手部感染耐甲氧西林葡萄球菌(MRSA)发生率正在上升

<正>作者回顾分析了一家市内医院2005~2012年手部感染资料,对于MRSA细菌培养和药敏试验进行分析。共发现683例MRSA手部感染,全部对青霉素、苯唑青霉素、氨苄青霉素耐药;克林霉素和左旋氧氟沙星耐药比例也显著上升;少数对复方新诺明、四环素、庆大霉素和莫西沙星耐药;未见对万古霉素、达托霉素、利奈唑胺和利福平耐药。因     

2008~2010年某院金黄色葡萄球菌感染现状及耐药性变迁分析

目的 了解本院院内金黄色葡萄球菌的临床分布及耐药性变迁,为临床合理使用抗菌药物提供一定的依据.方法 收集分离自2008年1月至2010年12月本院住院患者金黄色葡萄球菌共859株,采用 VITEK-2 Compact 进行鉴定,采用K-B纸片扩散法进行药敏试验,头孢西丁纸片扩散法鉴定耐甲氧西林金黄色葡萄球菌(MRSA),采用双纸片扩散法检测诱导型克林霉素耐药情况,应用WHONET 5.4软件进行数据处理.结果 本研究共检出金黄色葡萄球菌859株,主要分离自痰液524株(61.0%),伤口分泌物153株(17.8%);科室分布情况为:呼吸内科291株(33.9%),肿瘤科157株(18.3%),神经内科133株(15.5%).本研究所分离菌株中MRSA共253株(29.5%),诱导型克林霉素检测阳性菌155株(49.1%).MRSA检出率逐年升高,MRSA对16 种抗菌药物的耐药率均高于甲氧西林敏感金黄色葡萄球菌(MSSA),其中三者对头孢唑啉、头孢呋辛、环丙沙星、左氧氟沙星和利福平的耐药率比较,差异具有统计学意义(P< 0.05),未检出耐万古霉素和利奈唑胺菌株.结论临床中应根据病原学药敏结果合理选择抗菌药物,减少因抗菌药物滥用而导致的耐药菌株的产生.     

插入式E-test监测脑外伤昏迷患者痰中分离的耐甲氧西林金黄色葡萄球菌对万古霉素的敏感性研究

由于抗菌药物的广泛应用,细菌的高度耐药性越来越引起社会的关注,超级耐药菌的出现给抗菌药物的滥用敲响警钟,国外报道在耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus,MRSA）中分离到万古霉素中度敏感的金黄色葡萄球菌（vancomycin intermediate-resistant Staphylococcus aureus,VISA）和VRSA耐万古霉素金黄色葡萄球菌（vancomycin resistant Staphylococcus aureus,VRSA）后,我国学者亦对MRSA进行严密的万古霉素敏感性监测。本研究应用插入式E-test纸条检测MRSA最小抑菌浓度,观察脑外伤昏迷患者呼吸道分泌物中分离的MRSA对万古霉素敏感性的变化,现报道如下。     

单中心腹膜透析相关性腹膜炎致病菌谱与药敏分析

目的:分析腹膜透析相关性腹膜炎(PDAP)致病菌谱及其药敏特点,以指导抗菌药物的合理使用。方法:回顾性分析本院于2014年01月~2016年09月收治的PDAP病例42例次,统计分析临床资料、实验室检查、透出液致病菌分布与药敏、治疗转归情况。结果:透出液致病菌培养阳性率78.57%,其中G+球菌占69.70%、G+杆菌占3.03%、G-杆菌占27.27%。G+球菌对万古霉素、利奈唑烷及替加环素敏感,未发现耐药菌株;G+球菌对青霉素(86.96%)、苯唑西林(57.14%)、红霉素(50.00%)、克林霉素(47.83%)、复方新诺明(47.62%)、环丙沙星(31.82%)耐药率高。G-杆菌对替加环素、厄他培南与亚胺培南敏感,未发现耐药菌株;对丁胺卡那霉素和哌拉西林/他唑巴坦耐药率皆为11.11%;对氨苄西林、头孢唑林、头孢噻肟、头孢曲松、头孢西丁、复方新诺明和庆大霉素耐药率高,分别为85.71%、77.78%、66.67%、62.50%、50.00%、44.44%和33.33%。PDAP总治愈率为85.71%,透出液培养阴性组退出率最高达22.22%,其次是G-杆菌组为11.11%,G+球菌组最低为8.70%。结论:本中心PDAP的致病菌以G+球菌为主,推荐万古霉素联合丁胺卡那霉素作为本中心经验性治疗,治愈率达93.3%。     

慢性前列腺炎病原菌及药敏分析

目的了解慢性前列腺炎(CP)与病原菌的关系以及病原菌的耐药状况。方法对门诊274例CP患者进行前列腺液(EPS)细菌培养并进行菌种鉴定和耐药性测试,结果根据NCCLS规定进行判断。结果在274份标本中,107例(39．1%)培养呈阳性,G~ 菌占92．5%(99/107),G~-菌占7．5%(8/107)。其中金黄色葡萄球菌88株,占82．24%(88/107),远远高于其它菌种,检出耐甲氧西林金黄色葡萄球菌(MRSA)30株,占金黄色葡萄球菌的34．1%。MRSA对青霉素、苯唑西林、克林霉素、阿奇霉素、环丙沙星、庆大霉素,四环素的耐药率显著高于甲氧西林敏感金黄色葡萄球菌(MSSA)。没有发现耐万古霉素菌株。结论CP患者前列腺液中分离出的细菌以金黄色葡萄球菌为主,MRSA占相当高比例,呈多重耐药。在CP的治疗过程中要严格掌握抗生素使用指征,避免滥用抗生素。     

对"烧伤病房病原菌分布与抗药性分析及对策"一文的商榷

<中华外科杂志>2007年第13期刊登的"烧伤病房病原菌分布与抗药性分析及对策"一文中指出:"在榆出的114株金黄色葡萄球菌中MRSA占到了82.5%,MRSA对多种抗菌药物耐药情况严重,3年来,对阿莫西/棒酸、氨苄西林/舒巴坦、头孢唑啉、环丙沙星、庆大霉素、左氧氟沙星、红霉素、氯洁霉素、青霉素G等药物耐药性逐年上升(85.7%～100.0%),但未出现对万古霉素耐药的菌株,而对我院临床较长时间未使用的一些药物如:利福平(42.6%)、复方磺胺甲基异噁唑(13.8%)等呈现较低的耐药性."并给出了MRSA对抗菌药物阿莫西林/棒酸、氨苄西林/舒巴坦、头孢唑啉的耐药率.     

我院2003至2005年葡萄球菌感染的耐药性分析

目的 了解葡萄球菌在我院感染的分布及耐药情况,为病原学调查及临床治疗提供依据.方法 应用常规生化鉴定法进行葡萄球菌鉴定,药敏试验采用微量稀释法,部分药物采用KB纸片扩散法,对74株葡萄球菌进行11种抗生素耐药性检测.D试验测定红霉素对克林霉素的诱导耐药表型.结果 葡萄球菌的感染占医院病原菌感染首位,耐甲氧西林的葡萄球菌检出率是54.1%.葡萄球菌对青霉素、苯唑西林、红霉素、四环素、环丙沙星、庆大霉素、克林霉素、复方磺胺、氯霉素、万古霉素、替考拉宁抗生素耐药率分别为93.2%、54.1%、85.1%、56.7%、45.9%、48.6%、58.1%、45.9%、31.1%、0%、0%.D试验阳性即红霉素对克林霉素具有诱导耐药性占37.9%.结论 及时了解医院葡萄球菌感染的变迁及耐药性变化,为葡萄球菌的感染治疗提供依据.     

耐甲氧西林金黄色葡萄球菌流行病学及耐药性分析

目的：分析医院耐甲氧西林金黄色葡萄球菌（MRSA）流行病学特征和耐药性,从而采取有效措施控制。方法对本院2012年各标本中分离而得的118株MRSA进行人群、科室、时间分布特征,危险因素,耐药性进行分析。结果 MRSA主要来自痰液和脓液,分布ICU、神经外科、康复科和烧伤科,多见于损伤中毒、心脑血管病、呼吸道感染疾病而长期卧床和呼吸辅助的年老患者。住院天数长,侵入操作项目和抗菌药物使用种类多是MRSA危险因素。MRSA对万古霉素、替考拉宁、利奈唑胺、喹奴普汀/达福普汀无耐药,对丁胺卡那、呋喃妥因、复方新诺明和利福平耐药率低,对大多数抗菌药物耐药率明显高于MSSA。结论 MRSA流行病学分布有特征性,与多种危险因素有关,对大多数抗菌药物耐药。医院应积极采取有效措施控制。     

1 245株金黄色葡萄球菌临床感染分布及耐药性变迁

目的探讨临床分离的金黄色葡萄球菌的感染分布及耐药性变迁,为临床经验性用药及院内感染控制提供数据支持。 方法回顾调查分析本院2012年1月至2015年12月于住院部及门诊送检标本分离到的金黄色葡萄球菌耐药数据,使用Microscan Walkaway 40 Plus对金黄色葡萄球菌进行鉴定及抗菌药物敏感性试验,采用WHONET 5.6版本软件进行统计分析。 结果共分离1 245株金黄色葡萄球菌,主要分离自患者痰液（565株,45.4%）、伤口分泌物（234株,18.8%）、脓液（136株,10.9%）和血液（89株,7.1%）;检出657株耐甲氧西林金黄色葡萄球菌（MRSA）,检出率为52.8%,其中,痰液中MRSA检出率最高（75.6%）。金黄色葡萄球菌主要来源于神经外科（197株,15.8%）、ICU（172株,13.8%）、创伤骨科（161株,12.9%）和呼吸内科（132株,10.6%）;神经外科以MRSA检出率最高（77.2%）。金黄色葡萄球菌对利福平、复方新诺明、达托霉素、利奈唑胺、万古霉素和奎奴普丁/达福普汀敏感性较好,对青霉素类敏感性最差。MRSA仅对达托霉素、利奈唑胺、万古霉素和奎奴普丁/达福普汀敏感性较好,甲氧西林敏感金黄色葡萄球菌（MSSA）对常用抗菌药物除青霉素类以外的抗菌药物耐药率较低;MRSA对常用抗菌药物耐药率显著高于MSSA。 结论临床MRSA检出率较高,且对常用抗菌药物耐药形势严峻,临床科室经验用药同时应配合加强院内感染控制,预防及减少MRSA感染的发生。     

泌尿外科手术切口感染病原学特点及预防

目的分析泌尿外科手术切口感染病原学特点,提出针对性预防措施。方法随机抽取泌尿外科手术切口感染患者42例,对切口分泌物行细菌检测,分离病原菌,分析病原学特点。结果 42例分离出68株病原菌,属于院内流行杆菌,包括MSSA、大肠埃希菌、肠球菌、铜绿假单胞菌、MRCNC、肺炎克雷伯菌、MRSA、MSCNC等。革兰阳性菌对万古霉素敏感性100%,对青霉素、红霉素、克林霉素等抗生素具有较高耐药性。革兰阴性杆菌对亚胺培南、阿米卡星敏感性较高,对氨苄西林、哌拉西林、头孢唑林、庆大霉素等抗生素耐药性较高。结论院内流行菌株是导致泌尿外科手术切口感染的主要病原菌,对多种抗生素具有耐药性。泌尿外科手术围术期应采取有效措施,预防或减少切口感染。     

Characteristics of Musculoskeletal Involvement in Pediatric Patients with Disseminated Sepsis in a Tertiary Care Center

BackgroundPediatric bone and joint infections account for one of the major causes of childhood morbidity. Disseminated sepsis being a systemic disorder with multisystem involvement, overshadows the timely recognition of bone and joint infections. Hence, we did this cross sectional study to evaluate the prevalence of septic arthritis and osteomyelitis in disseminated sepsis in children, the organisms implicated, and their antibiotic sensitivities.MethodsWe prospectively collected data from 1st July 2016 to 31st September 2017 of children aged less than 12 years with disseminated sepsis, i.e., patients with fever and two or more sites of focal infection of anatomically non-contiguous tissues.ResultsFifty-four patients of disseminated disease were included, of which 25 patients (46.3%) had osteoarticular infections. Septic arthritis was seen in 17 patients, and osteomyelitis was seen in 12 patients. The most common joint was hip (41.6%), and the most common bone involved was femur (53.8%). Blood culture showed MRSA in 28% and MSSA in 20%. Joint and bone aspirates showed S. aureus in 56% with 28% of MRSA and MSSA each. All Staphylococcus aureus organisms were found sensitive to vancomycin and teicoplanin. The mean values of CRP, duration of stay and duration of intravenous antibiotic was higher in MRSA infected patients compared to MSSA patients.ConclusionsStaphylococcus aureus is the most prevalent organism in musculoskeletal infection in disseminated sepsis children, with vancomycin sensitivity of 100% and methicillin sensitivity of 46.2% only. Cases of osteoarticular involvement with MRSA were higher compared to MSSA among the cases of disseminated disease. The prevalence of osteoarticular involvement is high in disseminated sepsis in children and increased clinical suspicion for such must be maintained.     

Antimicrobial Resistance of Staphylococcus Aureus Isolated From Bovine Mastitis in China

Mastitis is one of the largest production concerns in the dairy industry worldwide. Mastitis caused by Staphylococcus aureus is a major concern to the dairy industry because of its resistance to antibiotic treatment. In this report, the results of antibiotic susceptibility test, carried out on 236 Staphylococcus aureus isolated from milk samples which were collected from cases of mastitis in cow herds of China, are presented. The regions and number of isolates include Inner Mongolia (112), Hebei (58) and Heilongjiang (66). Susceptibility to ampicillin, penicillin G, amoxicillin, piperacillin, cephalexin, cephazolin, cefotaxime, ceftazidime, cefoxitin, SMZ‐TMP, gentamycin, kanamycin, norfloxacin, ciprofloxacin, ofloxacin, furaxone, torlamician, roxithromycin, clindamycin and vancomycin was determined by the disc diffusion method. Antibiotic susceptibility testing showed 87.30% (206 of 236) isolates were resistant to penicillin G. This result compares with the reports from other countries; the overall level of resistance was generally high for all antimicrobial agents tested.     

Molecular epidemiologic analysis of Staphylococcus aureus isolated from four burn centers

Staphylococcus aureus has been a major cause of hospital-acquired infections. Methicillin-resistant Staphylococcus aureus (MRSA) has emerged since 1980s as an epidemiologic problem in hospitals. This old pathogen brings a new challenge to all physicians and bacteriologists. Hence, effective measures of MRSA control are in critical need. S. aureus or MRSA is one of the leading causes of infection among burn centers, resulting in a number of poor outcomes and even death. The present study performed a molecular epidemiologic analysis of S. aureus isolated from four burn centers in the southeast of China. A total of 85 isolates were collected, and molecular characters were determined for further investigation. In this study, the prevalent clone of MRSA among four burn centers was found to be SCCmec III (spa-type t030, agr I), which is resistant to 4 kinds of antimicrobials including erythromycin, clindamycin, kanamycin and mupirocin. Discrepancy between mecA detection and conventional tests used for MRSA identification was observed unintentionally. Our data demonstrated that the overall prevalence rate of MRSA was 55.3%, and drugs such as sulfamethoxazole/trimethoprim, linezolid and fusidic acid are efficient antibiotic options for treating S. aureus or MRSA infections among four burn centers studied in present investigation.     

男性泌尿生殖道感染患者分离的金黄色葡萄球菌耐药性及耐消毒剂基因流行特性研究

目的:研究男性泌尿生殖道感染患者尿道分泌物中分离的金黄色葡萄球菌对常用抗菌药物和消毒剂的耐药情况及消毒剂耐药基因携带情况。方法:收集男性泌尿生殖道感染患者尿道分泌物标本中分离的金黄色葡萄球菌152株,琼脂稀释法检测临床常用抗菌药物以及消毒剂氯已定对其最低抑菌浓度(MIC),同时采用头孢西丁纸片扩散法和mecA基因扩增法确定其中的耐甲氧西林金黄色葡萄球菌(MRSA);多重PCR对MRSA菌株进行SCCmec耐药基因盒(SCCmec)分型,PCR扩增耐消毒剂基因qac;脉冲场凝胶电泳(PFGE)分析qacA/B基因阳性MRSA菌株间的同源性。结果:152株金黄色葡萄球菌中,MRSA占59.9%(91/152);SCCmec分型结果显示以SCCmecⅤ型为主,占63.7%(58/91),Ⅰ型8株(8.8%),Ⅱ型2株(2.2%),Ⅲ型19株(20.9%),Ⅳ型4株(4.4%)。临床分离的金黄色葡萄球菌对青霉素、红霉素、环丙沙星、左氧氟沙星非敏感率较高,依次是:95.4%、72.4%、42.8%、44.7%,对呋喃妥因、替考拉宁、利奈唑胺以及万古霉素具有较高的敏感性。琼脂稀释法测得氯已定对152株菌的MIC值范围为0.25~16μg/ml;对MRSA菌株的MIC50=2.0μg/ml,MIC90=4.0μg/ml,对MSSA菌株的MIC50和MIC90均为1.0μg/ml;152株金黄色葡萄球菌中,有72株(47.4%)携带qacA/B基因,6株(3.9%)携带smr(qacC+qacD)基因,9株(5.9%)携带qacEΔ1基因,2株(1.3%)携带qacH基因,未检出qacG、qacJ基因。PFGE结果显示qacA/B基因阳性MRSA菌株呈多克隆分布。结论:临床分离的金黄色葡萄球菌对常用抗菌药物表现出不同程度耐药,部分菌株对消毒剂氯已定耐受力较强,耐消毒剂基因以qacA/B为主,临床医生应该合理使用抗菌药物和体外消毒剂。     

腹腔镜胆道手术患者胆汁中主要致病菌及耐药分析

目的探讨行腹腔镜胆道手术治疗的患者胆汁中致病菌及耐药性。 方法回顾性分析2013年10月至2017年9月收治的560例行腹腔镜胆道手术治疗的患者资料,对患者胆汁内的细菌进行分离培养,使用API细菌鉴定板条对细菌进行鉴定;采用纸片琼脂扩散法行药敏试验;使用WHONET 5.6软件(WHO细菌耐药监测中心)对数据行分析。采用SPSS 19.0行统计学分析,采用U检验及卡方检验分析组间数据差异,P<0.05则认为差异存统计学意义。 结果急诊手术组患者细菌培养阳性率为96.0%显著高于择期手术组的5.0%(P<0.05);在全部病原菌中,大肠埃希菌占比最高;粪肠球菌对克林霉素、红霉素耐药率大于50.0%,屎肠球菌对青霉素、氨苄西林、左氧氟沙星、四环素、克林霉素、红霉素、环丙沙星、链霉素、庆大霉素耐药率大于50.0%,凝固酶阴性葡萄球菌对青霉素、克林霉素、红霉素耐药率均大于50.0%;大肠埃希菌对头孢呋辛、头孢噻肟、氨苄西林、复发磺胺甲噁唑耐药率大于50.0%,肺炎克雷白杆菌对头孢吡肟、头孢呋辛、头孢噻肟、氨苄西林、复发磺胺甲噁唑耐药率大于50.0%,变形杆菌对头孢呋辛、头孢噻肟、氨苄西林、复发磺胺甲噁唑耐药率大于50.0%。 结论在行腹腔镜胆道手术治疗患者中,择期胆道手术可以不用抗生素,胆道感染的患者根据药敏分析选用相应抗生素。     

急性白血病患者血流感染的病原菌分布特点及耐药分析

目的探讨引起急性白血病患者血流感染的病原菌分布特点以及分析其耐药情况。 方法选择于2013年1月至2015年12月本院就诊并被诊断为急性白血病患者共100例,分析其血培养阳性结果,分析细菌种类和其药敏试验结果。 结果100株致病菌中,真菌2株（2%）,革兰阳性菌（G⁺菌）35株（占35%）,革兰阴性菌（G^-菌）63株（占63%）。G⁺菌中以葡萄球菌最多（30株,占30%）;G^-菌以肠杆菌科细菌最多（53株,占53%）。葡萄球菌中,耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）占36.7%（11/30）;肠杆菌科细菌中,产超广谱β-内酰胺酶（ESBLs）肠杆菌科细菌占17.31%（9/52）。对两种及两种以上抗菌药物耐药菌有92株,占总致病菌的92%。G^-菌对氨苄西林/舒巴坦、头孢曲松、头孢唑林、复方磺胺甲噁唑以及氨曲南等耐药率较高,G⁺菌对青霉素、克林霉素、阿奇霉素以及红霉素等耐药率较高。 结论血流感染的病原菌种类较多,耐药率较高,治疗G^-菌感染,头孢哌酮/舒巴坦、美罗培南、亚胺培南和哌拉西林/他唑巴坦等作为临床用药选择;治疗G⁺菌感染,左氧氟沙星、利奈唑胺和万古霉素等可作为临床经验性用药选择。     

The rising incidence of methicillin-resistant Staphylococcus aureus in pediatric neck abscesses.

OBJECTIVES: To examine the incidence of methicillin-resistant Staphylococcus aureus (MRSA) in pediatric neck abscesses and compare these with abscesses caused by methicillin-susceptible Staphylococcus aureus (MSSA) and other organisms (non-SA). STUDY DESIGN: Retrospective review of 245 children who underwent incision and drainage of neck abscesses from January 1, 2001, to December 1, 2005. RESULTS: The yearly incidence of MRSA increased from 9 percent to 40 percent during the study period. Abscesses in medial locations were less common in the MRSA group (P < 0.01) and MSSA group (P < 0.001) compared with the non-SA group. Average patient ages were MRSA 18.9 months, MSSA 18.7 months, and non-SA 47.6 months. Complication rates were MRSA 8 percent, MSSA 5 percent, and non-SA 5 percent. CONCLUSIONS: The incidence of MRSA in pediatric neck abscesses is increasing dramatically. MRSA and MSSA usually infect younger patients in the lateral locations. Clinical courses were similar in all groups.     

耐甲氧西林金黄色葡萄球菌感染的四肢创伤性骨髓炎的手术治疗

目的： 总结并探讨采用利奈唑胺静滴联合万古霉素局部靶向缓释治疗耐甲氧西林金黄色葡萄球菌（dumethicillin-resistant Staphylococcus aureus,MRSA）感染的四肢创伤性骨髓炎的临床疗效及应用价值。方法： 回顾分析2015年3月至2017年3月在我院就诊的MRSA感染的四肢创伤性骨髓炎30例,其中男21例,女9例;年龄25~64（47.94±6.23）岁;病程9~23（15.68±6.23）个月。病灶部位：胫骨18例,跟骨12例。致伤原因：摔伤12例,车祸伤9例,坠落伤9例。闭合性骨折22例,开放性骨折8例。存在内固定13例。22例存在窦道,8例存在一定范围的软组织缺损伴骨及内固定外露,软组织缺损面积2.0 cm×3.0 cm~8.2 cm×12.3 cm;10例存在骨缺损,缺损范围0.5~3.4 cm;所有患者窦道或创面分泌物细菌培养均为MRSA。所有病例在彻底清创的基础上,病灶处植入载万古霉素硫酸钙人工骨,同时在围手术期静滴利奈唑胺葡萄糖注射液。术后从抗生素使用时间,血常规、红细胞沉降率、超敏C反应蛋白及肝肾功能等相关实验室指标,X线片、CT等影像学检查,骨质愈合、皮瓣成活、关节功能等情况以及根据McKee等骨髓炎治愈标准进行定期随访评价。结果： 所有患者获随访,时间3~6（4.23±0.76）年,均未出现骨髓炎复发情况,实现了骨折愈合、感染控制、创面愈合、功能恢复。结论： 利奈唑胺静滴联合万古霉素局部靶向缓释治疗MRSA感染的四肢创伤性骨髓炎的疗效显著,复发率低。