about 40% to oxacillin, 51.4% and 39.6% to trimethoprim/sulfamethoxazole and chloramphenicol in 1998, and were reduced to 36.2% and 23.6% in 2001. 26.3% of the isloates from the inpatients in the surgery was resistant to oxacillin in 1996 and the resistant rate was increased to 45.9% in 2001. The resistant rates were 24.6% and 17.5% to gentamicin and ciprofloxacin in 1996 and were raised to 43.5% and 43.1% in 2001. Most of isolates S.aureus were resistant to oxacillin and ciproflxacin. 17.2% of the isolates from the outpatients was resistant to oxacillin in 1996 and the resistant rate was increased to 24.9% in 2001; more than 30% of the isolates were resistant to ciprofloxacin; in 1998, 61% of the stains were resistant to trimethoprim/sulfamethoxazole and resistant rate was reduced to 38.3% in 2001. Conclusions It is significant for empirical use of antimicrobial agents in clinic to study on the resistant rates of the isolates of S.aureus form the inpatients in different depatments and outpatients.